激光周边虹膜切开术后原发性闭角型青光眼的选择性激光小梁成形术：一项病例对照研究。
Selective Laser Trabeculoplasty in Primary Angle-closure Glaucoma After Laser Peripheral Iridotomy: A Case-Control Study.
作者信息
Ali Aljasim Leyla, Owaidhah Ohoud, Edward Deepak P
机构信息
*King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia †Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
出版信息
J Glaucoma. 2016 Mar;25(3):e253-8. doi: 10.1097/IJG.0000000000000282.
PURPOSE
To evaluate the outcomes of selective laser trabeculoplasty (SLT) in patients with primary angle closure (PAC/PACG) following a YAG peripheral laser iridotomy (PI) compared with primary open-angle glaucoma (POAG).
METHODS
A case-control study compared the effectiveness of SLT in PAC/PACG to POAG. Data from patients who underwent SLT after a successful PI for PAC/PACG (PAC/PACG group) with an opening of the angle for at least 180 degrees were compared with a POAG group that was randomly matched to the PAC/PACG group for age, baseline intraocular pressure (IOP), and severity of glaucoma. Data were collected on the change in IOP from baseline and reduction in number of medications following SLT in both groups. SLT was considered successful when IOP decreased by ≥20% of the baseline IOP without further medical or surgical intervention or a reduction in glaucoma medications by ≥1 from the baseline number while maintaining the target IOP.
RESULTS
In the PAC/PACG group, 59 eyes with persistent IOP elevation after successful PI underwent SLT in areas where the angle was open for at least 180 degrees; 41% (n=24) of PAC/PACG had scattered peripheral anterior synechiae (PAS) of ≤180 degrees. In the POAG group, 59 eyes underwent SLT. Fifty-nine percent in the PAC/PACG group and 85% in POAG group had 360-degree treatment, with 74 and 78 shots at 0.53 and 0.62 mJ per laser application, respectively. In the PAC/PACG group, IOP was 19.3±6.5 mm Hg at baseline and 15±3.5 mm Hg10 months after SLT, and the number of medications decreased from 2.3 at baseline to 1.4 at 10 months postoperatively. In the POAG group, IOP was 19.6±5.6 mm Hg at baseline, and 16.1±3.7 mm Hg 11 months after SLT and the glaucoma medications decreased from 2.3 to 1.1. The postoperative IOP reduction in the PAC/PACG and POAG was not significantly different (P=0.66). The success rate of achieving clinically significant IOP reduction of 20% or more from baseline, or discontinuation of one or more of glaucoma medications was 84.7% in the PAC/PACG group and 79.6% in the POAG group (P=0.47). An IOP spike occurred in 10% (n=6) in PACG/PAC and 5% (n=3) in POAG and was controlled with topical medications (P=0.49).
CONCLUSION
The safety and efficacy of SLT was equivalent in PAC/PACG and POAG.
目的
评估与原发性开角型青光眼（POAG）相比，原发性闭角型青光眼（PAC/PACG）患者在接受YAG周边激光虹膜切开术（PI）后行选择性激光小梁成形术（SLT）的效果。
方法
一项病例对照研究比较了SLT在PAC/PACG和POAG中的有效性。将成功接受PI治疗且房角开放至少180度后接受SLT的PAC/PACG患者（PAC/PACG组）的数据，与在年龄、基线眼压（IOP）和青光眼严重程度方面与PAC/PACG组随机匹配的POAG组的数据进行比较。收集两组患者SLT后眼压相对于基线的变化以及药物数量减少的数据。当眼压在无进一步药物或手术干预的情况下降低至基线眼压的≥20%，或在维持目标眼压的同时青光眼药物数量较基线减少≥1时，SLT被认为是成功的。
结果
在PAC/PACG组中，59只在成功PI后眼压持续升高的眼睛在房角开放至少180度的区域接受了SLT；41%（n = 24）的PAC/PACG患者有≤180度的散在周边前粘连（PAS）。在POAG组中，59只眼睛接受了SLT。PAC/PACG组中59%的患者和POAG组中85%的患者接受了360度治疗，分别以0.53和0.62 mJ的能量进行74次和78次激光照射。在PAC/PACG组中，基线眼压为19.3±6.5 mmHg，SLT后10个月为15±3.5 mmHg，药物数量从基线时的2.3种减少到术后10个月时的1.4种。在POAG组中，基线眼压为19.6±5.6 mmHg，SLT后11个月为16.1±3.7 mmHg，青光眼药物数量从2.3种减少到1.1种。PAC/PACG组和POAG组术后眼压降低无显著差异（P = 0.66）。从基线眼压降低20%或更多或停用一种或多种青光眼药物的临床显著成功率在PAC/PACG组中为84.7%，在POAG组中为79.6%（P = 0.47）。PACG/PAC组中有10%（n = 6）出现眼压峰值，POAG组中有5%（n = 3）出现眼压峰值，均通过局部药物控制（P = 0.49）。
结论
SLT在PAC/PACG和POAG中的安全性和有效性相当。
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