Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Chin Med J (Engl). 2013 Jan;126(1):41-5.
Argon laser peripheral iridoplasty (ALPI) is proved to be effective in lowering intraocular pressure (IOP) of patients with mild acute primary angle closure (APAC). It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed to evaluate the IOP-lowering efficacy of ALPI and laser peripheral iridotomy (LPI) on patients with refractory APAC, who have previously responded poorly to intensive medical therapy.
Thirty-six patients (8 men and 28 women) were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber (AC) angle, and IOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity (VA), best corrected VA (BCVA), IOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes.
All patients were affected unilaterally, with average age of (54.6 ± 11.7) (range, 37.0 - 75.0) years old. The mean IOP value of the affected eyes dropped from (31.6 ± 7.7) (range, 21.0 - 39.0) mmHg at enrollment to (18.4 ± 8.7) (range, 10.0 - 27.0) mmHg 2 hours after ALPI. At follow-up day 7, the mean IOP value maintained at (14.8 ± 4.2) (range, 9.0 - 21.0) mmHg, which was significantly different (P = 0.000) compared with baseline. The average decrease of IOP in the APAC eyes was (16.8 ± 7.4) (range, 12.0 - 21.0) mmHg. At follow-up three years later, the mean IOP of the APAC eyes stabilized at (16.3 ± 3.2) (range, 9.0 - 20.0) mmHg with at least 180° of AC angle opened.
ALPI and LPI lower the IOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.
氩激光周边虹膜成形术（ALPI）已被证明可有效降低轻度急性闭角型青光眼（APAC）患者的眼压（IOP）。目前尚不清楚这种激光治疗在管理对强化药物治疗反应不佳的严重 APAC 患者方面是否同样有效。本研究旨在评估 ALPI 和激光周边虹膜切开术（LPI）对经药物治疗反应不佳的难治性 APAC 患者的降眼压疗效，这些患者在接受两天或更长时间的抗青光眼药物治疗后仍存在眼部疼痛、眼红、角膜混浊、房角关闭和 IOP 不低于 21mmHg。所有入组患者均接受眼科检查，包括视力（VA）、最佳矫正视力（BCVA）、眼压、生物显微镜和房角镜检查，随后在 APAC 眼行 ALPI 治疗，双眼行 LPI 治疗。
所有患者均为单侧发病，平均年龄（54.6±11.7）岁（范围 37.0-75.0 岁）。患病眼的平均眼压值从入组时的（31.6±7.7）mmHg（范围 21.0-39.0mmHg）降至 ALPI 后 2 小时的（18.4±8.7）mmHg（范围 10.0-27.0mmHg）。在第 7 天随访时，平均眼压值维持在（14.8±4.2）mmHg（范围 9.0-21.0mmHg），与基线相比差异有统计学意义（P=0.000）。APAC 眼的平均眼压降低（16.8±7.4）mmHg（范围 12.0-21.0mmHg）。3 年后随访时，APAC 眼的平均眼压稳定在（16.3±3.2）mmHg（范围 9.0-20.0mmHg），房角至少开放 180°。
尽管对药物治疗反应不佳，ALPI 和 LPI 仍可降低药物治疗反应不佳的 APAC 病例的眼压。
