- 學位論文
雷射週邊虹膜穿孔手術對於急性原發性隅角閉鎖型青光眼與慢性隅角閉鎖型青光眼以及原發性隅角閉鎖患者療效之比較
THE EFFECT OF LASER PERIPHERAL IRIDOTOMY IN TAIWANESE ACUTE PRIMARY ANGLE CLOSURE GLAUCOMA, PRIMARY ANGLE CLOSURE, AND CHRONIC ANGLE CLOSURE GLAUCOMA EYES
摘要
研究目的： 收集台灣區臨床上常見的急性原發性隅角閉鎖型青光眼、慢性隅角閉鎖型青光眼與原發性隅角閉鎖患者，比較三者在接受雷射週邊虹膜穿孔術前後的客觀與主觀臨床症狀變化，以得知此術式對這些患者的成效與影響，以及進一步評估施行虹膜雷射穿孔術的利弊與價值。 研究方法： 採病歷回溯連續收集的方式整理分析上述三類病人雷射前後的變化。 結果： 有116位病患，196隻眼納入本研究，急性原發性隅角閉鎖型青光眼組有42位患者、47眼，原發性隅角閉鎖組有54位患者，74眼，慢性隅角閉鎖型青光眼組有53位患者、75眼，三組都以女性病患佔大多數（76.2 % & 83.3 % & 62.3%）。在急性原發性隅角閉鎖型青光眼組部分，接受雷射術後第一天眼壓即可以達到有顯著意義的下降（22.66 ± 14.5 mmHg vs.16.21 ± 5.73 mmHg，p＝0.007）且降壓效果在追蹤一個月期間都能持續（17.65 ± 5.70 mmHg，p＝0.034）；至於慢性隅角閉鎖型青光眼組的眼壓亦於術後一天便降低（20.87 ± 9.09 mmHg vs.17.54 ± 4.23 mmHg，p＝0.005），一個月後亦然（17.12 ± 4.34 mmHg，p＝0.002）。兩組平均隅角閉鎖範圍均在術後顯著減少(310.65 ± 65.88度減至171.92 ± 140.94度以及270.90 ± 82.92度減至112.50 ± 119.63度，皆p＜0.001）)。在原發性隅角閉鎖組，術前術後的平均眼壓無顯著的變化，隅角閉鎖範圍顯著減少（270.50 ± 87.77度 減至 21.76 ± 66.29，p＜0.001），有98.6%的案例隅角閉鎖範圍減少至180度以下。 在術後併發症部分，除了術後第一天有高比例的短暫前虹彩炎以及輪狀部充血，與少數個案在雷射術後出現眩光等不適症狀之外，有一例於術後54個月因慢性角膜水泡樣病變而接受角膜移植的個案。而分析雷射施行的位置發現，雷射孔位在上半部虹膜且部分被眼瞼遮蓋的案例術後發生主觀不適症狀的機會較高。 結論： 以雷射週邊虹膜穿孔術治療急性以及慢性原發性隅角閉鎖型青光眼可以達到良好眼壓控制及減少隅角閉鎖的效果，在原發性隅角閉鎖組施行亦可大幅減少隅角閉鎖範圍進而達到預防急性隅角閉鎖型青光眼發作的目的。然而，雖然術後併發症大多在短時間內緩解而且症狀輕微，嚴重併發症的個案仍偶然可見。因此，雷射術前詳細的評估，術中小心的操作，以及術後審慎的追蹤都是必要的。
並列摘要
Background: To compare the effect of laser peripheral iridotomy (LPI) in Taiwanese eyes between acute primary angle closure glaucoma (APACG), primary angle closure (PAC), and chronic primary angle closure glaucoma (CACG) eyes. Methods: Retrospective review of consecutive patients receiving LPI. Results: One hundred ninety-six eyes were enrolled, including 47 eyes in the APACG group, 74 eyes in the PAC group and 75 eyes in the CACG group. In APACG and CACG groups, intraocular pressure (IOP) significantly decreased post LPI day one (p<0.05) and the pressure-lowering effect could last throughout the one-month follow-up period (p<0.05). The average closure extent of drainage angles were significantly decreased (both p＜0.001). In PAC group, pre- and post-LPI IOP remained constant, and the angle grading of 98.6% PAC eyes became opened after laser application. Complications were mostly mild and transient such as anterior uveitis and ciliary injection. Some cases complained of glare after LPI which was highly correlated with LPI performed at upper half of the iris and the LPI hole partially covered by lid. There was one primary angle closure eye requiring penetrating keratoplasty due to bullous keratopathy. Conclusion: LPI is an effective method to reduce IOP in both APACG and CACG eyes and to reverse closed drainage angles in APACG, PAC and CACG patients. Although complications were mostly mild, occasionally devastating complications such as bullous keratopathy might occur. Therefore, a thorough assessment, a careful handling of the laser procedure, and long term follow-ups are highly recommended.