目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。

AIM: To investigate the effect of YAG laser peripheral iridectomy in difficult drug controlled acute angle-closure glaucoma. METHODS: Retrospectively analyzed 124 cases ( 124 eyes) of admission patients, among which males were 51 cases, females were 73 cases. Their admission diagnosis accorded with the clinical features of acute angle- closure glaucoma. After 24 hours'drug treatment, the intraocular pressure(IOP) of acute angle- closure glaucoma patients were still > 21mmHg, 51 eyes ( 41. 1% ) between 21 -35mmHg, 37 eyes(29. 8% ) between 36-50mmHg, 36 eyes (29. 1% ) >50mmHg. The range of visual acuity were light perception to 0. 3. All the cases accepted YAG laser peripheral iridectomy under topical anesthesia. The IOP, visual acuity, anterior chamber depth were observed postoperatively. After IOP was steady, trabeculectomy, glaucoma cataract combined with intraocular lens ( IOL) implantation, or single phacoemulsification combined with IOL implantation were performed respectively. RESULTS: Two days after YAG laser peripheral iridectomy, IOP was≤21mmHg in 28 eyes (22. 6% ), 22-35mmHg in 60 eyes (48. 4% ), 36 - 50 mmHg in 25 eyes(20.2% ), > 50mmHg in 11 eyes ( 8. 9% ). After laser surgery, visual acuity increased 3 lines in 33 eyes (26.6% ), 2 lines in 31 eyes (25. 0% ), 1 line in 44 eyes (35.5% ), no change in 16 eyes (12. 9% ), and the anterior chamber depth increased in 119 eyes ( 96. 0% ), postoperative hyphema in 98 eyes ( 79. 0% ). After IOP was steady, 37 eyes accepted trabeculectomy, 43 eyes accepted glaucoma cataract combined with IOL implantation, 44 eyes accepted phacoemulsification combined with IOL implantation. Followed up for 3 - 9 months, IOP ≤18mmHg were in 95 eyes, ≤25mmHg in 24 eyes, 26 - 35mmHg in 5 eyes, no hyphema, cystoid macular edema and other complications. CONCLUSION: YAG laser peripheral iridectomy can significantly reduce the IOP in difficult drug controlled acute angle - closure glaucoma, which provides safe and reliable condition for treatment of different glaucoma and is helpful to the protection and restoration of visual function, as well as increase the efficacy.