Zorić Geber Mia, Mandić Zdravko, Korsić Jadranka, Novak Laus Katia
Klinika za ocne bolesti, Klinicka bolnica Sestre milosrdnice, Zagreb, Hrvatska.
Acta Med Croatica. 2006;60(2):117-20.
Primary angle closure glaucoma remains a disease with high visual morbidity worldwide. Patients with primary angle closure glaucoma may have dramatic signs and symptoms that can lead to permanent blindness in a short period of time if not properly treated. Conventionally, medical treatment was used to lower the intraocular pressure (IOP), followed by laser peripheral iridotomy. It acts by elevating pupillary block present in the condition. Laser peripheral iridoplasty is a tehnique using low energy contraction burns to mechanically pull open the angle, thereby reducing the IOP.
The aim of this study was to evaluate the therapeutic effect and safety of combined laser technique (argon laser iridoplasty and YAG laser peripheral iridotomy) in the management of medically unresponsive acute and subacute angle closure glaucoma.
Sixteen eyes with acute and subacute primary angle closure glaucoma unresponsive to medical treatment were included in the study. All patients were treated by laser tehnique that included YAG laser peripheral iridotomy and argon laser iridoplasty in the eye without satisfactory response to previous laser treatment. We also documented complications of laser treatment. The IOP levels were documented by applanation tonometry.
In 14 of 16 eyes combined laser treatment resulted in rapid IOP reduction. Only two patients failed to respond to the combined laser therapy and were surgically treated (clear lens extraction). No serious laser complications were recorded during the early period after laser therapy.
YAG laser peripheral iridotomy and argon laser iridoplasty as a combined treatment may be useful for IDP lowering in the management of medically unresponsive acute and subacute primary angle closure glaucoma.
原发性闭角型青光眼在全球范围内仍然是一种导致高视力损害的疾病。原发性闭角型青光眼患者可能有明显的体征和症状，如果治疗不当，可在短时间内导致永久性失明。传统上，先采用药物治疗降低眼压（IOP），随后进行激光周边虹膜切开术。其作用是缓解该疾病中存在的瞳孔阻滞。激光周边虹膜成形术是一种利用低能量收缩性烧灼来机械性拉开房角从而降低眼压的技术。
本研究的目的是评估联合激光技术（氩激光虹膜成形术和YAG激光周边虹膜切开术）治疗药物治疗无效的急性和亚急性闭角型青光眼的疗效和安全性。
本研究纳入了16只药物治疗无效的急性和亚急性原发性闭角型青光眼患眼。所有患者均接受激光技术治疗，对于先前激光治疗效果不佳的患眼，采用YAG激光周边虹膜切开术和氩激光虹膜成形术。我们还记录了激光治疗的并发症。通过压平眼压计记录眼压水平。
16只眼中有14只联合激光治疗后眼压迅速降低。只有2例患者对联合激光治疗无反应，接受了手术治疗（透明晶状体摘除术）。激光治疗后的早期未记录到严重的激光并发症。
YAG激光周边虹膜切开术和氩激光虹膜成形术联合治疗对于药物治疗无效的急性和亚急性原发性闭角型青光眼降低眼压可能有效。
