Alsagoff Z, Aung T, Ang L P, Chew P T
Singapore National Eye Centre, Singapore, Singapore. Department of Ophthalmology, National University of Singapore, Singapore, Singapore.
Ophthalmology. 2000 Dec;107(12):2300-4. doi: 10.1016/s0161-6420(00)00385-7.
To study the long-term clinical course of patients with primary angle-closure glaucoma (PACG).
Retrospective, noncomparative, interventional case series.
Sixty-five consecutive patients who were diagnosed with PACG at one Singapore hospital from January 1990 through December 1994.
Primary angle-closure glaucoma was defined as the presence of glaucomatous optic neuropathy and compatible visual field loss associated with a closed angle in the same eye. All study eyes underwent laser peripheral iridotomy (LPI). There were two groups of patients studied. Group A consisted of those with a past documented history of an episode of acute angle closure (that had resolved after LPI). Group B consisted of those with no previous acute episode. The presenting features, management, and subsequent long-term intraocular pressure (IOP) outcome were analyzed.
Intraocular pressure and the need for further glaucoma treatment.
The follow-up period was 63 +/- 29 months (mean +/- standard deviation). The mean presenting IOP was 40 +/- 16 mmHg, and the presenting vertical cup-to-disc ratio was 0.6 +/- 0.2. Of the 83 eyes, only five eyes (6%) did not require any treatment after LPI in the long term. In group A (35 eyes), all eyes required further treatment with antiglaucoma medications. Twenty-two eyes (62. 9%) eventually underwent filtering surgery at a mean of 7.3 months after the commencement of treatment. In group B (48 eyes), 43 eyes (89.6%) underwent further medical therapy, of which 22 eyes (45.8%) eventually underwent filtering surgery at a mean of 18.4 months after the commencement of treatment.
Despite the presence of a patent LPI, most eyes with established PACG require further treatment to control IOP. Medical therapy fails in most cases, necessitating filtering surgery. Patients risk experiencing further glaucomatous visual damage if this trend is not detected.
研究原发性闭角型青光眼（PACG）患者的长期临床病程。
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连续诊断为PACG的65例患者。
原发性闭角型青光眼定义为存在青光眼性视神经病变以及与同眼闭角相关的相符视野缺损。所有研究眼均接受了激光周边虹膜切开术（LPI）。研究对象分为两组。A组由既往有急性闭角发作记录（LPI后已缓解）的患者组成。B组由既往无急性发作的患者组成。分析了患者的临床表现、治疗情况以及随后的长期眼压（IOP）结果。
眼压以及进一步青光眼治疗的需求。
随访期为63±29个月（均值±标准差）。初始眼压均值为40±16 mmHg，初始垂直杯盘比为0.6±0.2。在83只眼中，长期来看只有5只眼（6%）在LPI后无需任何治疗。在A组（35只眼）中，所有眼均需要使用抗青光眼药物进一步治疗。22只眼（62.9%）最终在治疗开始后平均7.3个月接受了滤过手术。在B组（48只眼）中，43只眼（89.6%）接受了进一步药物治疗，其中22只眼（45.8%）最终在治疗开始后平均18.4个月接受了滤过手术。
尽管存在通畅的LPI，但大多数已确诊的PACG患者仍需要进一步治疗以控制眼压。大多数情况下药物治疗失败，需要进行滤过手术。如果未察觉这种趋势，患者有青光眼性视力进一步损害的风险。
