氩激光周边虹膜成形术治疗急性闭角型青光眼3a随访研究.doc

　　氩激光周边虹膜成形术治疗急性闭角型青光眼3a随访研究 【摘要】 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。 【关键词】 闭角型青光眼;氩激光;虹膜成形术;随访 　Follomediate argon laser peripheral iridoplasty as treatment of acute attack of primary angleclosure glaua 　　KeHao Zhao, Ping Chen 　　Department of Ophthalmology, Beijing Shijingshan Hospital, Beijing 100043, China 　　Abstract AIM: To study the efficacy and persistency of argon laser peripheral iridoplasty (ALPI) as a firstline treatment of acute primary angleclosure glaua (PACG). 　　 METHODS: Tolol (5g/L), and immediate ALPI as primary treatment. The intraocular pressures (IOPs) 2 hours, 1 month, 6, 12, 24, 36 months after ALPI ented. The angle of anterior chamber ented at each folloe. Dark room, prone provocative tests ean IOP of this group patients 69.43±8.22mmHg before ALPI to 15.74±3.09mmHg 2 hours after ALPI. Some patients had ocular hypertension in the follober angle eshber angle e other patients in the follo, prone provocative tests ic 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 glaua in the 3 years follomediate argon laser peripheral iridoplasty as treatment of acute attack of primary angleclosure glaua. Int J Ophthalmol (Guoji Yanke Zazhi) 2010;10(8):15451547 　0引言 　　急性闭角型青光眼传统的治疗方法是局部及全身联合应用降眼压药物，待眼压被控制，角膜恢复透明后，下一步治疗为激光周边虹膜切开术，以阻止再次急性发作或进展为慢性闭角型青光眼。然而药物治疗可能对相当一部分急性闭角型青光眼无效，不能有效降低这部分患者眼压。即使药物治疗有效，但它可能花费几个小时或几天时间才能使眼压降低至安全