目 的: 比 较 不 同 能 量 氪 离 子 黄 绿 光 联 合 Nd ∶YAG 激 光 行 周 边 虹 膜 切 开 术 的 临 床 疗 效 和 对 眼压、血- 房 水 屏 障 的 影 响。

方 法: 使 用 激 光 蛋 白 细 胞 仪 及 压 平 式 眼 压 计 对 31 例(62 只 眼) 接 受 高 能 量 组 700 mW, 低 能量 组 400 mW的 氪 离 子 联 合 Nd: YAG 激 光 行 周 边 虹 膜 切 除 术 前、术 后 的 房 水 蛋 白 浓 度、前 房细 胞 数 和 眼 压 进 行 比 较。术 后 随 访 1 个 月。

结 果: 激 光 周 边 虹 膜 切 开 术 两 组 周 切 口 通 畅 无 闭 合, 无 角 膜 损 伤 及 晶 体 混 浊。 术 前 和 术 后1 h、3 d、7 d 及 1 个月的平均 Goldmann 眼压值在高能量组分别为 ( 15.68±2.41) 、(27.13±3.48) 、(20.97±5.27) 、(16.35±1.14) 、(15.06±2.02) , 在 低 能 量 组 分 别 为( 15.35±1.78) 、(22.77±3.26) 、(16.26±2.41) 、(15.68±2.06) 、( 15.06±1.36) 。术 前 和 术 后 3 d、7 d 及 1 个 月 的 平 均 房 水 闪 光 值在 高 能 量 组 分 别 为( 4.65±1.50) 、(10.41±2.47) 、(7.31±2.31) 、(6.15±2.16) , 在 低 能 量 组 分 别 为(4.45±1.19) 、(6.47±1.11) 、(4.81±0.55) 、(4.98±1.48) pc/ms; 前 房 细 胞 数 平 均 值 在 高 能 量 组 分别 为( 0.47±0.42) 、( 36.22±9.16) 、(18.54±3.60) 、( 6.29±0.98) , 在 低 能 量 组 分 别 为(0.58±0.52) 、(24.73±6.09) 、(10.61±1.70) 、(2.96±1.35) 。高 能 量 组 术 后 1 h 及 第 3 天 眼 压 的 升 高 幅 度 较 低能 量 组 高, 术 后 各 点 的 房 水 闪 光 值 和 前 房 细 胞 数 升 高 幅 度 均 较 低 能 量 组 明 显, 术 后 1 个 月 两组 前 房 细 胞 数 及 高 能 量 组 房 水 闪 光 值 仍 未 能 降 至 术 前 水 平, 差 异 有 显 著 性 意 义( P < 0.05) 。

结 论: 低 能 量 与 高 能 量 氪 黄 绿 激 光 联 合 Nd ∶YAG 激 光 周 边 虹 膜 切 开 术 两 组 周 切 口 通 畅, 临 床效 果 相 同; 低 能 量 组 术 后 一 过 性 眼 压 升 高 恢 复 至 正 常 较 快, 前 房 蛋 白 较 快 恢 复 正 常。提 示 在 进行 激 光 周 边 虹 膜 切 开 术 时 应 尽 可 能 用 低 能 量。两 组 术 后 1 个 月 前 房 仍 有 细 胞, 应 继 续 随 访。

Purpose: To compare the influence of krypton laser with different power densities combined with Nd: YAG laser peripheral iridotomy (LPI) on the intraocular pressure, blood-aqueous barrier and inflammatory of anterior chamber as well as the therapeutic effect.

Methods: Using a laser flare cell meter and Goldmann tonometer, the level of aqueous protein, the number of cells in the anterior chamber and intraocular pressure of 31 patients (62 eyes) who underwent krypton laser with different power densities combined with Nd: YAG laser peripheral iridotomy were examined and recorded preoperatively and postoperatively.

Results: The mean preoperative and 1-hour, 3-day, 7-day, 1-month postoperative intraocular pressure ( IOP) of the high power-density group were (15.68±2.41) , (27.13 ±3.48) , (20.97 ±5.27) , (16.35 ±1.14) and (15.06 ±2.02) mmHg, while those of the low were (15.35±1.78) , (22.77±3.26) , (16.26±2.41) , (15.68±2.06) and (15.06±1.36) mmHg. The mean preoperative and 3-day, 7-day, 1-month postoperative flare intensity of the high power-density group were (4.65±1.50) , (10.41±2.47) , (7.31±2.31) and (6.15±2.16) pc /ms, while those of the low were (4.45±1.19) , (6.47±1.11) , (4.81±0.55) and (4.98±1.48) pc/ms. The number of aqueous cells of the high was (0.47±0.42) , (36.22±9.16) , ( 18.54±3.60) and (6.29±0.98) , while that of the low was (0.58±0.52) , (24.73±6.09) , (10.61±1.70) and (2.96±1.35) . The mean 1-hour and 3-day postoperative IOP of the high was higher than that of the low. Both the mean flare intensity and the mean number of aqueous cells of the high power-density group were higher than those of the low. The differences were of statistical significance (P <0.05) . The mean flare intensity of the high power-density group in the 1-month postoperative follow-up was still higher than the baseline. The mean number of aqueous cells of both the high and the low power-density groups in the 1- month postoperative follow-up was still higher than the baseline. During 1-month follow-up, no obvious visual damage, diffuse corneal endothelial burns or corneal decompensation, lens injury and closure of the peripheral iris incision were observed.

Conclusion: When krypton laser combined with Nd: YAG laser peripheral iridotomy is under consideration, relatively low power-density krypton laser is recommended because it can achieve the similar therapeutic effects as high power-density krypton laser but leads to less complications and a briefer recovery. More follow-ups are needed after LPI, because the number of aqueous cells in 1-month follow-up was still abnormal. 

青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼(primary angle closure glaucoma，PACG)占25%。激光周边虹膜切除术(laser peripheral iridotomy，LPI)已成为PACG和原发性房角关闭的一线治疗。LPI机制为利用激光在周边虹膜上打孔，解除PACG的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明LPI在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。

Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy(LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle,restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.

患者因“左眼视物模糊2 0余年”就诊，2 0余年前曾行左眼小梁切除术，视力：右眼(oculus dexter，OD)无光感(no light perception，NLP)，左眼(oculus sinister，OS)光感(light perception，LP)光定位准确，右眼巩膜葡萄肿(鼻上)，前房浅约1/4 CT，瞳孔固定散大，晶状体脱位于玻璃体腔，左眼结膜上方滤过泡扁平，前房浅，约1/4 CT，虹膜层状分离漂浮于前房，上方虹膜切口引流通畅，C/D：0.4。眼压(intraocular pressure，IOP)示：右眼13.0 mmHg，左眼16.0 mmHg。超声生物显微(ultrasound biomicroscopy，UBM)示：右眼各象限前房角狭窄，晶体脱位；左眼前房浅，颞侧前房角狭窄，其余象限关闭，虹膜层状分离。B超示：右眼晶体脱离。诊断：左眼虹膜劈裂；右眼晶体脱位。

The patient was treated with ‘left eye blurred vision for more than 20 years’. The patient underwent left trabeculectomy more than 20 years ago. Visual acuity oculus dexter (OD): no light perception (NLP), oculus sinister (OS): light perception (LP), and light positioning was accurate, right eye scleral staphyloma (nose), the anterior chamber was approximately 1/4 CT, the pupil was fixed and scattered, the lens was displaced into the vitreous cavity, and the left eye conjunctiva was filtered. The blister was flat, the anterior chamber was shallow, about 1/4 CT, and the iris layer was separated and floated in the anterior chamber. The upper iris incision led to smooth flow, C/D: 0.4. Intraocular pressure (IOP): R 13.0 mmHg, L 16.0 mmHg. Ultrasound biomicroscopy (UBM): in the right eye, anterior chamber angle was narrow in each quadrant, dislocation of the lens; anterior chamber of the left eye was shallow, anterior chamber angle of the temporal stenosis was narrow, the remaining quadrants were closed, iris lamellar separated. B-ultrasound: the right eye lens was displaced into the vitreous cavity. Diagnosis: left eye Iridoshcisis; right eye lens dislocation.