激光周边虹膜成形术治疗原发性闭角型青光眼房角相关结构的超声生物显微镜观察

目的应用超声生物显微镜(ultrasoundbiomicroscopy,UBM)观察激光周边虹膜成形术治疗原发性闭角型青光眼房角结构的变化,进一步做疗效评价。方法对原发性闭角型青光眼经虹膜切除术后暗室俯卧试验阳性的31例38眼行激光周边虹膜成形术治疗,治疗前后均行眼前节裂隙灯显微镜、房角镜及UBM检查,对于治疗后无发作性眼压升高且连续两次暗室俯卧试验阴性的病例,应用0.5%托吡卡胺点眼散瞳后再行上述检查。结果36眼(94.7%)成功治愈。表现为:无青光眼发作、连续两次暗室俯卧试验阴性且散瞳试验均阴性。所有病例经治疗后周边前房深度均明显加深,静态房角镜检查小梁网可见范围增宽。UBM检查显示周边虹膜形态较术前明显变薄而平直,500um处小梁虹膜夹角(TIA500)、250um和500um处前房角开放距离(AOD250、AOD500)均较术前显著增加(p<0.01),周边虹膜厚度(IT1)明显变薄(p<0.01)。术后观察(1～2)年,疗效稳定且未见明显并发症。结论激光周边虹膜成形术可有效的改变周边虹膜形态,增加前房角宽度,防止瞳孔散大所造成的周边虹膜堆积,是治疗虹膜切除术后仍有急性发作或激发试验阳性的原发性闭角型青光眼安全、有效的治疗方法。

An ultrasound biomicroscopic study on changes of the structure of ocular anterior segment after laser peripheral iridoplasty for primary angle-closure glaucoma

Objective To study the changes of the structure of ocular anterior segment after peripheral iridoplasty for primary angle-closure glaucoma and assess the effectiveness of peripheral iridoplasty for primary angle-closure glaucoma with ultrasound biomicroscopy(UBM). Methods A prospective study of 38 eyes (31 cases) with primary angle-closure glaucoma who presented with positive dark room and prone provocation test after laser peripheral iridectomy were performed laser peripheral iridoplasty by Double-Frequency Nd:YAG laser. The ultrasound biomicroscopy and goniscope was performed after and before laser peripheral iridoplasty. The patients who have normal hypertension of IOP and negative dark room prone provocation test for two times were dropped with tropicamide eye drops, then the anterior chamber angle were examined again with UBM. Results 36 eyes (94.7%) were cured who prsented with normal IOP and negative dark room prone provocation test for two times. In all these cases, the peripheral anterior chamber depth were increased, the anterior chamber angle were widened on goniscope and the trabecular meshwork can be visualized widely in static stage. The shape of periph- eral iris became thin and straight by the examination of UBM. TIA500(angle-opening distance at 500 um from the scleral spur), AOD500(angle-opening distance at 500 um) and AOD250(angle-opening distance at 500 um) were significantly increased and IT1 (the peripheral thickness of the iris) were significantly decreased after laser treat- ment (p<0.01). The postoperative follow-up ranged from 1 year to 2 years. The ocular complications were not found in follow up. Conclusion The laser peripheral iridectomy can improve the shape of the peripheral iris effectively and it can widen the angle of anterior chamber, prevent the peripheral iris from heaping up while the pupil was dilated. This method can cure this kind of glaucoma effectively and safety.