Buffault J, Leray B, Bouillot A, Baudouin C, Labbé A
Department of ophthalmology, Ambroise-Paré hospital, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne Billancourt, France; DHU Sight Restore, université de Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France.
Department of ophthalmology, Ambroise-Paré hospital, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne Billancourt, France; DHU Sight Restore, université de Versailles-Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France; Department of ophthalmology 3, Quinze-Vingts national ophthalmology hospital, 28, rue de Charenton, 75012 Paris, France.
J Fr Ophtalmol. 2017 Nov;40(9):e315-e321. doi: 10.1016/j.jfo.2017.09.002. Epub 2017 Oct 4.
Pigment dispersion syndrome (PDS) is characterized by a structural abnormality of the posterior surface of the iris causing contact with the zonular fibers. It can lead to an open-angle glaucoma secondary to pigment dispersion into the trabecular meshwork. Laser peripheral iridotomy (PI) has been proposed as a treatment for pigmentary glaucoma (PG) and pigment dispersion syndrome (PDS) by reducing the dispersion of pigment. The goal of this review was to assess the effects of PI for PDS and PG.
We included six randomized controlled trials and two cohort studies (286 eyes of 218 participants). Four trials included participants with PG, and 4 trials enrolled participants with PDS with or without elevated intraocular pressure (IOP).
Among patients with PG, at an average of 9 months of follow-up, the mean difference in IOP between groups was 2.69mm Hg less in the PI group (95% CI: -6.05 to 0.67; 14 eyes). In patients with PDS, the average IOP was statistically lower after PI as compared to baseline (Student test t=11.49, P<0.01, 38 eyes). With regard to visual field progression in participants with PG, after an average follow-up of 28 months, the risk of progression was not influenced by PI (RR 1.00 95% CI: 0.16 to 6.25; 32 eyes). No trials that enrolled patients with PDS showed a diminution of the risk of glaucoma conversion at mid- and long-terms.
PI decreases the biomechanical factor causing contact between the iris and zonular fibers and may lower IOP over the long-term. Nevertheless, the effects of PI on visual field changes or progression have not been established in PG and PDS. There is no scientific evidence as of yet to advocate PI as a treatment for PDS or PG.
色素播散综合征（PDS）的特征是虹膜后表面结构异常，导致与晶状体悬韧带纤维接触。它可导致色素播散至小梁网继发开角型青光眼。激光周边虹膜切开术（PI）已被提议作为色素性青光眼（PG）和色素播散综合征（PDS）的一种治疗方法，通过减少色素播散来实现。本综述的目的是评估PI对PDS和PG的疗效。
我们纳入了6项随机对照试验和2项队列研究（218名参与者的286只眼）。4项试验纳入了PG患者，4项试验纳入了有或无眼压（IOP）升高的PDS患者。
在PG患者中，平均随访9个月时，PI组两组间IOP的平均差异少2.69mmHg（95%CI：-6.05至0.67；14只眼）。在PDS患者中，PI术后平均IOP与基线相比有统计学意义的降低（Student检验t=11.49，P<0.01，38只眼）。关于PG参与者的视野进展，平均随访28个月后，进展风险不受PI影响（RR 1.00，95%CI：0.16至6.25；32只眼）。没有纳入PDS患者的试验显示中期和长期青光眼转化风险降低。
PI降低了导致虹膜与晶状体悬韧带纤维接触的生物力学因素，可能长期降低IOP。然而，PI对PG和PDS视野变化或进展的影响尚未明确。目前尚无科学证据支持将PI作为PDS或PG的治疗方法。
