氪激光周边虹膜成形术治疗药物治疗无效的闭角型青光眼.doc

氪激光周边虹膜成形术治疗药物治疗无效的
闭角型青光眼

【摘要】 目的 探讨氪激光周边虹膜成形术对药物治疗无效的原

发性闭角型青光眼的有效性。方法 10 眼原发性闭角型青光眼患者，

其中 8 眼为急性发作，2 眼为慢性闭角型青光眼，经检查确诊后立即

给予局部和全身降眼压药物治疗，72 h 后眼压仍不能下降至 40 mm Hg

时行氪激光周边虹膜成形术，观察治疗前及治疗后 30 min、1 h、2 h、

24 h 的视力、角膜水肿、眼压及前房角变化。结果 氪激光周边虹膜

成形术 30 min 后，眼压从 42～71 mm Hg 降至 25～62 mm Hg，平均下

降 21.2%；术后 1 h 眼压为 15～37 mm Hg，平均下降 58.5%；术后 2 h

眼压为 11～25 mm Hg，平均下降 71.6%；术后 24 h 眼压为 9～16 mm Hg，

均降至正常，平均下降 79.9%。激光治疗后患者不适症状迅速缓解，

视力快速提高，角膜水肿消退，前房角有不同程度的加宽。结论 氪激

光周边虹膜成形术能机械性拉开房角，迅速降低原发性闭角型青光眼

的眼压，起效快，并发症少，是药物治疗无效青光眼的一种安全有效

的方法。

【关键词】 氪激光；激光周边虹膜成形术；青光眼；眼压

Krypton laser peripheral iridoplasty as treatment for

medically unresponsive angle-closure glaucoma

1

［ Abstract ］ Objective To evalute the intraocular

pressure-lowering effects of krypton laser peripheral

iridoplasty for medically unresponsive primary angle-closure

glaucoma.Methods 10 patients were included,8 were acute

attack ,2 were chronic angle-closure glaucome .They were

prescribed topical and systemic IOP-lowering drugs.72 hours

later,IOP is still above or equal 40 mm Hg.Visual acuity,corneal

edema,IOP and the angle of anterior chamber were observed

preoperatively and 30min,1 h,2 h,24 h postoperatively.Results

30 min after treatment,IOP decreased from 42～71 mm Hg to 25～

52 mm Hg,21.2% decreased in average;1 h later,IOP were 15～37

mm Hg,58.5% decreased in average;2 h later,IOP were 11～25 mm

Hg,71.6% decreased in average;24 h later,IOP were 9 ～ 16 mm

Hg,79.9% decreased in average.After laser treatment, the

uncomfortable symptoms were resolved quickly and visual acuity

rose fasten with corneal edema dispeared and the anterior

chamber-angle widened differently.Conclusion Laser peripheral

iridoplasty can mechanically open the anterior chamber angle and

rapidly reduce the IOP of the primary angle-closure glaucoma

with few complications.It is an effective and safety method for

medically unresponsive glaucoma.

2

［Key words］ krypton laser;laser peripheral iridoplasty;

glaucoma;intraocular pressure

原发性急性闭角型青光眼的急性发作是眼科的急症之一， 因为周

边虹膜组织阻塞前房角导致急剧升高，导致眼痛、眼红、视力下降、

头痛、恶心、呕吐等症状，应尽快开放前房角，降低眼压，挽救和保

护视功能。传统的方法是应用全身和局部降眼压药物治疗，待眼压控

制后行周边虹膜切除术或小梁切除术，但有一些患者使用足够的全身

和局部降眼压药物后也不能使眼压下降。还有一些慢性闭角型青光眼

患者虽然无明显临床症状，但其眼压经充分的药物治疗眼压仍居高不

下。高眼压时间过长可导致不可逆的视功能损害，高眼压状态下的抗

青光眼手术比眼处在安静状态下时危险大得多，更容易发生术中和术

后并发症。笔者用氪激光周边虹膜成形术对药物治疗无效的原发性闭

角型青光眼进行治疗，取得了较好的降眼压效果，现报告如下。

1 资料与方法

1.1 一般资料 所有患者均来自我院眼科门诊，共 10 例 10 眼，

急性发作期 8 眼，慢性闭角型青光眼 2 眼，男 4 例，女 6 例，年龄 51～

72 岁，平均 64.1 岁，右眼 6 只，左眼 4 只，急性发作期患者均有眼

胀痛、偏头痛、恶心、呕吐等症状及不同程度的瞳孔开大和角膜水肿，

慢性闭角型青光眼患者无明显临床症状，因视野受损来就诊，眼压

3