術後隅角狹窄程度與雅鉻雷射虹膜穿孔術療效之關係

Gonioscopy and Efficacy of Neodymium: YAG Laser Iridotomy in Angle Closure Glaucoma

沈素琴(Su-Chin Shen) ； 許慶堂(Ching-Tarng Hsu) ； 蕭靜熹(Ching-Hsi Hsiao) ； 陳賢立(Shan-Li Chen)

《中華民國眼科醫學會雜誌》 38卷4期 (1999/12) Pp. 627-634

https://doi.org/10.30048/ACTASOS.199912.0008

摘要

目的：長期追蹤雅鉻雷射虹膜穿孔術治療隅角閉鎖性青光眼的結果，並且評估術後隅角狹窄程度對於預測雅鉻雷射虹膜穿孔術治療效果所扮演的角色。
方法：針對長庚醫院三年間患有急性或慢性隅角閉鎖性青光眼之83隻患眼，施行雅鉻雷射虹膜穿孔術治療，平均追蹤51個月（從12.5個月到102個月）比較急性和慢性隅角閉鎖性青光眼的下列臨床資料，包括：年齡，性別，視力，眼壓，隅角情形等。
結果：大多數患眼(76.8%)經向雅鉻雷射虹膜穿孔術治療都能降低眼壓，只有10眼仍須要濾過手術來控制眼壓。在術後六個月的追蹤治療中，大部分的患眼(84.6%)視力維持不變或獲得改善。白內障惡化是其他患眼視力減退的主因。在大多數的患眼(87.9%)中，雅鉻雷射虹膜穿孔術治療排除了進一步手術治療的必要；但在12隻隅角黏合閉鎖大於270度的患眼中，仍8眼須要進一步的手術來控制眼壓。54.1%的患眼有暫時性的眼壓升高，22.9%的患眼有虹彩出血，其他的合併症很少發生。
結論：用雅鉻雷射虹膜穿孔術治療隅角狹窄性青光眼是一個安全有效的治療方式，而術後隅角狹窄程度對於預測雅鉻雷射虹膜穿孔術治療的效果更扮演了一個重要的角色。

並列摘要

Purpose: To assess the long-term results of Neodymium: YAG (Nd:YAG) laser iridotomy for the management of patients with primary angle closure glaucoma and the role of gonioscopy in predicting the outcome after Nd:YAG laser iridotomy.
Methods: Laser peripheral iridotomies were performed on 83 eyes with acute or chronic primary angle closure glaucoma in Chang Gung Memorial Hospital. The mean follow-up period was 51 months, ranged from 12.5 to 102 months. The clinical data, including age, gender, Snellen visual acuity, intraocular pressure, and gonioscopic findings, were compared between acute and chronic primary angle closure glaucoma.
Results: Decreased intraocular pressure (IOP) was noted in most eyes after Nd:YAG laser iridotomy (76.8%); only 10 eyes required further filtrating surgery to control intraocular pressure. Visual acuity remained unchanged or improved in the great majority (84.6%) of cases after 6-months follow up. Cataract progression was primarily responsible for those eyes with decreased acuity. Laser iridotomy, with or without medical treatment, obviated further surgical treatment in most categories; but eight of 12 eyes with severe peripheral anterior synechiae (PAS＞270(superscript o)) underwent further surgery to control IOP. Transient elevated IOP and iris bleeding occurred in 54.1% and 22.9% of eyes, respectively; other complications were rare.
Conclusions: Nd:YAG laser iridotomy is a safe and effective procedure in the treatment of angle closure glaucoma. The gonioscopy plays an important role in predicting the outcome after Nd:YAG laser iridotomy.

並列關鍵字

Nd:YAG laser iridotomy ； primary angle closure glaucoma ； gonioscopy