激光周边虹膜切开术与小梁切除术作为原发性闭角型青光眼的初始治疗方法比较
Laser Peripheral Iridotomy versus Trabeculectomy as an Initial Treatment for Primary Angle-Closure Glaucoma.
作者信息
Chen Yan Yun, Fan Su Jie, Liang Yuan Bo, Rong Shi Song, Meng Hai Lin, Wang Xing, Thomas Ravi, Wang Ning Li
机构信息
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China.
Handan Eye Hospital, Handan, Hebei Province, China.
出版信息
J Ophthalmol. 2017;2017:2761301. doi: 10.1155/2017/2761301. Epub 2017 Sep 1.
PURPOSE
To compare laser peripheral iridotomy (LPI) with trabeculectomy as an initial treatment for primary angle-closure glaucoma (PACG) with peripheral anterior synechiae (PAS) ≥ 6 clock hours.
METHODS
Patients were drawn from two randomized controlled trials. 38 eyes of 38 patients (PAS ≥ 6 clock hours) were treated with LPI (group 1) while 111 eyes of 111 PACG patients (PAS ≥ 6 clock hours) underwent primary trabeculectomy (group 2). All patients underwent a comprehensive ophthalmic examination at baseline and at postoperative visits and were followed up for a minimum of one year.
RESULTS
Group 2 had higher baseline IOP (45.7 ± 14.8 mmHg versus 34.3 ± 14.3 mmHg) than group 1 and more clock hours of PAS (10.4 ± 1.9 versus 9.0 ± 2.2). IOPs at all postoperative visits were significantly lower in group 2 than in group 1 ( = 0.000). Five eyes in group 1 required trabeculectomy. 17 of the 38 eyes in group 1 (44.7%) required IOP-lowering medications as compared to seven of the 111 eyes in group 2 (6.3%). Cataract progression was documented in 2 eyes (5.3%) in group 1 and 16 eyes (14.4%) in group 2.
CONCLUSIONS
Primary trabeculectomy for PACG (PAS ≥ 6 clock hours) is more effective than LPI in lowering IOP.
目的
比较激光周边虹膜切开术（LPI）与小梁切除术作为初始治疗方法，用于治疗周边前粘连（PAS）≥6个钟点的原发性闭角型青光眼（PACG）的效果。
方法
患者来自两项随机对照试验。38例患者的38只眼（PAS≥6个钟点）接受了LPI治疗（第1组），而111例PACG患者的111只眼（PAS≥6个钟点）接受了原发性小梁切除术（第2组）。所有患者在基线和术后随访时均接受了全面的眼科检查，并随访至少一年。
结果
第2组的基线眼压（45.7±14.8mmHg，而第1组为34.3±14.3mmHg）高于第1组，且PAS的钟点数更多（10.4±1.9对9.0±2.2）。第2组术后所有随访时的眼压均显著低于第1组（P = 0.000）。第1组有5只眼需要小梁切除术。第1组38只眼中有17只（44.7%）需要使用降低眼压的药物，而第2组111只眼中有7只（6.3%）需要。第1组有2只眼（5.3%）记录有白内障进展，第2组有16只眼（14.4%）。
结论
对于PACG（PAS≥6个钟点），原发性小梁切除术在降低眼压方面比LPI更有效。
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