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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。
Objective To observe the changes of angle structure of primary angle-closure glaucoma by ultrasound biomicroscopy (UBM) to evaluate the effect of laser peripheral iridoplasty. Methods Thirty-one eyes of 38 patients with primary angle-closure glaucoma who underwent posterior iridectomy and posterior chamber positive test were treated by laser peripheral iridoplasty. Anterior segment slit lamp microscopy, gonioscopy and UBM were performed before and after treatment. After no episodes of elevated intraocular pressure and darkroom prone to two consecutive cases of negative test cases, the application of 0.5% tropicamide mydriasis mydriasis after the above check. Results 36 eyes (94.7%) were cured successfully. Performance: no glaucoma attack, two consecutive darkroom prone test negative and mydriatic test were negative. All cases after treatment, the depth of the surrounding anterior chamber were significantly deepened, static glottic trabecular meshwork widened the visible range. The UBM showed that the morphology of peripheral iris was obviously thinner and straight than that before operation. The angle of trabecular adhesion (TIA500) at 500um and the distance of opening of anterior chamber at 250um and 500um (AOD250, AOD500) were significantly increased (p <0.01) , Peripheral iris thickness (IT1) was significantly thinner (p <0.01). Postoperative observation (1 ~ 2) years, the effect was stable and no significant complications. Conclusion Laser peripheral iridoplasty can effectively change the shape of peripheral iris, increase the width of anterior chamber angle, and prevent the accumulation of peripheral iris caused by mydriasis. It is the primary closure of acute iris or provocation test after iridectomy Angle glaucoma safe and effective treatment.