Nd:YAG激光虹膜打孔术在后房型有晶状体眼人工晶状体植入术前的应用

摘要

目的 探讨Nd：YAG激光打孔术在高度近视眼有晶状体眼后房型人工晶状体(PCIOL)植入术前的应用效果。方法 回顾性系列病例研究。收集行PCIOL植入术的高度近视患者38例(76眼)，平均年龄为(29.7±6.3)岁（20～46岁）。术前平均等效球镜度为(-16.2±18.2)D(-4.5～-22.0 D)。PCIOL术前7d，应用Nd：YAG激光机行虹膜周边打孔术，记录激光能量和激射点数，并于术后1h和24h测量眼压、虹膜孔大小和前节炎症反应。激光术后1周行PCIOL植入术，术后检查眼压及前节情况，并于术后第1天、第10天和第1、3、6、12个月随访，检查患者的视力、屈光度、眼压等相关指标。随访3～12个月，平均(6.2±4.8)个月。结果 76眼(100％)激光虹膜打孔术一次治疗成功，激光所用能量为(429.6±330.6)mJ，激射点数为(142±100)点。激光治疗后，术眼均出现不同程度的炎症反应，前房炎性渗出，部分有虹膜出血，但都在1～2 d内恢复正常。激光术后1h，有13例（20眼，26％）出现一过性眼压升高(眼压≥21 mmHg)，6例术后给予全身降眼压药物治疗，5眼因眼压高于45 mmHg行前房穿刺放液。除1眼外，所有眼压升高者均在24h内恢复正常。PCIOL术后早期，有3眼出现比较明显的光影，有2眼发生瞳孔阻滞，经治疗后均得以缓解。结论 近视患者PCIOL术前行Nd：YAG激光打孔对确保人工晶状体植入后眼压稳定有重要作用。激光前的综合评价和激光术中的操作技巧可以增加PCIOL手术的成功率，减少术后并发症。%Objective To evaluate the safety and efficacy of Nd:YAG laser peripheral iridectomy (LPI) in high myopia eyes before phakic posterior chamber intraocular lens (PCIOL)implantation. Methods A retrospective analysis was made of a consecutive series of 76 eyes of 38 patients who underwent LPI before phakic PCIOL implantation. The patients had a mean ages of (29.7±6.3)years (20-46 years). The mean preoperative myopia was (-16.2±18.2)D (-4.5--22.0 D). Nd:YAG laser was applied at two peripheral sites for each eye about 7 days before PCIOL implantation. The iridectomy size, laser energy, laser spots, intraocular pressure (IOP) and inflammatory indicators were measured and recorded. The mean follow-up was (6.2±4.8)months (3-12 months) for complications. Results All 76 eyes were successfully treated with LPI without severe complications. The average energy was (429.6±330.6)mJ. Mean spots for each eye were 142±100. LPI-related transient increased IOP (≥21 mmHg) post PCIOL implantation was 26％ (20/76 eyes) for all treated eyes. There were 6 patients needed systemic ocular hypotensive agents, 5 eyes were underwent paracentesis since the IOP≥45 mmHg. Papillary block glaucoma occurred in 2 patients (3％) which surgical intervention was needed after PCIOL implantation. Conclusion Customized LPI can reduce the risk of papillary block glaucoma and glare after PCIOL implantation.