YAG激光周边虹膜切开术对难治性青光眼治疗后眼内压的影响

分析钇铝石榴石晶体(YAG)激光周边虹膜切开术对难治性青光眼治疗后眼内压的影响。回顾性分析80例(116眼)行YAG激光周边切开术的难治性青光眼患者的临床资料,结果显示术后1 h不同能量患者眼压均有一过性升高(P<0.05),0~45 mJ组术后1 h眼压低于46~80 mJ组、＞80 mJ组(P<0.05);46~80 mJ组术后1 h眼压又低于＞80 mJ组(P<0.05);术后1 h ＞80 mJ患者高眼压发生率高于0~45 mJ组(P<0.05),其余各时间点比较差异无统计学意义(P>0.05);术后1 h,难治性青光眼房水闪光值上升(P<0.05),术后1周较术后1 h降低(P<0.05),术后4 周恢复至术前水平;激光能量、房水闪光值均与难治性青光眼患者术后1 h眼压呈正相关(r=0.485、0.612,P<0.05)。因此,激光能量、房水闪光值均与难治性青光眼YAG激光周边虹膜切开术后早期眼压变化有关,即随激光能量及房水闪光值的增加,患者术后早期眼压上升。     

Factors associated with axial length elongation in high myopia in adults

AIM: To report the progression rate (PR) to primary angle closure (PAC) following laser peripheral iridotomy (LPI) in primary angle closure suspects (PACS). METHODS: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12mo’ post LPI. RESULTS: Eighty of 134 patients (59.7%) could be followed up at one year. The mean IOP in treated eyes was 15.9±2.7 mm Hg at baseline, 15.4±3.0 mm Hg on day 7; 16.5±2.9 mm Hg at one month and 15.5±2.9 mm Hg at 12mo; the IOP in untreated eyes was similar (P=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. PR to PAC in untreated eyes was 3.75% and one developed acute angle closure glaucoma (AACG), PR to PAC in treated eyes was 2.5%, none had developed PAS or AACG. CONCLUSION: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees.     

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.     

Examination and Treatment of Patients with Angle-Closure Glaucoma in Japan: Results of a Nationwide Survey

Purpose To assess the present state of examination procedures and treatments for angle-closure glaucoma (ACG) in Japan.Methods A nationwide questionnaire survey was conducted, targeting 1237 registered facilities to Japanese Ophthalmological Society.Results Valid replies were obtained from 754 of 1232 facilities (61.2%). Primary ACG comprised a small percentage of the glaucoma types diagnosed in outpatient examinations. More than 50% of the laser iridotomy (LI) procedures were prophylactic at 52.9% of the facilities. Gonioscopy was most frequently used for determining indications for prophylactic LI. Specular microscopy was always performed prior to LI in 7.8% of the facilities. Prophylactic LI resulted in complications at 20.5% of the surveyed facilities, although the incidence was low. The following residual complications were reported at 82.9% of the facilities when treating ACG attacks: cataract, persistent elevation of intraocular pressure, and bullous keratopathy. One-third of the facilities experienced inadequate treatment of an ACG attack by physicians other than ophthalmologists.Conclusions The incidence of LI-induced complications was higher in ACG eyes than in narrow-angle eyes. However, prophylactic LI sometimes results in persistent ocular complications. Jpn J Ophthalmol 2004;48:133–140 © Japanese Ophthalmological Society 2004     

Study of the first hundred phakic eyes treated by peripheral iridotomy using the N.D. Yag laser

Performing a peripheral iridotomy with a ND Yag laser is a simple and efficient technique, with no side effects, no need for anaesthesia other than local and no surgical opening of the eye, with all the risks it entails. Out of 100 cases, 100% were a success from a technical point of view, and we observed no lesion of the lens which could have caused cataract.This out-patient technique, causing fewer complications than with Argon laser, can be used on any patient, whatever the age and the state of the angle, who has to be treated by peripheral iridotomy.The Neodymium Yag laser (ND: Yag) is a pulsed solid laser (1,2,3,8,29,31). It cuts tissues (photodisruption) by means of a shock-wave produced by optical breakdown (plasma formation). Its effect is different from that of the Argon laser which burns tissues (photocoagulation). The present study, of 100 cases, deals with the use of ND: Yag in peripheral iridotomies.     

不同能量对YAG激光周边虹膜切开术后眼压的影响

目的：研究不同能量对激光虹膜周边切开术后眼压的影响。 方法：解剖学窄房角患者68例136眼行YAG激光周边虹膜切开术。记录术前眼压、术后60min眼压和术中总能量。根据总能量的百分位数,将病例分为高、中、低能量组,记录各组术后眼压升高低于5mmHg和高于5mmHg的例数。 结果：在术后眼压升高例数的比较上,低能量组与中、高能量组间有统计学差异（P<0.05）,中、高能量组间无统计学差异（P>0.05）。 结论：YAG激光周边虹膜切开术,在一定范围内术中使用总能量越低,术后眼压升高风险越低。但在总能量超过44mJ时,总能量与术后眼压升高风险无明显相关性。     

原发性房角关闭眼激光虹膜切除术后UBM测量参数比较

目的:比较激光虹膜切开术前后原发性房角关闭(primary angle closure,PAC)眼超声生物显微镜(ultrasound biomicroscopy,UBM)参数。方法:对46例74眼PAC患者进行了一项前瞻性临床试验。平均年龄58,04±11.33(24.0-82.0)岁。所有病例行完整的眼科检查,前房角镜A超生物测量和超声生物显微镜检查(Vu-max,SonomedInc.,NY,USA)及24-2标准无色差视野检查(SAP,Humphrey Visual Field Analyzer-II i,Carl Zeiss Meditec Inc.,Dublin,CA,USA)。使用配对t检验评估基准和随访的平均值之间的变化。结果:激光周边虹膜切除术(laser peripheral iridotomy,LPI)术后,平均房角从8.02±4.61(0.10-19.60)度增加到17.66±6.39(0.10-32.70)度(P=0.000),房角开放距离500(angle opening distance 500,AOD500)从0.11±0.06(0.01-0.30)mm增加到0.23±0.07(0.13-0.50)mm(P=0.000),平均虹膜厚度(iris thickness,IT)从0.58±0.11(0.33-0.99)mm下降到0.52±0.10(0.25-0.77)mm(P=0.000)。小梁睫状突距离,虹膜睫状突距离和睫状体厚度均未发现显著统计学差异。结论:LPI术后PAC的白种人眼睛的AOD500,虹膜晶体距离和前房角增加,IT和虹膜晶体高度减少。这说明LPI解除了瞳孔阻滞,加深了前房,扩大了房角,减少了虹膜前凸和增厚。     

周边虹膜切除术与超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼的疗效比较

目的比较周边虹膜切除术与超声乳化联合人工晶状体植入术治疗早期原发性闭角型青光眼的临床效果。方法选择仅局部用药即可控制眼压在正常范围内的早期闭角型青光眼合并白内障患者48例(54眼),应用周边虹膜切除术对28例(32眼)早期闭角型青光眼进行手术治疗,其结果与同类病人(20例22眼)的超声乳化联合人工晶状体植入术治疗结果进行比较。术前,术后一个月内每周一次,半年内每月一次,半年后三个月一次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制、视力恢复及前房情况,并作统计学分析。结果应用周边虹膜切除术治疗组术后平均眼内压为15.2±3.1mmHg,而同类病人经超声乳化联合人工晶状体植入术治疗后平均眼内压为14.9±2.6mmHg。分别经周边虹膜切除术和超声乳化联合人工晶状体植入术治疗,两类病人眼内压在术后早期无明显差异(P>0.05)。经超声乳化联合人工晶状体植入术治疗,18眼(81.8%)最佳矫正视力提高,0.4者占63.6%,经周边虹膜切除术治疗术后最佳矫正视力无明显提高,其中8眼视力不增反降,最佳矫正视力0.4者占18.8%,两者差异有显著性(P<0.05)。经周边虹膜切除术治疗术后中央前房深度无明显变化,而经超声乳化联合人工晶状体植入术治疗术后中央前房深度显著加深,两者差异性明显(P<0.05)。结论原发性闭角型青光眼早期患者施行超声乳化联合人工晶状体植入术,术后房角显著加宽,中央前房深度显著加深,矫正视力也不同程度提高,且并发症少。     

前节光学相干断层扫描仪观察原发性闭角型青光眼激光虹膜周边切除术后前房形态的改变

目的通过前节光学相干断层扫描仪(AS-OCT)观察原发性闭角型青光眼(PACG)激光虹膜周边切除术(LPI)后前房形态的改变。方法 30例(30只眼)PACG患者均行LPI,于行LPI前、后1周使用AS-OCT检查前房深度(ACD)、晶状体膨隆高度(CLR)、房角开放距离(AOD)、虹膜小梁空间面积(TISA)及瞳孔直径(PD),观察LPI前后前房形态的改变。结果手术前眼压为(15.923±2.028)mmHg(1 mmHg=0.133 kPa),术后1周为(14.523±1.650)mmHg,术后1周眼压显著低于术前,差异有统计学意义(P<0.05)。LPI前患者ACD、CLR、PD与手术后1周比较,差异均无统计学意义(P>0.05)。LPI后1周患者鼻侧AOD500、颞侧AOD500、鼻侧AOD750、颞侧AOD750、鼻侧TISA500、颞侧TISA500、鼻侧TISA750、颞侧TISA750及双侧平均AOD500、AOD750、TISA500、TISA750均显著大于手术前,差异均有统计学意义(P<0.01)。结论 LPI可以显著改善PACG患者眼前房结构,AS-OCT可以客观准确地观察PACG患者的前房形态。