Nd:YAG激光房角穿刺治疗非穿透性小梁手术后高眼压

目的观察评估Nd:YAG激光行房角穿刺治疗非穿透性小梁手术后眼压控制不理想的原发性开角型青光眼患者的临床疗效。方法选取非穿透性小梁手术后眼压控制不理想(不用降眼压药物眼压>21mmHg,1kPa=7.5mmHg)的原发性开角型青光眼患者35例(38眼)为研究对象,硝酸毛果芸香碱缩瞳后,在激光房角镜下原手术部位行Nd:YAG激光房角穿刺,观察激光前及激光后1h、1d、1周、1个月、3个月、6个月、12个月、18个月、2a时的眼压、滤过泡、房角及前房反应情况。结果激光前及激光后1h、1d、1周、1个月、3个月、6个月、12个月、18个月、2a的眼压分别为(25.0±3.4)mmHg、(12.5±3.4)mm-Hg、(12.0±3.2)mmHg、(13.1±3.0)mmHg、(14.0±3.1)mmHg、(14.1±2.7)mmHg、(14.3±2.9)mmHg、(15.3±2.6)mmHg、(16.2±2.8)mmHg、(16.0±3.0)mmHg,激光后各时间点眼压均较激光前下降,差异均有统计学意义(均为P<0.01)。其中10眼激光后眼压、滤过泡无明显改善,28眼滤过泡形成或原滤过泡面积、隆起度增大;激光后发生浅前房2眼(5.3%),虹膜周边前粘连2眼(5.3%),无前房出血、脉络膜脱离等并发症发生。结论 Nd:YAG激光房角穿刺能够安全有效地改善非穿透性小梁手术后小梁网-狄氏膜的房水低滤过状态,是非穿透性小梁手术后高眼压治疗的有效方法。

Nd:YAG laser goniopuncture for ocular hypertension after non-penetrating trabecular surgery

Objective To investigate the efficacy and safety of Nd:YAG laser goniopuncture for ocular hypertension after non-penetrating trabecular surgery. Methods Thirty-five patients (38 eyes) with primary open-angle glaucoma,whose intraocular pressure (IOP) were more than 21 mmHg(1 kPa=7.5 mmHg) after non-penetrating trabecular surgery,were chosen.Nd:YAG laser goniopuncture was performed after miosising with pilocarpine.IOP,filtering bleb,anterior chamber angle structure and anterior chamber reaction were recorded at pre-operation and postoperative 1 hour,1 day,1 week,1 month,3 months,6 months,12 months,18 months and 2 years. Results The mean at pre-operation and postoperative 1 hour,1 day,1 week,1 month,3 months,6 months,12 months,18 months and 2 years were (25.0±3.4)mmHg,(12.5±3.4)mmHg,(12.0±3.2)mmHg,(13.1±3.0)mmHg,(14.0±3.1)mmHg,(14.1±2.7)mmHg,(14.3±2.9)mmHg,(15.3±2.6)mmHg,(16.2±2.8)mmHg and (16.0±3.0)mmHg,respectively,the preoperative IOP at different time points were lower than pre-operation,there were statistical differences(both P<0.05).After laser goniopuncture,there were 10 eyes without any IOP and filtering bleb change,and 28 eyes with filtering bleb area increased.Complications included shallow anterior chamber (2 eyes,5.3%) and around anterior synechia(2 eyes,5.3%). Conclusion Nd:YAG goniopuncture can improve the trabeculo-Descemet’s membrane filtration effectively and safely,is the effective treatment for ocular hypertension after non-penetrating trabecular surgery.