Nanophthalmos: A Perspective on Identification and Therapy

Nanophthalmos is a rare and blinding disease. Diagnostic features include a small eye, small cornea, shallow anterior chamber, narrow angle, high lens/eye volume ratio, and uveal effusion. Intraocular surgery has a high rate of disastrous complications and blindness. The 32 eyes (16 patients) presented are in three categories based on angle closure and intraocular pressure levels. Treatment methods included medication, laser iridotomy and gonioplasty, peripheral iridectomy, filtration surgery, and cataract extraction. Glaucoma medication was effective, although miotics sometimes increased pupillary block. Laser iridotomy was successful in 83% of six eyes; laser gonioplasty in 91.6% of 12 eyes. Peripheral iridectomy succeeded in two of seven eyes, and filtering operations provided tension control in two of five eyes. Thirteen of 15 eyes undergoing filtration surgery suffered severe postoperative visual loss. Cataract extraction improved vision in only three of six eyes. The authors’ experience confirms that surgery in nanophthalmic eyes has an extremely high complication rate with disastrous results. Medication and laser therapy are the procedures of choice for angle-closure glaucoma in nanophthalmos.     

白内障超声乳化联合前房角成形术治疗原发性闭角型青光眼的疗效观察

目的:评价白内障超声乳化后房型人工晶状体植入联合前房角成形术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障的临床疗效。方法:分析1998-01/2008-01在我科住院的PACG患者35例35眼,其中急性PACG28例,慢性PACG7例,均有不同程度的晶状体混浊,行白内障超声乳化后房型人工晶状体植入联合前房角成形术,随访6mo。结果:术后平均眼压14.6±2.3mmHg,比术前用药后眼压23.2±3.6mmHg明显降低,中央前房深度由术前的1.64±0.32mm,增加到术后的3.16±0.53mm,差异均有统计学意义(P<0.05)。术后32眼(91%)最佳矫正视力均有不同程度提高。结论:白内障超声乳化后房型人工晶状体植入联合前房角成形术,可有效治疗PACG合并白内障。     

氩激光小梁成形术联合房角成形术治疗慢性闭角青光眼的临床研究

用氩激光小梁成形术联合房角成形术治疗慢性闭角青光眼13例15眼(大多属晚期病例),随访5～7月,平均眼压下降1.62kPa,64.3%的治疗眼眼压低于2.79kPa,且房角普遍增宽,视力及视野无恶化者,随访期间未发现严重并发症,表明该治疗方法是可行的。     

改良激光房角成形术治疗原发性闭角型青光眼

目的　探索提高激光房角成形术治疗原发性闭角型青光眼远期效果的新术式。方法　在门诊选择确诊的房角粘连超过 180°的原发性闭角型青光眼患者 80例 112眼 ,随机分成实验组与对照组 ,每组 4 0例。对照组 4 0例 5 7眼 ,采用激光房角成形术加激光周边虹膜切除术治疗。实验组 4 0例 5 5眼 ,在激光房角成形术的基础上再光凝巩膜突及根部虹膜打微孔 ,每个象限 1～ 2个。术后随访 2a以上 ,观察眼压、视力、视野、房角宽度和C值。结果　实验组成功率为 97.5 % ,对照组成功率为 87.7% ,χ2 检验其差异有显著性 (P <0 .0 5 ) ,2组患者激光术后眼压均有不同程度下降与术前比较均有显著性 (P <0 .0 0 1) ,房角与C值均有明显改善 (P <0 .0 1) ,但以实验组改善更为显著。 2组间术前眼压、房角宽度和C值比较无差异 (P均 >0 .0 5 ) ,但术后比较则有差异 (P均 <0 .0 5 ) ,视力、视野均比术前有所改善。结论　改良激光房角成形术是治疗原发性闭角型青光眼的安全有效方法。     

TWO YEARS' EXPERIENCE WITH LASER TRABECULOPLASTY

A series of 115 argon laser trabeculoplasties on 109 eyes in 84 patients over a two-year period is reviewed. Control of glaucoma was achieved in 85%. There was correlation of a greater fall in intraocular pressure with initial height of intraocular pressure and degree of pigmentation of the angle. Gonioplasty proved an effective means of treating cases with a narrowed angle to gain access to the trabecular meshwork.     

LASER TRABECULOPLASTY: EARLY EXPERIENCE WITH A NEW PROCEDURE

Twenty-live laser trabeculoplasty procedures were performed on 20 patients. All patients were treated as inpatients so that early changes in intraocular pressure could be monitored. The range of fall was recorded: in four cases there was a significant rise in intraocular pressure in the first four hours which, if sustained, could have lead to a further visual field loss in patients with advanced chronic simple open-angle glaucoma. Patients with a high initial intraocular pressure had the greatest fall in intraocular pressure. Those patients with a more pigmented trabecular meshwork with wide open angles were the easiest to treat and gave the best signs of effective laser endpoint reaction. Gonioplasty was performed in many patients with narrow angles, which gave much better access to the posterior trabecular meshwork.