联合激光与传统药物治疗原发性闭角型青光眼急性发作期的临床研究

doi:10.3877/cma.j.issn.2095-2007.2019.06.006

目的

评价激光周边虹膜成形术联合激光瞳孔成形术与传统降眼压药物治疗原发性闭角型青光眼急性发作的有效性和安全性。

方法

收集2014年1月至2015年7月于邯郸市眼科医院(邯郸市第三医院)就诊的62例(68只眼)确诊为原发性闭角型青光眼首次急性发作并未做降眼压治疗患者的病例资料。其中，男性15例(17只眼)，女性47例(51只眼)，平均年龄(67.5±8.5)岁，所有患者眼压升高≥40 mmHg(1 mmHg＝0.133 kPa)。将入选患者采用数字表法随机分为激光组和药物组。激光组给予激光周边虹膜成形术联合激光瞳孔成形术治疗，药物组给予传统降眼压药物治疗。采用TA03型Icare眼压计测量治疗前、治疗后1 h和2 h的眼压，记录两组角膜及前房情况。以治疗后2 h眼压降至30 mmHg及以下为抢救成功，反之则为治疗失败。激光组和药物组年龄、就诊时眼压和发作时间等资料的描述采用均数±标准差表示，组间比较使用独立样本t检验；两组治疗成功率的描述采用眼数和百分比，比较采用χ²检验；两组治疗前、治疗后1 h和2 h眼压的比较采用两因素重复测量方差分析。

结果

治疗后1 h激光组14只眼抢救成功，成功率为41.2%；药物组15只眼抢救成功，成功率为44.2%。治疗后2 h激光组18只眼抢救成功，成功率为52.9%；药物组20只眼抢救成功，成功率为58.2%。治疗后1 h与2 h两组间成功率无统计学意义( χ²＝0.06，0.24；P>0.05)。激光组治疗前视力为光感至0.4，治疗后1 h视力为眼前手动至0.6，治疗后2 h视力为眼前手动至0.6。药物组治疗前视力为光感至0.4，治疗后1 h视力为光感至0.8，治疗后2 h视力为光感至0.8。两组主要并发症为前房内炎症反应和角膜内皮皱褶，无眼内感染和脉络膜下暴发性出血等严重并发症。激光组治疗前、治疗后1 h和2 h平均眼压分别为(56.9±8.7)mmHg、(37.9±16.2)mmHg和(32.9±16.4)mmHg，治疗后眼压下降，与治疗前的比较差异有统计学意义(t＝6.02，7.76；P<0.05)。药物组治疗前、治疗后1 h和2 h平均眼压分别为(55.8±9.5)mmHg、(37.6±17.7)mmHg和(30.6±18.2)mmHg，治疗后眼压下降，与治疗前的比较差异有统计学意义(t＝5.28，7.16；P<0.05)。但两组各时间点的眼压比较均无统计学意义(t＝0.89，0.58，0.85；P>0.05)。

结论

激光周边虹膜成形术联合激光瞳孔成形术和传统的降眼压药物治疗均能快速降低原发性闭角型青光眼急性发作期的眼压，但激光治疗安全、有效，可避免药物治疗给机体带来的副作用，是治疗原发性闭角型青光眼急性发作期的重要辅助措施。

关键词: 激光周边虹膜成形术, 激光瞳孔成形术, 原发性闭角型青光眼, 急性发作

Objective

The aim of this study was to evaluate the efficacy and safety of laser peripheral iridoplasty combined with laser pupil plasty in the treatment of acute primary angle-closure glaucoma.

Methods

From January 2014 to July 2015, sixty-two patients in Handan Eye Hospital (the Third Hospital of Handan) with acute primary angle-closure glaucoma (68 eyes) who were not treated with intraocular pressure reduction for the first acute attack were collected. Among them, 15 cases (17 eyes) were male and 47 cases (51 eyes) were female with an average age of 67.5±8.5 years. All patients had intraocular pressure≥40 mmHg (1 mmHg=0.133 kPa). The enrolled patients were randomly divided into two groups: laser treatment group and drug group. The laser treatment group was treated with combined laser (laser peripheral iridoplasty combined with laser pupil plasty), and drug group was treated with traditional medication. Intraocular pressure was measured by TA03 Icare tonometer before treatment, 1 h and 2 h after treatment, respectively. Changes of cornea and anterior chamber were recorded between groups. Rescue was successful when intraocular pressure dropped to 30 mmHg or below after 2 h of treatment, and failure to control intraocular pressure below 30 mmHg after 2 h of treatment was failed treatment. Age, intraocular pressure and onset time in the laser and drug groups were described by mean ± standard deviation. Independent sample t-test was used for inter-group comparison. The number of eyes and percentage were used to describe the power of two components, and chi-square test was used to compare. The comparison of intraocular pressure between two groups before treatment, 1 h and 2 h after treatment was performed by two-factor repeated measurement analysis of variance.

Results

After 1 h after treatment, 14 eyes in the laser group were successfully rescued, with a success rate of 41.2%; 15 eyes in the drug group were successfully rescued, with a success rate of 44.2%; 18 eyes in the 2 h after treatment, laser group were successfully rescued, with a success rate of 52.9%; 20 eyes in the drug group were successfully rescued, with a success rate of 58.2%. There was no statistical difference in success rate between two groups after 1 h and 2 h after treatment (χ²=0.06, 0.24; P>0.05). The visual acuity of the laser group was light perception to 0.4 before treatment, hand moving to 0.6 after 1 h after treatment, and hand moving to 0.6 after 2 h after treatment. The visual acuity of the drug group was light perception 0.4 before treatment, light perception to 0.8 after 1 h after treatment, and light perception to 0.8 after 2 h after treatment. The main complications in two groups were inflammation in the anterior chamber and corneal endothelium fold, but there were no serious complications such as intraocular infection and subchoroidal hemorrhage. The mean intraocular pressure in the laser group was (56.9±8.7) mmHg, (37.9±16.2) mmHg and (32.9±16.4) mmHg before treatment, 1 h and 2 h after treatment, respectively. Intraocular pressure decreased after treatment, and the difference was statistically significant (t=6.02, 7.76; P<0.05). The mean intraocular pressure in the drug group was (55.8±9.5) mmHg, (37.6±17.7) mmHg and (30.6±18.2) mmHg before and after treatment for 1 h and 2 h, respectively. Intraocular pressure decreased after treatment, and the difference was statistically significant (t=5.28, 7.16; P<0.05). However, there was no statistical difference in intraocular pressure between two groups at each time point (t=0.89, 0.58, 0.85; P>0.05).

Conclusions

Both combined laser therapy and traditional therapy can rapidly reduce intraocular pressure during acute attack of primary angle-closure glaucoma. Laser therapy is safe and effective, it can avoid the side effects of drug therapy to the body, and it is an important adjuvant therapy in the treatment of acute attack of acute primary angle-closure glaucoma.

Key words: Laser peripheral iridoplasty, Laser pupil plasty, Acute primary angle closure glaucoma, Acute attack

表1 激光组与药物组患者一般资料的比较

组别	例数	性别(男/女)	年龄(岁)	就诊时眼压(mmHg)	发作时间(h)
激光组	30	8/22	68.4±7.6	56.9±8.7	53.1±74.5
药物组	32	7/25	66.6±9.3	55.8±9.5	64.6±78.3
χ²/t值		0.19^*	0.85^△	0.51^△	-0.62^△
P值		>0.05	>0.05	>0.05	>0.05

表1 激光组与药物组患者一般资料的比较

组别	例数	性别(男/女)	年龄(岁)	就诊时眼压(mmHg)	发作时间(h)
激光组	30	8/22	68.4±7.6	56.9±8.7	53.1±74.5
药物组	32	7/25	66.6±9.3	55.8±9.5	64.6±78.3
χ²/t值		0.19^*	0.85^△	0.51^△	-0.62^△
P值		>0.05	>0.05	>0.05	>0.05

表2 激光组与药物组患者抢救成功率的比较[%(眼数/总眼数)]

组别	治疗后1 h		治疗后2 h
组别	成功率	失败率	成功率	失败率
激光组	41.2(14/34)	58.8(20/34)	52.9(18/34)	47.1(16/34)
药物组	44.2(15/34)	55.8(19/34)	58.8(20/34)	41.2(14/34)
χ²值	0.06	0.24
P值	>0.05	>0.05

表2 激光组与药物组患者抢救成功率的比较[%(眼数/总眼数)]

组别	治疗后1 h		治疗后2 h
组别	成功率	失败率	成功率	失败率
激光组	41.2(14/34)	58.8(20/34)	52.9(18/34)	47.1(16/34)
药物组	44.2(15/34)	55.8(19/34)	58.8(20/34)	41.2(14/34)
χ²值	0.06	0.24
P值	>0.05	>0.05

表3 激光组与药物组患者眼压下降率的比较

组别	例数	治疗前眼压(mmHg)	治疗后1 h眼压(mmHg)	治疗后2 h眼压(mmHg)
激光组	34	56.9±8.7	37.9±16.2^*	32.9±16.4^*
药物组	34	55.8±9.5	37.6±17.7^*	30.6±18.2^*
t值		0.89	0.58	0.85
P值		>0.05	>0.05	>0.05

表3 激光组与药物组患者眼压下降率的比较

组别	例数	治疗前眼压(mmHg)	治疗后1 h眼压(mmHg)	治疗后2 h眼压(mmHg)
激光组	34	56.9±8.7	37.9±16.2^*	32.9±16.4^*
药物组	34	55.8±9.5	37.6±17.7^*	30.6±18.2^*
t值		0.89	0.58	0.85
P值		>0.05	>0.05	>0.05

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An observation on the treatment of primary acute angle-closure glaucoma with combined laser surgery and traditional medicine

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An observation on the treatment of primary acute angle-closure glaucoma with combined laser surgery and traditional medicine