激光周边虹膜成形术治疗药物难控制性急性闭角型青光眼的房角观察

目的:探讨激光周边虹膜成形术(laser peripheral iridoplasty,LPIP)治疗急性闭角型青光眼(acute angle-closure glaucoma,AACG)急性发作期药物不能控制的高眼压持续状态中的疗效。方法:原发性急性闭角型青光眼67例69眼发作期药物治疗3～6h后眼压仍>30mmHg时,行LPIP治疗。监测术前和术后30,60min和2h眼压、视力变化。应用UBM测量术前、术后2h房角宽度和虹膜厚度,并应用房角镜观察前房角粘连情况。结果:LPIP后2h,房角开放距离(AOD)较术前明显增大(P<0.01),小梁虹膜夹角(TIA)增宽、部分患者周边虹膜前粘连(PAS)减少、周边虹膜变薄。所有患者眼压在激光虹膜成形术后不同时间均有不同程度下降。术前平均眼压53.81±10.22mmHg,术后30min平均眼压33.81±9.22mmHg,术后60min为21.93±7.19mmHg,2h后眼压下降至15.16±3.07mmHg,治疗前后差异有显著统计学意义(F=151.79,P<0.01)。同时所有患者视力都有所提高。结论:LPIP可以明显加深患者的周边前房,增宽房角入口,降低患者眼压,是治疗AACG急性发作期药物不能控制高眼压持续状态的重要辅助措施,为青光眼的进一步治疗创造了条件,并且能够改善预后。

Angle observation of laser peripheral iridoplasty for the treatment of acute angle-closure glaucoma which could not be controlled by drugs

AIM: To evaluate the effect of laser peripheral iridoplasty(LPIP)to treat acute angle-closure glaucoma(AACG)which could not controlled by drugs and with persistent ocular hypertension.

METHODS: Totally 67 patients(69 eyes)with AACG were performed LPIP when intraocular pressure(IOP)was still over 30mmHg after the medicine therapy for 3-6 hours. Visual acuity and intraocular pressure were under detection before laser treatment and 30 minutes, 60 minutes and 2 hours after laser treatment. We measured the anterior chamber depth, width of angle, iris thickness with ultrasound biomicroscope(UBM). Dynamic gonioscopy was used to evaluate the degree of peripheral anterior synechia(PAS).

RESULTS: Angle open distance(AOD)after iridoplasty was increased(P<0.01). Trabecular-iris angle(TIA)was widen(P<0.01)and the extents of PAS were reduced in some cases. IOP reduced at different levels in different time after laser treatment. The mean IOP before acute attack was(53.81±10.22)mmHg. The mean IOP were(33.81±9.22)mmHg,(21.93±7.19)mmHg and(15.16±3.07)mmHg at 30 minutes, 60 minutes and 2 hours after laser treatment respectively(F=151.79, P<0.01). Visual acuity increased in all patients.

CONCLUSION: LPIP can deepen peripheral anterior chamber, increase the angle access and lower the IOP immediately. It is an important ongoing adjuvant treatment, which can reduce the patients suffering by lowering the IOP quickly, reduce the damage of visual function caused by long-term high intraocular pressure, avoid side effect of the drugs, and can improve the prognosis.