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目的探讨单纯Nd∶YAG激光、氪红激光或两种激光联合虹膜松解术治疗严重虹膜后粘连的有效性。方法强散瞳药物散瞳治疗无效的严重虹膜后粘连134例155只眼,男性76例,女性58例;年龄21～70岁。滴散瞳药物半小时后角膜表面放置眼前节激光接触镜后行虹膜后粘连松解激光治疗,对粘连膜较薄而透明、界限清晰且色素较少者应用单纯Nd∶YAG激光治疗,波长1 064 nm,能量0.3～2.4 mJ;对色素为主的粘连而且粘连区虹膜与晶状体界限不清者应用单纯氪红激光,波长647 nm;光斑直径100～500μm,时间0.1～0.3 s,功率0.3～0.5 W;对色素性粘连较厚者以两种激光联合操作治疗。结果 155只眼中经激光粘连松解术后粘连全部解除瞳孔近圆者102只眼;粘连大部分解除,瞳孔不圆者53只眼。术后瞳孔立即扩大至直径≥6.5 mm者111只眼,占71.6%;瞳孔扩大至直径5.5～6.4 mm者24只眼,占15.4%;瞳孔直径≤5.5 mm 20只眼,占13%。术中瞳孔扩大见晶状体不同程度混浊者107只眼,其中轻度浑浊者52只眼,瞳孔中央混浊或极化膜残留者32只眼;严重混浊者23只眼。术后视力≤0.08者由术前的57%降低到15%,而术后视力0.1～0.4和0.5以上者则分别由术前的31%、12%上升到59%、26%。轻度前房积血13只眼,晶状体前囊膜损伤2只眼。结论单纯Nd∶YAG激光、氪红激光或两种激光联合术进行严重虹膜后粘连松解是一种简便、安全、有效的方法,值得推广。
Objective To investigate the effectiveness of simple Nd:YAG laser, krypton red laser or both laser combined with iris release in the treatment of post-iris adhesions. Methods Mydriatic mydriasis was treated in 134 patients (155 eyes) with severe iris. There were 76 males and 58 females, aged 21-70 years. Dripping mydriatic drugs half an hour after the corneal surface placed anterior segment of the laser contact lens posterior iridia adhesion release laser treatment of the adhesive film thin and transparent, clear boundaries and less pigment application of simple Nd: YAG laser treatment, wavelength 1 064 nm, energy 0.3 ~ 2.4 mJ; for the pigment-based adhesions and adhesions iris and lens confined those who use a simple krypton red laser wavelength 647 nm; spot diameter of 100 ~ 500μm, time 0.1 ~ 0.3 s, power 0.3 ~ 0.5 W; for those with thick pigmented adhesions treated with two laser operations. Results In the 155 eyes, the adhesions were completely relieved in 102 eyes by laser adhesion after loosening. Most of the adhesions were relieved, and 53 eyes had no pupil. Immediately after the operation, the pupil was expanded to 111 eyes with a diameter of 6.5 mm or more, accounting for 71.6%. The pupil was expanded to 5.5 eyes with a diameter of 5.5-6.4 mm (15.4%), and the pupil diameter was 5.5 mm (20%). Intraocular dilatation was seen in 107 eyes of varying degrees of opacity of the lens, of which 52 were mild turbidity, pupil central opacity or residual film 32 eyes; severe haze in 23 eyes. Postoperative visual acuity ≤ 0.08 from 57% preoperative to 15%, while postoperative visual acuity of 0.1 to 0.4 and 0.5 were from preoperative 31%, 12% to 59%, 26%. 13 eyes with mild hyphema, 2 eyes with anterior lens capsule damage. Conclusions Simple Nd:YAG laser, krypton red laser or both laser combined with severe post-iris adhesion release is a simple, safe and effective method, which is worth promoting.