激光周边虹膜切开术后房角增宽的解剖学变化及预测因素：中山闭角防治试验。
Anatomic Changes and Predictors of Angle Widening after Laser Peripheral Iridotomy: The Zhongshan Angle Closure Prevention Trial.
机构信息
Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts.
出版信息
Ophthalmology. 2021 Aug;128(8):1161-1168. doi: 10.1016/j.ophtha.2021.01.021. Epub 2021 Jan 23.
PURPOSE
To assess anatomic changes after laser peripheral iridotomy (LPI) and predictors of angle widening based on anterior segment (AS) OCT and angle opening based on gonioscopy.
DESIGN
Prospective observational study.
PARTICIPANTS
Primary angle-closure suspects (PACSs) 50 to 70 years of age.
METHODS
Participants of the Zhongshan Angle Closure Prevention (ZAP) Trial underwent gonioscopy and AS-OCT imaging at baseline and 2 weeks after LPI. Primary angle-closure suspect was defined as the inability to visualize pigmented trabecular meshwork in 2 or more quadrants on static gonioscopy. Laser peripheral iridotomy was performed on 1 eye per patient in superior (between 11 and 1 o'clock) or temporal or nasal locations (at or below 10:30 or 1:30 o'clock). Biometric parameters in horizontal and vertical AS-OCT scans were measured and averaged. Linear and logistic regression modeling were performed to determine predictors of angle widening, defined as change in mean angle opening distance measured at 750 μm from the scleral spur (AOD); poor angle widening, defined as the lowest quintile of change in mean AOD; and poor angle opening, defined as residual PACS after LPI based on gonioscopy.
MAIN OUTCOME MEASURES
Anatomic changes and predictors of angle widening and opening after LPI.
RESULTS
Four hundred fifty-four patients were included in the analysis. Two hundred nineteen underwent superior LPI and 235 underwent temporal or nasal LPI. Significant changes were found among most biometric parameters (P < 0.006) after LPI, including greater AOD (P < 0.001). One hundred twenty eyes (26.4%) showed residual PACS after LPI. In multivariate regression analysis, superior LPI location (P = 0.004), smaller AOD (P < 0.001), and greater iris curvature (P < 0.001), were predictive of greater angle widening. Temporal or nasal LPI locations (odds ratio [OR], 2.60, P < 0.001) was predictive of poor angle widening. Smaller mean gonioscopy grade (OR, 0.34, 1-grade increment) was predictive of poor angle opening.
CONCLUSIONS
Superior LPI location results in significantly greater angle widening compared with temporal or nasal locations in a Chinese population with PACS. This supports consideration of superior LPI locations to optimize anatomic changes after LPI.
目的
评估激光周边虹膜切开术（LPI）后的解剖学变化，并根据眼前节（AS）OCT 和房角镜检查的房角开口来预测角度扩大。
设计
前瞻性观察研究。
参与者
年龄在 50 至 70 岁的原发性闭角型青光眼疑似患者（PACS）。
方法
中山闭角防治研究（ZAP）试验的参与者在基线和 LPI 后 2 周时接受房角镜检查和 AS-OCT 成像。原发性闭角型青光眼疑似患者定义为在静态房角镜检查中，两个或更多象限无法观察到色素性小梁网。每位患者的一只眼在上方（11 点至 1 点之间）或颞侧或鼻侧进行 LPI（在 10:30 或 1:30 点钟以下）。测量并平均水平和垂直 AS-OCT 扫描中的生物测量参数。进行线性和逻辑回归建模，以确定角度扩大的预测因素，角度扩大定义为巩膜嵴 750μm 处测量的平均房角开口距离（AOD）的变化；角度扩大不良，定义为平均 AOD 变化的最低五分位数；以及 LPI 后基于房角镜检查的残余 PACS，定义为残留 PACS。
主要观察指标
LPI 后的解剖学变化和角度扩大及开口的预测因素。
结果
共有 454 例患者纳入分析。219 例患者行上方 LPI，235 例患者行颞侧或鼻侧 LPI。LPI 后大多数生物测量参数均发生显著变化（P<0.006），包括更大的 AOD（P<0.001）。120 只眼（26.4%）LPI 后仍存在残余 PACS。多变量回归分析显示，上方 LPI 位置（P=0.004）、较小的 AOD（P<0.001）和较大的虹膜曲率（P<0.001）是角度扩大更大的预测因素。颞侧或鼻侧 LPI 位置（比值比[OR]，2.60，P<0.001）是角度扩大不良的预测因素。较小的平均房角镜检查分级（OR，0.34，每增加 1 级）是角度扩大不良的预测因素。
结论
在中国 PACS 人群中，与颞侧或鼻侧位置相比，上方 LPI 位置可显著增加角度扩大。这支持考虑上方 LPI 位置以优化 LPI 后的解剖学变化。
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