Nd:YAG激光虹膜切除术治疗葡萄膜炎继发闭角型青光眼

目的 评价Nd：YAG激光虹膜切除术治疗葡萄膜炎继发闭角型青光眼的临床效果。方法 回顾性分析27例葡萄膜炎继发瞳孔阻滞闭角型青光眼经Nd：YAG激光虹膜切除术治疗的情况。随诊时间2月到4年。结果1)一次激光所有患眼均成功击穿虹膜。虽经术后积极抗炎治疗．12眼(44％)发生虹膜孔关闭。多次激光治疗后，最终89％的患眼获得了通畅的激光孔。2)在46次激光治疗中，击射点数为3～376点，激光能量为12～2077mJ。所用激光能量较原发闭角型青光眼高。3)75％的患眼激光治疗后眼压控制正常，6只眼(22％)眼压不能控制行滤过手术。4)激光手术的并发症主要是激光时虹膜的出血和暂时的眼压升高。5)术前有活动性炎症的患眼，发生激光孔闭合的比例更高。结论 Nd：YAG激光虹膜切除术是治疗葡萄膜炎继发闭角型青光眼的一种安全有效的方法。为提高手术的成功率，应在积极抗炎的同时，尽早行激光虹膜切除术。若激光后虹膜孔反复关闭，应考虑手术周边虹膜切除术。

Nd:YAG laser iridotomy in angle - closure glaucoma secondary to uveitis

Objective Retrospectively evaluate the value of Nd:YAG laser iridotomy in angle-closure glaucoma secondary to uveitis.Methods 27 eyes of 27 patients with angle-closure glaucoma secondary to uveitis were treated by Nd:YAG laser iridotomy.They were followed from 2 months to 4 years.Results 1)All eyes got patent holes in iris after the initial treatment,but iris holes were closed in 12eyes(44%).And 89% eyes got patent laser holes after multiple treatments.2)In 46 episodes of treatment,the number of burns ranged from 3 to 376,and laser output energy ranged from 12 to 2077mJ,which was higher compared with primary angle-closure glaucomatous eyes.3)The intraocular pressure(IOP)of the final follow up was controlled in 75% of all eyes.While filtery surgery was needed in 6 eyes(22%).4)The most common complications included hemorrhage of iris and transient raise of IOP.5)The incidence of failure was higher in eyes with evidence of intraocular inflammation before iridotomy.Conclusions Nd:YAG laser iridotomy is a safe and effective therapy in the control of IOP in angle-closure glaucoma secondary to uveitis.Aggressive anti-inflammatory therapy were very important.Broad based surgical iridectomy should be considered if closure of the irirs holes occurred.