Bian Ai-Ling, Zhao Jia-Liang, Zhou Qi, Zhang Yang, Liu Xiao-Li, Mao Jin
Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Yan Ke Za Zhi. 2009 Dec;45(12):1099-104.
To explore the long-term efficacy and safety of laser peripheral iridectomy for primary angle closure glaucoma (PACG).
It was a retrospective case series study. Data were collected from those patients who received laser peripheral iridectomy (LPI) for acute or chronic PACG from April 1992 through October 2002 at the Peking Union Medical College Hospital. Only patients who were followed for at least 5 years were included in this study. The control of intraocular pressure (IOP), visual acuity and managements after LPI were analyzed. All of the studied eyes were re-classified into three categories according to the status of anterior chamber angle, optic nerve head and visual field before LPI: primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG). Satisfactory control of IOP was defined as the IOP was less than 21 mm Hg (1 mm Hg = 0.133 kPa) without any medications after LPI. No satisfactory control of IOP was defined as the IOP was greater than 21 mm Hg after LPI, yet could be controlled below 21 mm Hg by anti-glaucoma medications. A failure in IOP control was defined as an acute attack of angle closure developed or filtering surgery was required to control IOP after LPI. Chi-square analysis was used for comparison of IOP control in different groups.
One hundred and thirty one patients (251 eyes) with PACG were eligible for this study. The mean follow-up period was (9.2 +/- 3.7) years. Of the 251 eyes, 18 eyes (7.2%) were identified as PACS, 98 eyes (39.0%) PAC, 129 eyes (51.4%) PACG, and 6 eyes (2.4%) could not be classified owing to the lack of the information on the optic nerve head and visual field before LPI. The rates of satisfactory control of IOP were 27.1% in all eyes, and 88.9% (16/18), 38.8% (38/98) and 10.9% (14/129) in PACS, PAC and PACG eyes respectively. The rates of no satisfactory control of IOP were 59.8% in all eyes, and 5.6% (1/18), 48.0% (47/98) and 75.2% (97/129) in PACS, PAC and PACG eyes respectively. The rates of failure in IOP control were 13.1% in all eyes, and 5.6% (1/18), 13.3% (13/98) and 14.0% (18/129) in PACS, PAC, PACG eyes respectively. The difference in IOP control between PACS, PAC and PACG eyes was statistically significant (chi(2) = 59.08, P = 0.000). Only 8 eyes had an acute attack of angle closure after LPI. No long-term complications after LPI were observed in all eyes.
The IOP control after LPI in PACG eyes is not so good as expected. However, most of PACG eyes after LPI are free of acute attack of angle closure. PACG eyes should be given close and regular follow-up in a long-term to monitor the IOP control and the progression of PACG after LPI.
探讨激光周边虹膜切除术治疗原发性闭角型青光眼（PACG）的长期疗效和安全性。
这是一项回顾性病例系列研究。收集1992年4月至2002年10月在北京协和医院接受激光周边虹膜切除术（LPI）治疗急性或慢性PACG的患者的数据。本研究仅纳入随访至少5年的患者。分析LPI术后的眼压（IOP）控制、视力及处理情况。根据LPI术前前房角、视神经乳头和视野状况，将所有研究眼重新分为三类：原发性房角关闭可疑（PACS）、原发性房角关闭（PAC）和原发性闭角型青光眼（PACG）。IOP控制良好定义为LPI术后无需任何药物治疗，眼压低于21 mmHg（1 mmHg = 0.133 kPa）。IOP控制不满意定义为LPI术后眼压大于21 mmHg，但可通过抗青光眼药物控制在21 mmHg以下。IOP控制失败定义为LPI术后发生急性房角关闭发作或需要行滤过手术来控制眼压。采用卡方检验比较不同组间的IOP控制情况。
131例（251只眼）PACG患者符合本研究条件。平均随访时间为（9.2±3.7）年。251只眼中，18只眼（7.2%）被诊断为PACS，98只眼（39.0%）为PAC，129只眼（51.4%）为PACG，6只眼（2.4%）因缺乏LPI术前视神经乳头和视野信息无法分类。所有眼中IOP控制良好率为27.1%，PACS、PAC和PACG眼中分别为88.9%（16/18）、38.8%（38/98）和10.9%（14/129）。所有眼中IOP控制不满意率为59.8%，PACS、PAC和PACG眼中分别为5.6%（1/18）、48.0%（47/98）和75.2%（97/129）。所有眼中IOP控制失败率为13.1%，PACS、PAC、PACG眼中分别为5.6%（1/18）、13.3%（13/98）和14.0%（18/129）。PACS、PAC和PACG眼之间的IOP控制差异有统计学意义（χ² = 59.08，P = 0.000）。LPI术后仅8只眼发生急性房角关闭发作。所有眼中均未观察到LPI术后的长期并发症。
PACG眼LPI术后的IOP控制不如预期。然而，大多数PACG眼LPI术后无急性房角关闭发作。PACG眼应长期密切定期随访，以监测LPI术后的IOP控制及PACG的进展。
