Lam Dennis S C, Leung Dexter Y L, Tham Clement C Y, Li Felix C H, Kwong Yolanda Y Y, Chiu Thomas Y H, Fan Dorothy S P
Department of Ophthalmology & Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong, China.
Ophthalmology. 2008 Jul;115(7):1134-40. doi: 10.1016/j.ophtha.2007.10.033. Epub 2007 Dec 27.
To compare the efficacy of early phacoemulsification versus laser peripheral iridotomy (LPI) in the prevention of intraocular pressure (IOP) rise in patients after acute primary angle closure (APAC).
Prospective randomized controlled trial.
Sixty-two eyes of 62 Chinese subjects, with 31 eyes in each arm.
Subjects were randomized to receive either early phacoemulsification or LPI after aborting APAC by medications. Patients were followed up on day 1; week 1; and months 1, 3, 6, 12, and 18. Predictors for IOP rise were studied.
Prevalence of IOP rise above 21 mmHg (primary) and number of glaucoma medications, IOP, and Shaffer gonioscopy grading (secondary).
Prevalences of IOP rise for the LPI group were 16.1%, 32.3%, 41.9%, and 46.7% for the follow-ups at 3, 6, 12, and 18 months, respectively. There was only one eye (3.2%) in the phacoemulsification group that had IOP rise at all follow-up time points (P<0.0001). Treatment by LPI was associated with significantly increased hazard of IOP rise (hazard ratio [HR], 14.9; 95% confidence interval [CI], 1.9-114.2; P = 0.009). In addition, a maximum IOP at presentation > 55 mmHg was associated with IOP rise (HR, 4.1; 95% CI, 1.3-13.0; P = 0.017). At 18 months, the mean number of medications required to maintain IOP <or= 21 mmHg was significantly higher in the LPI group (0.90+/-1.14) than in the phacoemulsification group (0.03+/-0.18, P<0.0001). Mean IOP for phacoemulsification group (12.6+/-1.9 mmHg) was consistently lower than that of the LPI group (15.0+/-3.4 mmHg, P = 0.009). Mean Shaffer grading for the phacoemulsification group (2.10+/-0.76) was consistently greater than that of the LPI group (0.73+/-0.64, P<0.0001).
Early phacoemulsification appeared to be more effective in preventing IOP rise than LPI in patients after abortion of APAC. High presenting IOP of >55 mmHg is an added risk factor for subsequent IOP rise. For patients with coexisting cataract and presenting IOP of >55 mmHg, early phacoemulsification can be considered as a definitive treatment to prevent IOP rise.
比较早期白内障超声乳化术与激光周边虹膜切开术（LPI）在预防急性原发性闭角型青光眼（APAC）患者眼压（IOP）升高方面的疗效。
前瞻性随机对照试验。
62名中国受试者的62只眼，每组31只眼。
通过药物中止APAC后，受试者被随机分配接受早期白内障超声乳化术或LPI。患者在第1天、第1周以及第1、3、6、12和18个月进行随访。研究了眼压升高的预测因素。
眼压升高至21 mmHg以上的发生率（主要指标）以及青光眼药物使用数量、眼压和Shaffer前房角镜分级（次要指标）。
LPI组在3、6、12和18个月随访时眼压升高的发生率分别为16.1%、32.3%、41.9%和46.7%。白内障超声乳化术组在所有随访时间点仅有一只眼（3.2%）眼压升高（P<0.0001）。LPI治疗与眼压升高的风险显著增加相关（风险比[HR]，14.9；95%置信区间[CI]，1.9 - 114.2；P = 0.009）。此外，就诊时最高眼压 > 55 mmHg与眼压升高相关（HR，4.1；95% CI，1.3 - 13.0；P = 0.017）。在18个月时，LPI组维持眼压≤21 mmHg所需的平均药物数量（0.90±1.14）显著高于白内障超声乳化术组（0.03±0.18，P<0.0001）。白内障超声乳化术组的平均眼压（12.6±1.9 mmHg）始终低于LPI组（15.0±3.4 mmHg，P = 0.009）。白内障超声乳化术组的平均Shaffer分级（2.10±0.76）始终高于LPI组（0.73±0.64，P<0.0001）。
在APAC中止后，早期白内障超声乳化术在预防眼压升高方面似乎比LPI更有效。就诊时眼压>55 mmHg是随后眼压升高的一个额外风险因素。对于合并白内障且就诊时眼压>55 mmHg的患者，可考虑早期白内障超声乳化术作为预防眼压升高的确定性治疗方法。
