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目的探讨采用逐层氩激光光凝－Ｎｄ：ＹＡＧ激光透切的方法行虹膜周边切除术的疗效。方法使用Ｃｏｈｅｒｅｎｔ联合激光器对１００例１２６眼闭角型青光眼患者施行虹膜周边切除术。切孔部位选择在颞上或颞下或鼻上或鼻下周边部虹膜。先以小能量Ａｒｇｏｎ激光在切孔处预光凝，再以Ｎｄ：ＹＡＧ激光进行透切，如此２种激光交替反复使用，逐层进行光切，直至切穿为止。切孔直径控制在０．６～１．０ｍｍ。结果全部患者经１次激光治疗均成功获得虹膜切孔。术后１ｍｏ和１ａ时眼压均较术前明显降低（Ｐ＜０．０００１）。房角开放１／２以上者，其治愈率为９７．５９％，房角开放１／２以下者治愈率５５．８１％，二者有显著性差别（Ｐ＜０．０００１）。主要不良反应为术中虹膜出血、角膜损伤、前房炎性反应、术后暂时性眼压升高等，随访１ａ未发现晶状体混浊及切孔关闭。结论使用联合激光逐层透切法行虹膜周边切除可显著减少２种激光的能量，提高了手术的成功率，使激光手术操作方便、安全、可靠。
Objective To investigate the curative effect of peripheral iridectomy using argon laser photocoagulation-Nd: YAG laser. Methods 100 cases of 126 eyes with angle closure glaucoma were treated with peri-iris excision using Coherent combined laser. Cut the site selection in the temporal or temporal or nasal or nasal peripheral iris. Argon laser with a small energy before the cut in the pre-photocoagulation, and then Nd: YAG laser through the cut, so that the two kinds of laser alternately repeated use, layer by layer cut, until cut through. Cut hole diameter control in 0.6 ~ 1.0mm. Results All the patients successfully obtained iris hole by laser treatment. The intraocular pressure at 1 month and 1 hour after operation was significantly lower than that before operation (P <0.0001). When the angle was more than 1/2, the cure rate was 97.59%, and the cure rate was 55.81% when the angle was less than 1/2. There was a significant difference (P <0.0001). The main adverse reactions were intraoperative iris hemorrhage, corneal injury, inflammatory reaction in the anterior chamber and postoperative transient intraocular pressure. Laparoscopic occlusion was not observed at follow-up. Conclusions The use of laser-guided layer-by-layer dissection can significantly reduce the energy of the two kinds of lasers and improve the success rate of the operation, making the laser operation convenient, safe and reliable.