Wishart P K, Nagasubramanian S, Hitchings R A
Glaucoma Unit, Moorfields Eye Hospital, London.
Eye (Lond). 1987;1 ( Pt 5):567-76. doi: 10.1038/eye.1987.87.
A prospective trial of argon laser trabeculoplasty (ALT) in narrow angle glaucoma (NAG) was undertaken. In eyes with NAG the mechanism of the glaucoma could be a combination of pupil block with subsequent irido-trabecular adhesion and trabecular damage with an increase in outflow resistance. To achieve relief of pupil block, eyes were randomly assigned to treatment with short pulsed laser iridotomy (LI) with the YAG or Dye lasers, or surgical peripheral iridectomy (PI). Alternatively, argon laser iridoplasty (IP) was performed to widen the anterior chamber angle sufficiently to permit ALT. Fifty-two eyes were treated and follow-up was from 12 to 22 months. A high rate of failure to control IOP with topical medication and progression of visual field loss occurred in all treatment groups. Iridoplasty followed by ALT was particularly unsuccessful as, in 50 per cent of cases, progressive synechial closure of the anterior chamber angle occurred following treatment. In eyes treated with PI/LI and ALT, the IOP control was improved in 12 per cent, unchanged in 30 per cent and remained uncontrolled in 58 per cent. By 15 months follow-up, a satisfactory outcome (IOP less than 21 mmHg on topical medication, visual field and acuity stable) was obtained in 24 per cent of the 33 eyes treated with PI/LI and ALT. Thirty-one of these eyes showed visual field loss. Of the 10 eyes that did not receive ALT following PI or LI, 90 per cent had a satisfactory outcome. Eight of these eyes showed little or no visual field loss. The authors conclude that iridoplasty followed by ALT is an unsuitable treatment for eyes with NAG. We further conclude that ALT is unlikely to be of benefit in eyes with NAG and visual field loss, even after pupil block has been relieved. Relief of pupil block alone may help eyes with early NAG without visual field loss.
对窄角型青光眼（NAG）患者进行了一项前瞻性氩激光小梁成形术（ALT）试验。在NAG患者眼中，青光眼的发病机制可能是瞳孔阻滞合并随后的虹膜小梁粘连，以及小梁损伤导致房水流出阻力增加。为缓解瞳孔阻滞，将患者随机分为三组，分别接受YAG或染料激光短脉冲激光虹膜切开术（LI）治疗、手术周边虹膜切除术（PI）治疗，或者接受氩激光虹膜成形术（IP）以充分扩大前房角，从而能够进行ALT。共治疗了52只眼睛，随访时间为12至22个月。所有治疗组中，局部用药控制眼压失败率高，且视野缺损均有进展。先进行虹膜成形术再行ALT尤其不成功，因为在50%的病例中，治疗后前房角出现了进行性粘连闭合。在接受PI/LI和ALT治疗的眼睛中，12%的患者眼压得到改善，30%的患者眼压不变，58%的患者眼压仍未得到控制。到随访15个月时，在接受PI/LI和ALT治疗的33只眼睛中，24%的患者获得了满意的结果（局部用药时眼压低于21 mmHg，视野和视力稳定）。其中31只眼睛出现了视野缺损。在10只接受PI或LI治疗后未接受ALT的眼睛中，90%的患者获得了满意的结果。其中8只眼睛几乎没有或没有视野缺损。作者得出结论，先进行虹膜成形术再行ALT不适用于NAG患者。我们进一步得出结论，即使瞳孔阻滞已得到缓解，ALT对伴有视野缺损的NAG患者也不太可能有益。仅缓解瞳孔阻滞可能有助于早期无视野缺损的NAG患者。
