Corneal edema following argon laser iridotomy.
Corneal edema following argon laser iridotomy.
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氩激光虹膜切开术后角膜水肿。
DOI：
10.3928/1542-8877-19920801-07
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
K. Wilhelmus
中科院分区：
文献类型：
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作者：
K. Wilhelmus
激光虹膜切开术通常是治疗窄角青光眼的安全有效的手术。然而，由于氩激光手术的成功取决于焦点热效应，因此角膜烧伤是一种可能的并发症。我描述了五名患有前房角闭塞和双侧角膜点滴的患者，他们在氩激光虹膜切开术后出现单眼进行性角膜水肿并伴有视力丧失。这5名患者接受了虹膜切开术，激光总能量分别为63、48.5、7、25和25 J，并分别在5、2、4和2年后因角膜水肿开始丧失视力。在进行穿透性角膜移植和白内障手术后，角膜纽扣的组织病理学显示所有五种角膜纽扣均出现广泛的内皮细胞损失。滴虫牙和后弹力层增厚的微观结构发现表明，先前的内皮营养不良使这些患者容易受到激光诱导的损伤。氩激光虹膜切开术后即刻或迟发性大疱性角膜病的危险因素包括先前的房角闭合、预先存在的内皮点滴以及多次应用的高激光能量。认识到这种并发症的可能性为制定预防策略提供了机会。
Laser iridotomy is generally a safe and effective procedure for narrow-angle glaucoma. However, since surgical success with the argon laser depends on a focal thermal effect, a corneal burn is a possible complication. I describe five patients with occludable anterior chamber angles and bilateral corneal guttata who developed uniocular progressive corneal edema with visual loss following argon laser iridotomy. These five patients underwent iridotomy with a total laser energy of 63, 48.5, 7, 25, and 25 J, respectively, and began to lose vision due to corneal edema immediately, and 5, 2, 4, and 2 years later, respectively. Following penetrating keratoplasty with cataract surgery, histopathology of the corneal buttons showed generalized endothelial cell loss in all five. Microstructural findings of guttata and thickened Descemet's membrane implied that prior endothelial dystrophy had predisposed these patients to laser-induced damage. Risk factors for immediate or delayed-onset bullous keratopathy after argon laser iridotomy include prior angle closure, preexisting endothelial guttata, and high laser energy with multiple applications. Recognizing the potential of this complication offers opportunities for preventive strategies.