目的:评价氩激光周边虹膜成形术治疗原发性闭角型青光眼急性发作期疗效及随访3a疗效的稳定性。方法:原发性闭角型青光眼第1次急性发作患者23例23眼,局部予以10g/L毛果芸香碱滴眼液及5g/L噻吗心安滴眼液各1滴后,行氩激光周边虹膜成形术,眼压控制稳定后5～7d行激光周边虹膜切开术。观察氩激光周边虹膜成形术治疗前及治疗后2h;1,6,12,24,36mo眼压;观察相应时间点房角变化;术后1,6,12,24,36mo行暗室加俯卧激发试验。结果:氩激光周边虹膜成形术前平均眼压为69.43±8.22mmHg,术后2h眼压为15.74±3.09mmHg,1a随访期间患者未发生高眼压,2,3a部分患者眼压升高;术前所有23眼前房角镜检查可见前房角关闭,术后2h所有23眼静态前房角镜检查前房角增宽,小梁网可见范围增宽,1a随访期间房角无明显变化,2a随访3眼房角较前窄,3a随访又有3眼房角变窄;所有患者术后1,6,12mo行暗室加俯卧激发试验均为阴性,24mo时2眼阳性,36mo时又有4眼阳性。结论:氩激光周边虹膜成形术治疗原发性闭角型青光眼急性发作期(不联合使用全身降眼压药物治疗)可迅速、有效、安全降低眼压,重新开放房角,随访1a疗效稳定,随访3a部分患者进展为慢性闭角型青光眼。

· AIM:To study the efficacy and persistency of argon laser peripheral iridoplasty(ALPI)as a first-line treatment of acute primary angle-closure glaucoma(PACG).· METHODS:Twenty-three patients with acute PACG were recruited into the study.Each patient received topical pilocarpine(10g/L),timolol(5g/L),and immediate ALPI as primary treatment.The intraocular pressures(IOPs)2 hours,1 month,6,12,24,36 months after ALPI were documented.The angle of anterior chamber were documented at each follow-up time.Dark room,prone provocative tests were done in the follow-up.· RESULTS:The mean IOP of this group patients was reduced from 69.43±8.22mmHg before ALPI to 15.74±3.09mmHg 2 hours after ALPI.Some patients had ocular hypertension in the follow-up.The anterior chamber angle was widened on goniscope and the trabecular meshwork could be visualized widely in static state after ALPI,but the anterior chamber angle was narrowed on goniscope in some other patients in the follow-up.Dark room,prone provocative tests were positive in part of patients in the follow-up.·CONCLUSION:ALPI,without adjunctive systemic carbonic anhydrase inhibitors and hyperosmotic agents,appeared to be effective and safe in controlling the IOP in acute PACG;part of patients developed chronic angle-closure glaucoma in the 3 years follow-up.·

R779.63