YAG激光预防性治疗青光眼的临床观察

Clinical Observation of YAG Laser in the Prophylactic Treatment of Glaucoma

摘要: 目的：探讨Nd:YAG激光预防性治疗青光眼及激光后即刻药物干预减少炎症、降低眼压的有效性。方法：收集我院眼科治疗的836例(1077只眼)青光眼的资料，进行回顾性分析，其中青光眼先兆期230眼，青光眼临床前期847眼，所有患者均采用Nd:YAG激光虹膜切除术进行治疗，观察激光术后患者的激光孔、前房深度、眼压、视力、前房反应及并发症。结果：1077眼激光孔保持通畅、前房深度加深，至随访终点，激光后平均ACD、AA及AOD500均优于激光前，差异有统计学意义(P < 0.01)。术前眼压平均18.47 ± 4.83 mmHg (1 kP = 7.5 mmHg)，术后1周、1个月、3个月、6个月及13个月与术前比较降低，差异有统计学意义。术后1周、1个月、3个月660眼(61.28%)最佳矫正视力较术前提高，差异无统计学意义；术后6个月、13个月复查视野1077眼均无视野缺损出现。前房虹膜炎性反应32.22% (347/1077)，123眼虹膜表面小片状出血。结论：Nd:YAG激光预防性青光眼治疗是一种安全有效的方法，操作简便，痛苦小，减少危险性，节约医疗资源。激光后即刻药物干预减少激光后并发症。

Abstract: Objective: Objective to investigate the effectiveness of Nd:YAG laser prophylactic treatment of glaucoma and immediate drug intervention after laser to reduce inflammation and intraocular pressure. Methods: The data of 836 cases (1077 eyes) with glaucoma treated in our hospital were collected and analyzed retrospectively. Among them, 230 eyes were in the preclinical stage of glaucoma, 847 eyes were in preclinical stage. All patients were treated with Nd:YAG laser iridectomy. The laser hole, anterior chamber depth, intraocular pressure, visual acuity, anterior chamber reaction and complications were observed. Result: 1077 eyes were kept unobstructed, the depth of anterior chamber was deepened. At the end of follow-up, the average ACD, AA and AOD500 after laser were better than those before laser (P < 0.01). Intraocular pressure (IOP) was 18.47 ± 4.83 mmHg (1 kp = 7.5 mmHg) preoperatively, and decreased at 1 week, 1 month, 3 months, 6 months and 13 months after operation. The best corrected visual acuity (BCVA) of 660 eyes (61.28%) at 1 week, 1 month and 3 months after operation was improved compared with that before operation, and the difference was not statistically significant. No visual field defect was found in 1077 eyes at 6 months and 13 months after operation. The inflammatory reaction of anterior chamber iris was 32.22% (347/1077), and there were small pieces of hemorrhage on the surface of iris in 123 eyes. Conclusion: Nd:YAG laser prophylactic glaucoma treatment is a safe and effective method, easy to operate, less pain, reduce risk, save medical resources. Drug is used immediately after laser to reduce complications after laser.