Department of Ophthalmology, Scheie Eye Institute.
Department of Ophthalmology, Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine.
J Glaucoma. 2022 Apr 1;31(4):218-223. doi: 10.1097/IJG.0000000000001995.
In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis.
The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS.
The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension.
The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all).
The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.
在原发性闭角型青光眼疑似患者（PACS）中，自我认定的黑色人种是激光周边虹膜切开术（LPI）后眼压升高和虹膜炎的危险因素。多变量分析显示，激光类型与即刻 LPI 后眼压升高或虹膜炎均无关。
旨在确定激光类型和患者特征对 PACS 患者 LPI 后眼压升高和虹膜炎发生率的影响。
回顾性分析了 2010 年至 2018 年期间在宾夕法尼亚大学接受钕掺杂钇铝石榴石或序贯氩和钕掺杂钇铝石榴石 LPI 的 1485 例 PACS（2407 只眼）的电子病历。收集了 LPI 前 30 天内的平均眼压（基线眼压）、LPI 后 1 小时内的眼压、激光类型、激光能量以及术后 30 天内新发虹膜炎的发生率。多变量逻辑回归考虑了眼间相关性，用于评估与术后眼压升高和虹膜炎发生率相关的因素，调整因素为年龄、性别、外科医生以及自身免疫性疾病、糖尿病和高血压病史。
术后眼压升高和虹膜炎的发生率分别为 9.3%（95%置信区间：8.1%-10.5%）和 2.6%（95%CI：1.9%-3.2%）。多变量分析显示，自我认定的黑色人种是眼压升高（比值比[OR]：2.08 比白人；P=0.002）和虹膜炎（OR：5.07；P<0.001）的危险因素。较高的基线眼压与术后 LPI 后眼压升高的风险增加相关（OR：1.19；P<0.001）。激光类型和能量与术后眼压升高或虹膜炎均无关（所有 P>0.11）。
无论激光类型和能量如何，预防性 LPI 后即刻眼压升高和虹膜炎的发生率在黑人患者中更高。建议在术前和术后加强警惕并增加药物管理，以帮助降低这些风险。
