Napier Maria L, Azuara-Blanco Augusto
Ophthalmology Department, Royal Victoria Hospital.
Centre for Public Health, Queen's University Belfast, UK.
Curr Opin Ophthalmol. 2018 Mar;29(2):130-134. doi: 10.1097/ICU.0000000000000453.
Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids our understanding of pathogenesis and allows more robust and objective measurement of treatment modalities. We will also review recent literature regarding the role of laser and surgical interventions for the treatment of primary angle closure disease.
Recent studies evaluating the efficacy of laser peripheral iridotomy (LPI) in primary angle closure suspects (PACs) show that while it is a safe intervention and initially anterior chamber angle widens following the laser treatment, the effect is lost with time. Only a small minority of PACs patients develop primary angle closure (PAC) or primary angle closure glaucoma (PACG). Trials evaluating argon laser peripheral iridoplasty (ALPI) have failed to show a substantial clinical benefit. In patients with early or moderate PACG and those with PAC with IOP over 30 mmHg, clear lens extraction is associated with better clinical and quality of life outcomes than LPI.
Recent evidence supports initial clear lens extraction in the context of PACG or primary angle closure with IOP more than 30 mmHg.
闭角型青光眼是全球失明的主要原因之一，治疗该疾病的最佳方法的趋势正在不断发展。眼前段成像技术的出现有助于我们理解其发病机制，并能更可靠、客观地评估治疗方式。我们还将回顾近期有关激光和手术干预在原发性闭角型疾病治疗中作用的文献。
近期评估激光周边虹膜切开术（LPI）对原发性闭角型可疑患者（PACs）疗效的研究表明，虽然该手术安全，且激光治疗后前房角最初会变宽，但这种效果会随时间消失。只有少数PACs患者会发展为原发性闭角型青光眼（PAC）或原发性闭角型青光眼（PACG）。评估氩激光周边虹膜成形术（ALPI）的试验未能显示出显著的临床益处。对于早期或中度PACG患者以及眼压超过30 mmHg的PAC患者，与LPI相比，透明晶状体摘除术能带来更好的临床和生活质量结果。
近期证据支持在PACG或眼压超过30 mmHg的原发性闭角型青光眼患者中，最初应进行透明晶状体摘除术。
