氩激光虹膜成形术治疗高褶虹膜综合征：48 只眼的长期疗效。

Department of Ophthalmology, Saint Joseph Hospital.

Ophthalmologic Center Trocadero, Paris, France.

J Glaucoma. 2019 Sep;28(9):767-771. doi: 10.1097/IJG.0000000000001313.

PRECIS

Argon laser peripheral iridoplasty (ALPI) was performed on 48 eyes with plateau iris syndrome (PIS). Indentation gonioscopy was used to monitor the opening of the iridocorneal angle. Mean intraocular pressure (IOP) at 5 years decreased from 15.9 to 14.4 mm Hg. None of the eyes required trabeculectomy.

PURPOSE

The purpose of this article was to report the long-term outcomes of ALPI for PIS.

MATERIALS AND METHODS

A retrospective chart review was performed on all patients with PIS treated with ALPI from 2001 to 2012. The study included 48 eyes from 28 patients with PIS after peripheral iridotomy, with a follow-up of at least 5 years. Patients with advanced glaucoma requiring initial surgical treatment (pathologic discs and IOP above the target IOP despite medical treatment) were excluded. The primary outcomes were the effect on the number of IOP medications, and the need for complementary selective laser trabeculoplasty (SLT) or surgery (trabeculectomy and/or phacoemulsification). Secondary outcomes were optic nerve head changes and adverse events.

RESULTS

The mean IOP statistically decreased after ALPI (15.91±2.62 vs. 14.35±2.18 mm Hg, P>0.001). The mean number of IOP-lowering medications statistically increased after ALPI (0.81±0.94 vs. 1.2±1.04, P>0.001). Mean follow-up was 92.4±26.5 months. At the end of the follow-up, 12 (25%) eyes had no medications, 20 (42%) had 1 medication, 11 (23%) had 2 medications, 3 (6%) had 3 medications, and 2 (4%) had 4. Ten (21%) eyes underwent SLT, 6 (10%) underwent phacoemulsification, and no trabeculectomy was necessary during follow-up. The change in cup to disc ratio from pre-ALPI to latest follow-up was not statistically significant, and no adverse events were reported.

CONCLUSIONS

ALPI is relatively effective and safe to prevent angle-closure glaucoma and avoid trabeculectomy in patients with PIS. This procedure often helps to control IOP, although SLT and additional medical treatments are frequently necessary to maintain the target IOP.

目的

本文旨在报告氩激光周边虹膜成形术（ALPI）治疗房角型闭角青光眼（PIS）的长期疗效。

材料和方法

对 2001 年至 2012 年间接受 ALPI 治疗的所有 PIS 患者进行回顾性图表分析。该研究包括经周边虹膜切开术后的 28 例 PIS 患者的 48 只眼，随访时间至少 5 年。排除初始手术治疗（病理性视盘和眼压高于目标眼压，尽管药物治疗）需要的患者。主要结果是眼压药物数量的影响，以及补充选择性激光小梁成形术（SLT）或手术（小梁切除术和/或超声乳化白内障吸除术）的需求。次要结果是视盘变化和不良事件。

结果

ALPI 后平均眼压统计学上降低（15.91±2.62 与 14.35±2.18mmHg，P>0.001）。ALPI 后平均降眼压药物数量统计学上增加（0.81±0.94 与 1.2±1.04，P>0.001）。平均随访时间为 92.4±26.5 个月。随访结束时，12 只（25%）眼无需药物治疗，20 只（42%）眼需 1 种药物，11 只（23%）眼需 2 种药物，3 只（6%）眼需 3 种药物，2 只（4%）眼需 4 种药物。10 只（21%）眼接受 SLT，6 只（10%）眼接受超声乳化白内障吸除术，随访期间无需行小梁切除术。ALPI 前后杯盘比的变化无统计学意义，无不良事件报告。