Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom.
Ophthalmology. 2011 Mar;118(3):468-73. doi: 10.1016/j.ophtha.2010.07.026. Epub 2010 Oct 29.
To test the hypothesis that neodymium:yttrium-aluminum-garnet (Nd:YAG) laser peripheral iridotomy (LPI) significantly reduces the incidence of conversion from pigment dispersion syndrome (PDS) with ocular hypertension (OHT) to pigmentary glaucoma (PG).
Prospective, randomized, controlled 3-year trial.
One hundred sixteen eyes of 116 patients with PDS and OHT.
Patients were assigned randomly either to Nd:YAG LPI or to a control group (no laser).
The primary outcome measure was conversion to PG within 3 years, based on full-threshold visual field (VF) analysis using the Ocular Hypertension Treatment Study criteria. Secondary outcome measures were whether eyes required topical antiglaucoma medications during the study period and the time to conversion or medication.
Fifty-seven patients were randomized to undergo laser treatment and 59 were randomized to no laser (controls). Age, gender, spherical equivalent refraction, and intraocular pressure at baseline were similar between groups. Outcome data were available for 105 (90%) of recruited subjects, 52 in the laser treatment group and 53 in the no laser treatment group. Patients were followed up for a median of 35.9 months (range, 10-36 months) in the laser arm and 35.9 months (range, 1-36 months) in the control arm. Eight eyes (15%) in the laser group and 3 eyes (6%) in the control group converted to glaucoma in the study period. The proportion of eyes started on medical treatment was similar in the 2 groups: 8 eyes (15%) in the laser group and 9 eyes (17%) in the control group. Survival analyses showed no evidence of any difference in time to VF progression or commencement of topical therapy between the 2 groups. Cataract extraction was performed on 1 patient in the laser group and in 1 patient in the control group during the study period (laser eye at 18 months; control eye at 34 months).
This study suggests that there was no benefit of Nd:YAG LPI in preventing progression from PDS with OHT to PG within 3 years of follow-up.
检验钕：钇铝石榴石（Nd：YAG）激光周边虹膜切开术（LPI）是否能显著降低色素性青光眼（PG）从色素性青光眼（PDS）伴高眼压（OHT）的转化率的假说。
前瞻性、随机、对照的 3 年试验。
116 例 PDS 伴 OHT 患者的 116 只眼。
患者随机分为 Nd：YAG LPI 组或对照组（无激光）。
根据使用眼高血压治疗研究标准的全阈值视野（VF）分析，主要观察指标为 3 年内 PG 转化率。次要观察指标为研究期间是否需要局部抗青光眼药物以及转化或用药时间。
57 例患者随机接受激光治疗，59 例患者随机接受无激光治疗（对照组）。两组患者年龄、性别、等效球镜屈光度和基线眼压相似。纳入的 105 名（90%）受试者获得了结果数据，其中激光治疗组 52 名，无激光治疗组 53 名。激光组患者中位随访时间为 35.9 个月（范围 10-36 个月），对照组为 35.9 个月（范围 1-36 个月）。激光组有 8 只眼（15%）和对照组有 3 只眼（6%）在研究期间转为青光眼。两组开始药物治疗的眼数相似：激光组 8 只眼（15%），对照组 9 只眼（17%）。生存分析显示两组之间 VF 进展或开始局部治疗的时间无差异。研究期间，激光组 1 例和对照组 1 例患者行白内障摘除术（激光眼 18 个月；对照组眼 34 个月）。
本研究表明，在 3 年的随访中，Nd：YAG LPI 对预防 PDS 伴 OHT 进展为 PG 无益处。
