Kurysheva N I, Lepeshkina L V
Ophthalmological Center of the Federal Medical-Biological Agency of the Russian Federation, A.I. Burnazyan Federal Medical and Biophysical Center of FMBA, 15 Gamalei St., Moscow, Russian Federation, 123098.
Vestn Oftalmol. 2020;136(1):17-24. doi: 10.17116/oftalma202013601117.
To study the changes in central corneal thickness (CCT) and corneal hysteresis (CH) after selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) after laser peripheral iridotomy (LPI) and to determine their effect on the prognosis of the surgery.
The prospective study involved 68 eyes with initial PACG after LPI and 74 eyes with initial POAG observed for 6 months. Corneal-compensated IOP (IOPcc), corneal resistance factor (CRF), CH and CCT were studied as the predictors of SLT, which was considered successful when IOPcc decreased by 20% or more from the baseline without additional hypotensive therapy and/or repeated SLT.
In both forms of glaucoma, CCT increased within the first hour after SLT: 567±24.08 µm (p=0.001) in POAG, and 572±21.41 µm (p=0.000) - persisting for over a month - in PACG. CCT correlated with laser energy at all stages of the examination both in POAG and PACG patients. The following predictors of SLT failure were determined: CH (p=0.000 in PACG and p=0.001 in POAG), as well as initial IOP (p=0.010 in PACG and p=0.016 in POAG) and CRF (p=0.003 in PACG and p=0.005 in POAG) and CCT (p=0.023 in PACG and p=0.026 in POAG). The value of anterior chamber angle (ACA) was a predictor only for PACG (p=0.011).
SLT leads to an increase in CCT, which lasts longer in PACG after LPI than in POAG and correlates with the level of laser energy. Lower CH and initially higher IOP are the common predictors of SLT failure in the long term for both forms of glaucoma. Smaller ACA have a negative prognostic sign in POAG.
研究原发性开角型青光眼（POAG）行选择性激光小梁成形术（SLT）后以及原发性闭角型青光眼（PACG）行激光周边虹膜切开术（LPI）后中央角膜厚度（CCT）和角膜滞后（CH）的变化，并确定它们对手术预后的影响。
这项前瞻性研究纳入了68例LPI术后初发PACG患者的眼睛和74例初发POAG患者的眼睛，观察6个月。研究角膜补偿眼压（IOPcc）、角膜阻力因子（CRF）、CH和CCT作为SLT的预测指标，当IOPcc在无额外降压治疗和/或重复SLT的情况下较基线降低20%或更多时，SLT被认为成功。
在两种类型的青光眼中，SLT后第1小时内CCT均增加：POAG中为567±24.08 µm（p = 0.001），PACG中为572±21.41 µm（p = 0.000），且持续超过1个月。在POAG和PACG患者检查的各个阶段，CCT均与激光能量相关。确定了以下SLT失败的预测指标：CH（PACG中p = 0.000，POAG中p = 0.001），以及初始眼压（PACG中p = 0.010，POAG中p = 0.016）、CRF（PACG中p = 0.003，POAG中p = 0.005）和CCT（PACG中p = 0.023，POAG中p = 0.026）。前房角（ACA）的值仅为PACG的预测指标（p = 0.011）。
SLT导致CCT增加，LPI术后PACG中CCT增加持续的时间比POAG更长，且与激光能量水平相关。较低的CH和初始较高的眼压是两种类型青光眼长期SLT失败的常见预测指标。较小的ACA在POAG中具有不良预后迹象。
