Chang Dolly Shuo-Teh, Jiang Yuzhen, Kim Julia Anne, Huang Shengsong, Munoz Beatriz, Aung Tin, He Mingguang, Foster Paul J, Friedman David
Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA.
gRED ECD OMNI, Genentech Inc, South San Francisco, California, USA.
Br J Ophthalmol. 2023 Sep;107(9):1264-1268. doi: 10.1136/bjophthalmol-2021-320929. Epub 2022 May 2.
BACKGROUND/AIMS: Prophylactic laser peripheral iridotomy (LPI) is performed in primary angle-closure suspect (PACS) eyes to prevent acute angle-closure attacks. However, accelerated cataractogenesis is a potential risk of the procedure that may result in decreased visual acuity. We aimed to assess the long-term impact of LPI on cataract formation in Chinese PACS.
In the Zhongshan Angle Closure Prevention Trial, eligible bilateral PACS participants received LPI in one randomly selected eye, while the fellow eye remained untreated. Cataract was graded using the Lens Opacity Classification System III, and progression was defined as an increase in grade by at least two units in any category or cataract surgery.
In total, 889 participants were randomly assigned to LPI in one eye only (mean age 59±5 years, 83% female). At 72 months, treated eyes had slightly higher average nuclear grades (p<0.001). However, there were no differences between eyes for predefined cataract progression (cumulative probability at 72 months: 21.2% in LPI vs 19.4% in control, p=0.401) or cataract surgery (1% for both). While LPI-treated eyes had a 10% higher risk of progression over 6 years (HR=1.10 (95% CI 0.88 to 1.36)), this was not statistically significant. Visual acuity at 72 months was similar in treated and untreated eyes (p=0.43).
Although lenses were graded on average as slightly more opaque in laser-treated eyes, prophylactic neodymium:yttrium-aluminum-garnet LPI did not cause significant cataract progression. Our results suggest that LPI treatment of asymptomatic narrow angles does not increase the risk of developing clinically meaningful cataract worsening over time.
ISRCTN45213099.
背景/目的：预防性激光周边虹膜切开术（LPI）用于原发性闭角型青光眼可疑（PACS）患者的患眼，以预防急性闭角型青光眼发作。然而，该手术存在加速白内障形成的潜在风险，这可能导致视力下降。我们旨在评估LPI对中国PACS患者白内障形成的长期影响。
在中山闭角型青光眼预防试验中，符合条件的双侧PACS参与者被随机选择一只眼接受LPI，而对侧眼不进行治疗。使用晶状体混浊分级系统III对白内障进行分级，进展定义为任何类别中分级至少增加两个单位或进行白内障手术。
共有889名参与者被随机分配仅对一只眼进行LPI（平均年龄59±5岁，83%为女性）。在72个月时，接受治疗的眼睛平均核分级略高（p<0.001）。然而，对于预先定义的白内障进展（72个月时的累积概率：LPI组为21.2%，对照组为19.4%，p=0.401）或白内障手术（两组均为1%），两眼之间没有差异。虽然接受LPI治疗的眼睛在6年期间进展风险高10%（风险比=1.10（95%置信区间0.88至1.36）），但这在统计学上并不显著。72个月时，治疗眼和未治疗眼的视力相似（p=0.43）。
虽然激光治疗眼的晶状体平均分级为略更混浊，但预防性钕：钇铝石榴石激光周边虹膜切开术并未导致显著的白内障进展。我们的结果表明，对无症状窄角进行LPI治疗不会增加随着时间推移发生具有临床意义的白内障恶化的风险。
ISRCTN45213099。
