Ang L P, Aung T, Chew P T
Singapore National Eye Centre, Singapore, Singapore.
Ophthalmology. 2000 Nov;107(11):2092-6. doi: 10.1016/s0161-6420(00)00360-2.
To study the long-term outcome of fellow eyes of Asian patients with acute primary angle closure (APAC) who underwent prophylactic laser peripheral iridotomy (LPI).
Retrospective, noncomparative, interventional case series.
Ninety-six consecutive patients with APAC at presentation to one Singapore hospital from January 1990 through December 1994.
The presenting features of the fellow eye were recorded, and the subsequent long-term intraocular pressure (IOP) outcome after LPI was analyzed. All fellow eyes were initially treated with pilocarpine 2% eyedrops four times daily before LPI, which was performed within 1 week of presentation. For any eye, a rise in IOP during follow-up was defined as a rise in IOP requiring treatment by medication or surgery.
Incidence of acute angle closure and IOP.
The mean follow-up period was 50.8 months (range, 9-99 months). Of the 96 patients, 15 patients had bilateral APAC, and APAC developed in one fellow eye before LPI could be performed. The remaining 80 fellow eyes were studied. No cases of APAC developed after prophylactic LPI. Seventy-one fellow eyes (88.8%) were successfully treated with LPI alone without the need for additional glaucoma treatment in the long term. Seven eyes (8.8%) had IOPs of 21 mmHg or less on presentation, but a rise in IOP developed on follow-up despite the presence of a patent LPI. Two fellow eyes (2.5%) had signs of preexisting chronic angle closure glaucoma at presentation and required further glaucoma treatment even after LPI. There were no significant complications from the procedure in any of the fellow eyes studied.
In this Asian population with APAC, prophylactic LPI is safe and effective in preventing acute angle closure in fellow eyes. In addition, prophylactic LPI prevents long-term rise in IOP in 88.8% of fellow eyes (with approximately 4 years of follow-up). However, because a small proportion of fellow eyes did experience a rise in IOP within the first year, despite the presence of a patent LPI, close monitoring is still advised in the follow-up of fellow eyes of patients with APAC.
研究接受预防性激光周边虹膜切开术（LPI）的亚洲急性原发性闭角型青光眼（APAC）患者对侧眼的长期预后。
回顾性、非对照、干预性病例系列研究。
1990年1月至1994年12月期间在新加坡一家医院就诊的96例连续APAC患者。
记录对侧眼的初始表现特征，并分析LPI术后的长期眼压（IOP）结果。所有对侧眼在LPI术前均先用2%毛果芸香碱滴眼液每日4次治疗，LPI在就诊后1周内进行。对于任何一只眼，随访期间眼压升高定义为需要药物或手术治疗的眼压升高。
急性闭角型青光眼的发生率和眼压。
平均随访期为50.8个月（范围9 - 99个月）。96例患者中，15例为双侧APAC，1例对侧眼在LPI术前发生急性闭角型青光眼。其余80只对侧眼纳入研究。预防性LPI术后无急性闭角型青光眼病例发生。71只对侧眼（88.8%）仅通过LPI成功治疗，长期无需额外的青光眼治疗。7只眼（8.8%）初诊时眼压≤21 mmHg，但随访中尽管LPI通畅眼压仍升高。2只对侧眼（2.5%）初诊时有慢性闭角型青光眼的体征，即使LPI术后仍需进一步的青光眼治疗。所研究的任何一只对侧眼手术均无明显并发症。
在这一亚洲APAC人群中，预防性LPI对预防对侧眼急性闭角型青光眼安全有效。此外，预防性LPI可使88.8%的对侧眼（随访约4年）长期眼压不升高。然而，由于一小部分对侧眼尽管LPI通畅，但在第一年仍出现眼压升高，因此在APAC患者对侧眼的随访中仍建议密切监测。
