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目的对改良黏小管切开术(VCS)后高眼压的患者予Nd:YAG激光房角穿孔术(LGP)治疗,探讨其临床有效性及安全性。设计回顾性病例系列。研究对象改良VCS术后眼压升高,于表麻下行Nd:YAG激光房角穿孔术的26例患者(35眼)。方法对改良VCS术后随诊期间眼压高者在表麻下行Nd:YAG激光房角穿孔术。记录手术前后眼压、裂隙灯、房角镜、眼前节相干光断层成像(AS-OCT)检查结果,施行激光房角穿孔术的时间及手术成功率。主要指标眼压,房角镜、AS-OCT图像,激光时间。结果改良VCS术后平均眼压(23.3±8.2)mm Hg,LGP术后平均眼压降至(17.6±6.3)mm Hg。其中31眼(88.6%)眼压下降,4眼(11.4%)眼压升高。成功(眼压<19 mm Hg,且较术前下降30%)15眼(42.9%)。长期随访(3个月～2年),15眼(42.9%)无须降眼压药物,20眼(57.1%)需联合降眼压药物才能降至靶眼压。2眼(5.7%)术后激光区域少量出血,1周后完全吸收。改良VCS术后3个月内行LGP者15眼(42.9%),3个月后行LGP者20眼(57.1%)。结论 Nd:YAG激光房角穿孔术能有效降低改良VCS术后的眼压升高,安全性高,是其有效的补充。
Objective To evaluate Nd: YAG laser angle-perforation (LGP) in patients with elevated intraocular pressure (IOP) after modified small tube incision (VCS) and investigate the clinical efficacy and safety. Design retrospective case series. Subjects improved intraocular pressure (IOP) elevation after VCS. Twenty-six patients (35 eyes) underwent Nd: YAG laser perforation under epidural anesthesia. Methods The patients with high intraocular pressure (IOP) who underwent improved VCS underwent Nd: YAG laser perforation under epidural anesthesia. Ocular pressure, slit lamp, gonioscopy, and anterior segment coherence tomography (AS-OCT) were recorded before and after the operation. The time and the successful rate of laser angle perforation were recorded. The main indicators of intraocular pressure, gonioscopy, AS-OCT images, laser time. Results The average intraocular pressure (IOP) after modified VCS was (23.3 ± 8.2) mm Hg, and the mean IOP decreased to (17.6 ± 6.3) mm Hg after LGP. Among them, intraocular pressure decreased in 31 eyes (88.6%) and intraocular pressure in 4 eyes (11.4%). Fifteen eyes (42.9%) were successful (IOP <19 mm Hg with a 30% reduction from preoperative). Long-term follow-up (3 months to 2 years), 15 eyes (42.9%) do not need to reduce intraocular pressure medication, 20 eyes (57.1%) need to be combined with intraocular pressure lowering drugs to target IOP. Two eyes (5.7%) had a small amount of bleeding in the laser area and were completely absorbed after one week. Fifteen eyes (42.9%) underwent LGP within 3 months after modified VCS and 20 eyes (57.1%) underwent LGP after 3 months. Conclusion Nd: YAG laser angle-perforation can effectively reduce the elevated intraocular pressure (IOP) after modified VCS, which is safe and effective.