Ng Wai Siene, Ang Ghee Soon, Azuara-Blanco Augusto
c/o Cochrane Eyes andVision, ICEH, London School ofHygiene&TropicalMedicine, London,UK.
Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD006746. doi: 10.1002/14651858.CD006746.pub3.
Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.
To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles (PACs), PAC and PACG.
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012.
We included only randomised controlled trials (RCTs) in this review. Patients with narrow angles, PAC or PACG were eligible. We excluded studies that included only patients with acute presentations, using laser peripheral iridoplasty to break acute crisis.
No analysis was carried out as only one trial was included in the review.
We included one RCT with 158 participants. The trial reported laser peripheral iridoplasty as an adjunct to laser peripheral iridotomy compared to iridotomy alone. The authors report no superiority in using iridoplasty as an adjunct to iridotomy for IOP, number of medications or need for surgery.
AUTHORS' CONCLUSIONS: There is currently no strong evidence for laser peripheral iridoplasty's use in treating angle-closure.
闭角型青光眼是全球不可逆性失明的主要原因。治疗旨在通过药物和/或手术治疗（如小梁切除术、晶状体摘除术）打开前房角并降低眼压。激光虹膜切开术通过消除瞳孔阻滞起作用，在大多数患者中可加宽前房角。当激光虹膜切开术未能打开前房角时，激光虹膜成形术可能作为闭角型青光眼当前标准治疗的选择之一被推荐。激光周边虹膜成形术通过收缩并牵拉周边虹膜组织使其远离小梁网起作用。激光周边虹膜成形术可用于急性闭角型青光眼发作期，也可用于非急性情况。
评估与任何其他干预措施相比，激光周边虹膜成形术在非急性情况下治疗窄房角（即原发性闭角型青光眼可疑患者）、原发性闭角型青光眼（PAC）或原发性闭角型青光眼（PACG）的有效性。在本综述中，闭角型青光眼将指窄房角患者（PAC）、PAC和PACG。
我们检索了Cochrane中心对照临床试验注册库（CENTRAL）（其中包含Cochrane眼科和视力组试验注册库）（《Cochrane图书馆》2011年第12期）、MEDLINE（1950年1月至2012年1月）、EMBASE（1980年1月至2012年1月）、拉丁美洲和加勒比地区卫生科学文献数据库（LILACS）（1982年1月至2012年1月）、对照试验元注册库（mRCT）（www.controlled-trials.com）、ClinicalTrials.gov（www.clinicaltrials.gov）以及世界卫生组织国际临床试验注册平台（ICTRP）（www.who.int/ictrp/search/en）。电子检索试验时没有日期或语言限制。电子数据库最后一次检索时间为2012年1月5日。
本综述仅纳入随机对照试验（RCT）。窄房角、PAC或PACG患者符合入选标准。我们排除了仅纳入急性发作患者且使用激光周边虹膜成形术来打破急性发作期的研究。
由于本综述仅纳入了一项试验，因此未进行分析。
我们纳入了一项有158名参与者的RCT。该试验报告了与单纯虹膜切开术相比，激光周边虹膜成形术作为激光周边虹膜切开术的辅助治疗。作者报告称，在降低眼压、用药数量或手术需求方面，使用虹膜成形术作为虹膜切开术的辅助治疗并无优势。
目前尚无有力证据支持激光周边虹膜成形术用于治疗闭角型青光眼。
