| The laser treatment in glaucoma has become more and more important in the recent years. All kinds of laser methods have been devised according to the mechanism of different kinds of glaucoma. Laser peripheral iridoplasty(LPI) and iridectomy are both for intraocular drainage. They do a little change on the structure of anterior segment and even it is failed, other treatments will be performed. They are ideal for the Chinese Primary Angle Closure Glaucoma (PACG) and can be performed outpatient. It is simple, safe and painless.The purpose of this study is to investigate the curative effect of laser peripheral iridoplasty (LPI) and laser peripheral iridoplasty combined with iridectomy (LPICI). The structure of anterior segment before and after laser treatment was analyzed with UBM, which is usefull in laser treatment. We also studied the effect on the cornea) endothelial cells and the change of visual field of the two kinds of laser techniques.We collected the patients of primary angle closure glaucoma (PACG) 32 cases (43 eyes) from 2000.11 to 2001.12 in Tianjin Medical University Eye Center. 20 eyes were performed with LPI and 23 eyes with LPICI. Vision, intraocular pressure(IOP) , anterior segment, fundus, angle, UBM,and corneal endothelial cells were examined preoperatively and post-operative 1 hour, 1 week, 1 month, 3 months and 6 months. Visual fields were examined preoperatively and post-operative 6 months. In laser peripheral iridoplasty (LPI) a ring of contraction burns was produced by using low power, large spot size and long duration laser spot on all 360?peripheral iris to contract the iris stroma near the angle with Abraham gonioscope by krypton yellow-green laser. Parameters: yellow-green laser, power 280~400mW, duration 0.4s, spot size 500um, times 30-45. In laser peripheral iridoplasty combined with iridectomy (LPICI) LPI was donein the first, then photocoagulate the iris where the quadrant expected iridectomy (upper temperal or lower temperal, upper nasal or lower nasal). Parameters: yellow-green laser, power 100~300mW, duration 0.4s, spot size SOOum, times 15-40. At last , We penetrate the iris with Abraham iridectomy contact lens by Nd:YAG laser. Parameters: power 8~18mJ, times 2~15.The results were as follows:1. The laser spots were clear 1 week after laser treatment. The iris photocoagulated tend to atrophic and the laser hole has been patent at 6 months postoperatively The visual acuity before and after operation have no significant difference in the two groups. Except for the eyes with acute attack , the intraocular pressure (1OP) was normal before treatment , so the post-operative intraocular pressure (IOP) was not changed markedly. In the LPI group the peripheral anterior chamber depth has no significant difference before and 6 months after operation, but the difference in the LPICI group was significant. The chamber angle after laser treatment was wider than that before laser treatment in the two groups, the difference was significant. The amount of anti-glaucomatous drugs was less 6 months postoperatively except for the 3 eyes with trabeculectomy. No cases of iris hemorrhage and ciliary body detachment occurred in LPI group. The incidence of transient high pressure and iritis in LPICI group was higher than that in LPI group, but it was not significanct. According to the above mentioned results, the conclusion was: LPI and LPICI were effective to all types of primary angle closure glaucoma(PACG). The peripheral anterior chamber depth and the width of chamber angle of the eyes that were treated by LPICI were better than that only by LPI. The effect of krypton/Nd:YAG iridectomy was stable and the hole was patent 6 months postoperatively.2.By UBM examination it demonstrate that there was still iris gibbera 6 months postoperatively in LPI group, which indicated that the factor papillary block was still not removed. But iris was even and theangle was open in post-operative 6 months in LPICI group. There was no significant difference of the cental anterior chamber depth be...
|
PDF Full Text Request