【摘要】 目的 :通过周边虹膜切除术与小梁切除术的对比研究 ,探讨周边虹膜切除术治疗急性闭角型青光眼 (以下简称急闭 )急性发作期持续性高眼压的有效性和安全性。方法 :63例 ( 63只眼 )经最大剂量降眼压药物紧急处理后眼压仍 >4 0mmHg的急闭急性发作期患者 ,随机分成周边虹膜切除术组 (以下简称周切组 ) ( 33只眼 )和小梁切除术组 (以下简称小梁组 ) ( 30只眼 )。结果 :术后随访 6～ 66个月 ,平均2 1 5个月。周切组手术成功率 84 8% ,小梁组 86 7% ,P >0 0 5;周切组术后眼压 1 8 1 8± 4 35mmHg,小梁组 1 7 57± 4 83mmHg ,P >0 0 5;周切组术后视力 4 78± 0 2 8,小梁组 4 51± 0 31 ,P <0 0 5。周切组术后 2 9只眼 ( 87 9% )瞳孔可调节 ,小梁组 1 3只眼 ( 43 3% ) ,P <0 0 5。周切组术后并发症少 ,无伤口渗漏、脉络膜脱离及恶性青光眼 ,眼前节炎症 3% ,白内障发展 6 1 % ,与小梁组比较P >0 0 5。结论 :周边虹膜切除术简便快捷、安全有效 ,手术并发症少 ,术后视力好 ,并可保持瞳孔调节性 ,是治疗急闭急性发作期持续性高眼压理想的急诊手术方式 ,而把握手术时机是提高手术成功率的关键。更多还原

【Abstract】 Objective:To investigate the effectiveness and safety of peripheral iridectomy on the angle-closure glaucoma at acute stage with sustained high intraocular pressure(IOP),we compared it with trabeculectomy.Methods:63 patients(63 eyes)with angle-closure glaucoma were randomized into peripheral iridectomy group (33 eyes)and trabeculectomy group (30 eyes).They were seen at acute stage,and their intraocular pressures sustained over 40 mmHg,even after maximal medical treatment.Results:The patients were followed up for 6～66 months(average 21 5 months).The success rate of operation was 84 8% after peripheral iridectomy and 86 7% after trabeculectomy(P>0 05).The postoperative IOP in the peripheral iridectomy group was 18 18±4 35mmHg,and 17 57±4 83mmHg in the trabeculectomy group (P>0 05).The postoperative visual acuity in the peripheral iridectomy group and in the trabeculectomy group was 4 78±0 28 and 4 51±0 31 respectively(P<0 05).In 29 eyes(87 9%)of the peripheral iridectomy group and 13 eyes (43 3%) of the trabeculectomy group (P<0 05), the pupils were adjustable. There were few complications in the peripheral iridectomy group,with no wound effusion,choroid detachment,or malignant glaucoma. Of 33 eyes,only 3% had inflammation of anterior segment and 6 1% developed cataract.The complications were much less in the peripheral iridectomy group than in the trabeculectomy group,and the difference was significant statistically (P<0 05).Conclusion:Peripheral iridectomy is a fast,convenient,safe and effective operation with few complications.It is able to maintain better visual acuity and adjustable pupils.It is an ideal emergency surgery for curing the acute attack of angle-closure glaucoma with sustained elevated intraocular pressure.Mastering and grasping the opportunity of surgery is the key to raise the successful rate of curing angle-closure glaucomas.更多还原