急性隅角閉鎖性青光眼雷射治療與小樑切除術之比較

Comparison of Visual Outcome between Laser Treatment and Trabeculectomy in Acute Angle-Closure Glaucoma

吳鑑修(Chien-Shu Wu) ； 謝瑞玟(Jui-Wen Hsieh)

《中華民國眼科醫學會雜誌》 32卷2期 (1993/06) Pp. 168-174

https://doi.org/10.30048/ACTASOS.199306.0006

摘要

對於隅角閉鎖性青光眼之瞳孔阻斷機轉，雷射虹膜穿孔術由於施行容易，併發症少，已取代大部分傳統的手術療法。在急性發作時，由於角膜水腫、瞳孔擴大，施行雷射治療時，角膜內皮之損傷及花費時間延長，常使雷射治療事倍功半，長期的控制效果在有些病例上仍感不足。小樑切除術由於顯微手術器械之改良，術後之併發症已較從前降低許多，所以本篇收集自民國75年5月至80年11月間，在馬偕醫院接受治療的急性隅角閉鎖性青光眼病例共35例，且瞳孔均已擴大無法縮回，其中26位（33眼）接受雷射治療，9位（9眼）接受小樑切除術，結果顯示兩組術前及術後眼內壓之控制，視力，視神經盤凹陷比例及水晶體並與明顯之差異，唯獨術後用藥之多寡，在小樑切除術明顯比雷射虹膜穿孔術減少許多。至於視野與視神經盤凹陷之進展的關聯，仍有持進一步的研究。

並列摘要

The decision making in treating angle-closure glaucoma with argon laser iridotomy versus trabeculectomy is still a difficult task for most ophthalmologists. Because of the advantages of easy performance and rare complications, laser iridotomy has constituted the majority of the conventional surgical therapies. During the acute attacks of angle-closure glaucoma, corneal edema and pupillary dilatation which increase the probability of damage to the corneal endothelium and which prolong the therapeutic time often lower the effectiveness of laser iridotomy. For the longterm control of IOP, laser iridotomy alone is not effective enough in some cases. As of trabeculectomy, there are many advances in techniques and microsurgical instruments. The postoperative complications have also been lowered in recent stuies.
We evaluated retrospectively 35 patients (42 eyes) with acute angle-closure glaucoma treated in our hospital from May, 1986 to November, 1991. Of the 35 patients whose diagnoses were based on mid-dilated pupils with no response to direct and/or consensual light reflex, 26 patients received the laser iridotomy; the other 9 received trabeculectomy.
The results revealed that there were no differences in the postoperative IOP control, changes of VA, cupdisc ratio and lens changes between the two groups. However, there are less postoperative medications required in the trabeculectomy treated group than in the laser iridotomy treated group.

並列關鍵字

Acute angle-closure glaucoma ； Laser iridectomy ； Trabeculectomy