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目的观察氩激光周边虹膜成形术(不联合使用全身降眼压药物治疗)在原发性闭角型青光眼急性发作期的作用,评价该治疗方法的有效性及安全性。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1%毛果芸香碱滴眼液及0.5%噻吗心安滴眼液各1滴后,行氩激光周边虹膜成形术。观察治疗前及治疗后15、30、60、120min眼压变化;治疗前及治疗后2h房角变化;治疗前与治疗后2h视力、角膜、前房、瞳孔、虹膜及患者症状变化;评估该手术并发症。结果激光术前平均眼压为69.43±8.22mmHg,术后15min,30min,60min,120min分别降至38.48±8.75mmHg,28.30±7.99mmHg,16.91±5.22mmHg,15.74±3.09mmHg;术前各方房角不同程度关闭,鼻侧为3.31±3.19°、下方为3.58±3.69°、颞侧为3.42±3.37°、上方为3.21±2.87°,术后2h各方房角均开放,鼻侧为25.47±7.93°、下方为29.04±8.69°、颞侧为27.49±8.67°、上方为23.71±7.54°;术后2小时21眼角膜恢复透明,余2眼次日恢复透明;所有病例无明显并发症。结论氩激光周边虹膜成形术在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,迅速缓解急性发作期症状及体征。
Objective To observe the effect of argon laser peripheral iridoplasty (without the combination of systemic intraocular pressure reducing agents) on the acute episode of primary angle-closure glaucoma and to evaluate its efficacy and safety. Methods Twenty-three patients (23 eyes) with primary acute angle-closure glaucoma were divided into two groups: one (1%) pilocarpine and one (0.5%) timolol eye drops respectively, and argon laser peripheral iridoplasty . The changes of intraocular pressure (IOP) at 15, 30, 60, 120min before and after treatment were observed before and 2h after treatment. The changes of visual acuity, cornea, anterior chamber, pupil, iris and patients’ symptoms before and 2h after treatment were observed. Surgical complications. Results The average intraocular pressure before laser surgery was 69.43 ± 8.22mmHg, and decreased to 38.48 ± 8.75mmHg, 28.30 ± 7.99mmHg, 16.91 ± 5.22mmHg and 15.74 ± 3.09mmHg after 15min, 30min, 60min and 120min respectively. The angles were closed to varying degrees, the nasal side was 3.31 ± 3.19 °, the bottom was 3.58 ± 3.69 °, the temporal side was 3.42 ± 3.37 ° and the top was 3.21 ± 2.87 °. The angles of the two sides were both open at 2h and the nasal side was 25.47 ± 7.93 °, 29.04 ± 8.69 ° lower, 27.49 ± 8.67 ° temporal, and 23.71 ± 7.54 ° superior. After 2 hours and 21 eyes, the cornea recovered and became clear. The remaining 2 eyes returned to the next day with no obvious complications. Conclusion Argon laser peripheral iridoplasty can rapidly, effectively and safely reduce intraocular pressure (IOP) and reopen the angle in the acute attack of primary angle-closure glaucoma And signs.