氩离子及Nd:YAG联合激光虹膜切除术治疗PAACG的远期疗效观察

The long-term clinical effect of laser peripheral iridoplasty for PAACG

摘要:

目的:观察激光周边虹膜切除术(laser peripheral iridoplasty,LPIP)治疗房角广泛粘连的原发性急性闭角型青光眼(primary actue angle-closure glaucoma,PAACG)的长期效果。方法:回顾性总结原发性闭角型青光眼(primary angle-closure glaucoma,PACG)急性发作后房角广泛粘连33例33眼的LPIP治疗的远期效果,主要观察患者眼压控制情况及房角粘连的变化。以不使用或使用不超过3种局部降眼压药物,眼压≤21mmHg视为眼压控制。结果:患者24眼随访21～37mo,眼压成功控制,其中15眼使用1～2种局部降眼压药物;9眼因眼压控制不满意最终行小梁切除术,其中6眼于LPIP后3d内手术治疗,另3眼分别于LPIP后18,42d;9mo手术治疗。LPIP治疗后短期内27眼房角粘连不同程度开放,6～12mo后,6眼的房角粘连程度较治疗早期扩大。LPIP治疗后3眼出现核性白内障,其中1眼于激光后3a行白内障超声乳化术。结论:LPIP是治疗房角广泛粘连的急性闭角型青光眼的有效手段,但部分患者在激光后不同时间出现眼压升高,房角再次粘连,应定期检查。

Abstract:

AIM:To evaluate the long-term effect of laser peripheral iridoplasty (LPIP) on primary acute angle-closure glaucoma(PAACG) with extensive goniosynechia. METHODS:Retrospective case series.33 PAACG patients who had extensive goniosynechia were given LPIP treatment.The clinical responses of each patient,especially in their lOP reduction and goniosynechia changes,were tracked closely,and any complication from the laser treatment was recorded and studied.An lOP lower than 21mmHg with or without 3 kinds of topical medication was defined as a successful outcome. RESULTS:ln 21-37 months follow-up, lOP were successfully controlled in 24 eyes,15 of which were given 1 or 2 topical medication. 9 eyes finally failed to respond to LPIP therapy and were given trabeculectomy,6 of which received trabeculectomy 3 days after LPIP and 3 of which received the same treatment 18 days,42 days and 9 months after LPIP,respectively. After LPIP, iridocomeal angles of 27 eyes were observed to be widened by certain degrees in a short period of time,6 eyes suffered goniosynechia development during 6-12 months follow-up.3 eyes developed nuclear cataract during the follow-up,1 of which was performed phacoemulsification 3 years after LPIP. CONCLUSION:LPIP appeared to be an effective treatment for acute angle-closure glaucoma with extensive goniosynechia.Certain eyes may suffer increase in IOP and development of iris peripheral anterior synechiae,therefore inspection should be applied carefully to these patients.