目的: 探讨泪膜改变对 Goldmann 压平眼压计测量值的影响。

方法: 将 68 例(136 只眼) 受检者随机分为 2 组, 每组 34 例。随机选择一只眼作为实验眼, 另一只眼作为对照眼。A 组的实验眼采用右旋糖苷 70 滴眼液滴眼, B 组的实验眼采用粘弹剂 Viscoat 滴眼。采用 Goldmann 眼压计测量 2 次眼压, 比较滴眼前、后测量值的差异。

结果: A 组对照眼第 1、2 次的眼压测量值分别为(14.44±2.68) mmHg(1 mmHg = 0.133 KPa) 、(14.47 ± 2.69) mmHg, 两次眼压测量值的差异无统计学意义(t = - 0.329, P = 0.744) 。实验眼滴右旋糖苷 70 滴眼液前、后的眼压测量值分别为(14.41 ±2 .63) mmHg、(12.94 ± 2.59) mmHg, 两次眼压测量值的差异有统计学意义 (t = 13.949, P = 0.000) 。B 组对照眼第 1、2 次的眼压测量值分别为(14.29 ± 2.96) mmHg、(14.35 ± 3.12) mmHg, 两次眼压测量值的差异无统计学意义(t = - 0.466, P = 0.644) 。实验眼滴 Viscoat 前、后的眼压测量值分别为 (14.53 ± 3.13) mmHg、(11.18 ± 3.07) mmHg, 两次眼压测量值的差异有统计学意义( t = 22.126, P = 0.000) 。两组的实验眼滴眼后的眼压均呈一致性的下降。

结论: 泪膜的改变可以使 Goldmann 压平眼压计的测量值产生偏差。

Purpose: To explore the effect of tear film changes on the intraocular pressure (IOP) measurement by Goldmann applantion tonometer.

Methods: Sixty-eight normal subjects were randomly divided into two groups (Gruop A and B) , 34 in each group. One eye of each subject by random selection was given Dextran (in Group A) and Viscoat (in Group B) , respectively. And the fellow eyes were used as controls. IOP was measured in all subjects twice using Goldmann applantion tonometer. And the difference between first and second measurements was compared.

Result: In the control eyes of Group A, the average IOP of first and second measurements were (14.44 ± 2.68) mmHg (1 mmHg= 0.133 KPa) and (14.47 ± 2.69) mmHg, there was no difference between the two measurements (t =- 0.329, P = 0.744) . In eyes given Dextran, the average IOP of two measurements were (14.41 ± 2.63) mmHg and (12.94 ± 2.59) mmHg, there was significant difference between the two mea-surements (t =13.949, P= 0.000) . In control eyes of Group B, the average IOP of first and second measurements were (14.53 ± 3.13) mmHg and (11.18 ± 3.07) mmHg, and there was no difference between the two measurements (t = -0.466, P = 0.644) . In eyes given Viscoat, the average IOP of two measurements were (14.53 ± 3.13) mmHg and (11.18 ± 3.07) mmHg, and there was significant difference between the two measurements (t = 22.126, P = 0.000) . After being given Dextran or Viscoat, the IOP values decreased consistently in both Group A and Group B.

Conclusions: The change of tear film components can affect IOP values by Goldmann applantion tonometer.

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.