Nolan W P, Foster P J, Devereux J G, Uranchimeg D, Johnson G J, Baasanhu J
Department of Epidemiology and International Eye Health, Institute of Ophthalmology, University College, London, UK.
Br J Ophthalmol. 2000 Nov;84(11):1255-9. doi: 10.1136/bjo.84.11.1255.
To assess the efficacy of Nd:YAG laser iridotomy as initial treatment for primary angle closure in a community setting in rural Mongolia.
Subjects with occludable drainage angles in two glaucoma prevalence surveys in Mongolia (carried out in 1995 and 1997) were treated with YAG laser iridotomy at the time of diagnosis. These patients were re-examined in 1998. Patency of iridotomy, intraocular pressure (IOP), visual acuity, and gonioscopic findings were recorded. Iridotomy was classified unsuccessful in eyes where further surgical intervention was required or in which there was a loss of visual acuity to <3/60 from glaucomatous optic neuropathy.
164 eyes of 98 subjects were examined. Patent peripheral iridotomies were found in 98.1% (157/160) of eyes that had not undergone surgery. Median angle width increased by two Shaffer grades following iridotomy. Iridotomy alone failed in 3% eyes with narrow drainage angles and either peripheral anterior synechiae or raised IOP, but normal optic discs and visual fields. However, in eyes with established glaucomatous optic neuropathy at diagnosis iridotomy failed in 47%. None of the eyes with occludable angles that were normal in all other respects, and underwent iridotomy, developed glaucomatous optic neuropathy or symptomatic angle closure within the follow up period.
Nd: YAG laser iridotomy is effective in widening the drainage angle and reducing elevated IOP in east Asian people with primary angle closure. This suggests that pupil block is a significant mechanism causing closure of the angle in this population. Once glaucomatous optic neuropathy associated with synechial angle closure has occurred, iridotomy alone is less effective at controlling IOP.
评估钕：钇铝石榴石激光虹膜切开术作为蒙古国农村社区原发性闭角型青光眼初始治疗方法的疗效。
在蒙古国的两次青光眼患病率调查（分别于1995年和1997年开展）中，具有可关闭房角的受试者在诊断时接受了钇铝石榴石激光虹膜切开术治疗。这些患者于1998年接受复查。记录虹膜切开术的通畅情况、眼压、视力和前房角镜检查结果。若需要进一步手术干预，或因青光眼性视神经病变导致视力下降至<3/60，则虹膜切开术被判定为失败。
对98名受试者的164只眼进行了检查。在未接受手术的眼中，98.1%（157/160）发现周边虹膜切开术通畅。虹膜切开术后房角宽度中位数增加了两个Shaffer等级。单独的虹膜切开术在3%具有狭窄房角且伴有周边前粘连或眼压升高，但视盘和视野正常的眼中失败。然而，在诊断时已存在青光眼性视神经病变的眼中，虹膜切开术失败率为47%。在所有其他方面均正常且接受了虹膜切开术的可关闭房角的眼中，在随访期内均未发生青光眼性视神经病变或症状性房角关闭。
钕：钇铝石榴石激光虹膜切开术对于东亚原发性闭角型青光眼患者扩大房角和降低眼压有效。这表明瞳孔阻滞是导致该人群房角关闭的重要机制。一旦发生与粘连性房角关闭相关的青光眼性视神经病变，单独的虹膜切开术在控制眼压方面效果较差。
