Motschmann M, Utermann D
Augenabteilung des Allgemeinen Krankenhauses St. Georg/Hamburg.
Klin Monbl Augenheilkd. 1995 Jul;207(1):22-8. doi: 10.1055/s-2008-1035344.
The combined application of the argon- and Nd:YAG-laser for iridotomies permits utilizing advantages of both lasertypes and avoiding their disadvantages. Long-term results of this thermal-photodisruptive technique have so far not been presented, however.
127 eyes of 70 patients with an average age of 67.8 years were retrospectively examined in order to obtain information on the longterm results, with special attention being given to a potential occlusion of the iris coloboma, potential cataract progression, regulation of IOP, the pigmentation of the anterior chamber angle and the formation of synechiae. The average time of follow-up was 2.8 years. Laser iridotomy had been performed because of glaucoma of the involved eye or at the fellow eye or because of a narrow angle situation.
The total amount of energies applied was 1.1 J on the average for the argon laser and 172.2 mJ for the Nd:YAG-laser. Iris colobomas with an average diameter of 500 microns were performed on all eyes. Due to this large diameter none of the colobomas was found to be occluded. Progression of cataract was seen in 21/127 eyes (16.5%). In some of the cases this seemed to be attributable to a lentogene component already in starting the acute angle closure glaucoma or the narrow angle situation. IOP was within the normal range in 113/127 (89.0%) eyes not additionally treated by any other therapy. In 46/74 (62.2%) eyes was increased pigmentation of the chamber angle. Synechiae arose in 25/74 (33.8%) eyes. These, however, could be significantly reduced by giving mydriatics immediately after the procedure. There were no significant differences on comparing laser iridotomy with surgical iridectomy.
Thermal-photodisruptive laser iridotomy has become a successful alternative method to the application of either argon- or Nd:YAG-laser alone. Since it is a low-risk procedure, it should be regarded as the method of choice prior to surgical iridectomy.
氩激光和钕：钇铝石榴石激光联合应用于虹膜切开术，可兼取两种激光的优点并避免其缺点。然而，这种热光破坏技术的长期效果迄今尚未见报道。
回顾性检查了70例患者的127只眼，平均年龄67.8岁，以获取长期效果的信息，特别关注虹膜缺损的潜在阻塞、潜在的白内障进展、眼压调节、前房角色素沉着以及粘连的形成。平均随访时间为2.8年。进行激光虹膜切开术的原因是患眼或对侧眼患有青光眼或存在窄角情况。
氩激光平均总能量为1.1焦耳，钕：钇铝石榴石激光为172.2毫焦耳。所有眼睛均进行了平均直径为500微米的虹膜缺损切开。由于直径较大，未发现任何缺损被阻塞。21/127只眼（16.5%）出现白内障进展。在某些病例中，这似乎归因于急性闭角型青光眼或窄角情况开始时就已存在的晶状体成分。113/127只眼（89.0%）未接受任何其他治疗，眼压在正常范围内。46/74只眼（62.2%）房角色素沉着增加。25/74只眼（33.8%）出现粘连。然而，术后立即使用散瞳剂可显著减少粘连。与手术虹膜切除术相比，激光虹膜切开术无显著差异。
热光破坏激光虹膜切开术已成为单独应用氩激光或钕：钇铝石榴石激光的一种成功替代方法。由于它是一种低风险手术，应被视为手术虹膜切除术之前的首选方法。
