摘要目的 评价选择性激光小梁成形(SLT)联合激光周边虹膜成形术(LPI)治疗闭角型青光眼的疗效及安全性.方法 对31例42只原发闭角型青光眼,经LPI治疗前房角被开放.术前平均眼压(24.44±3.26) mm Hg,日均用药指数(1.77±0.85)分.所有眼前房角能看到小梁网的范围约180度.用Q开关倍频Nd:YAG激光机在患眼开放的前房角照射小梁网.在180°范围内照射70～80点.术后继续使用术前的降眼压药物,定期复查眼压、视力、眼前节、前房角镜检查和房水流畅系数测定.结果 42只眼术后l、7天、l、3、6、9、12月的平均眼压分别为(17.23±3.06) mm Hg、(18.15±3.15) mm Hg、(19.82±3.22) mm Hg、(19.56±2.98) mm Hg、(19.01±3.14) mm Hg、(20.38±2.94) mm Hg、(20.77±3.27) mm Hg.与术前相比,术后1／12月眼压有显著下降(P＜0.Ol),用药指数差异无统计学意义(P＞0.05).术后即现睫状充血和前房闪辉,不用抗炎眼液l周自然消退.29眼术前和术后3月的房水流畅系数均值分别为0.13±0.09和0.36±0.14,差异有统计学意义(P =0.001).结论 SLT联合LPI能够安全有效降低部分闭角青光患者的眼压,但其前提是必须有1/2周的虹膜小梁角是被开放的.

abstractsObjective To investigate the safety and efficacy of selective laser trabeculoplasty combined with laser peripheral iridoplasty for primary angle-closure glaucoma.Methods Forty-two eyes of 31 patients with angle-closure glaucoma of 180° angle opened were enrolled in this study.The average preoperative intraocular pressure (IOP) and number of medications (NM) were (24.44±3.26) mmHg and (1.77±0.85),respectively.The trabecular meshwork (TM) of each eye can be observed about 180°,which was irradiated with a frequency doubled Q-switched Nd:YAG laser.Total of 70-80 laser spots were placed over 180° of the TM.Topical antiglaucoma drugs were given as the same as preoperative during the follow up period.Visual acuity,IOP,slit lamp examination,gonioseopy,and coefficient of outflow facility were regularly performed after laser surgery.Results At the end of 1 day,1 week,and 1,3,6,9,12 months of follow-up period,IOP of 42 eyes were 17.23±3.06 mmHg,18.15±3.15mmHg,19.82±3.22 mmHg,19.56±2.98 mmHg,19.01±3.14 mmHg,20.38±2.94mmHg,20.77±3.27 mmHg,respectively.Compared with baseline,there were statistically significant lOP decrease (P ＜ 0.01),and without obviously decrease of NM (P ＞ 0.05),during 1-12months postoperatively.Ciliary congestion and aqueous flare were disappearance without anti-inflammatory eye drops 1 week later.Coefficient of outflow facility were 0.13±0.09 和0.36±0.14 respectively at pretreatment and 3 months after SLT,difference was statistically significant (P =0.001).Conclusions Selective laser trabeculoplasty combined with laser peripheral iridoplasty for primary angle-closure glaucoma is effective and safe for angle-closure glaucoma,however,it is an essential prerequisite that 1/2 circle of angle of the anterior chamber is opened.