Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts.
Byers Eye Institute, Stanford University, Palo Alto, California; Genentech, Inc., South San Francisco, California.
Ophthalmol Glaucoma. 2022 Nov-Dec;5(6):581-586. doi: 10.1016/j.ogla.2022.04.003. Epub 2022 May 11.
Angle-closure glaucoma is a major cause of blindness worldwide that carries an excessive risk of severe, bilateral visual impairment. A common concern among clinicians is the precipitation of acute angle-closure (AAC) attacks because of mydriasis. We evaluated the risk of AAC after pharmacologic dilation in Chinese individuals classified as having bilateral primary angle-closure suspects (PACSs).
Randomized, interventional, controlled trial.
A total of 889 patients with bilateral PACSs, aged between 50 and 70 years, were identified through community screening in Guangzhou, China, and enrolled in the study.
In the Zhongshan Angle-Closure Prevention Trial, bilateral PACSs were treated with laser peripheral iridotomy (LPI) in 1 randomly selected eye, with the fellow eye serving as an untreated control. Over 72 months of follow-up, the participants had their pupils pharmacologically dilated 6 times with 5% phenylephrine and 0.5% tropicamide.
Incidence and risk of post-mydriasis AAC in LPI-treated and untreated, control eyes classified as PACSs.
One bilateral AAC attack occurred after mydriasis at the 2-week post-LPI visit. No other AAC events occurred in the LPI-treated eyes. In the untreated eyes, 4 additional attacks occurred: 2 occurred after dilation (1 at 54 months and 1 at 72 months of follow-up) and 2 occurred spontaneously. The risk of post-mydriasis AAC in the untreated eyes was 1 attack in 1587 dilations. The risk of spontaneous AAC in the untreated eyes was 0.44 per 1000 eye-years (95% confidence interval, 0.11-1.77 per 1000 eye-years).
The risk of incident AAC attacks in PACSs was extremely low, even in a higher-risk group that underwent repeated pharmacologic pupillary dilation over 6 years of follow-up. Prophylactic LPI reduced this small but real risk. This trial was registered at ISRCTN.com as ISRCTN45213099.
闭角型青光眼是全球范围内导致失明的主要原因之一，它会使双眼严重受损的风险大大增加。临床医生普遍关注的一个问题是瞳孔散大后急性闭角型青光眼（AAC）发作的可能性。我们评估了在中国被诊断为双侧原发性闭角型青光眼可疑患者（PACS）的人群中，药物散瞳后发生 AAC 的风险。
随机、干预性、对照试验。
通过在中国广州的社区筛查，共确定了 889 名年龄在 50 至 70 岁之间的双侧 PACS 患者，并将其纳入本研究。
在中山闭角型青光眼防治试验中，用激光周边虹膜切除术（LPI）治疗双侧 PACS 中的一只眼，对侧眼作为未治疗的对照。在 72 个月的随访中，将参与者的瞳孔用 5%苯肾上腺素和 0.5%托吡卡胺进行 6 次药物散瞳。
LPI 治疗和未治疗的、被分类为 PACS 的瞳孔散大后发生 AAC 的发生率和风险。
在 LPI 治疗后 2 周的散瞳后检查中，有 1 例发生双侧 AAC 发作。LPI 治疗眼未发生其他 AAC 事件。在未治疗的眼中，又发生了 4 次发作：2 次发生在散瞳后（1 次发生在 54 个月，1 次发生在 72 个月的随访中），2 次自发发生。未治疗眼散瞳后发生 AAC 的风险为每 1587 次散瞳 1 次发作。未治疗眼自发发生 AAC 的风险为每 1000 眼年 0.44 次（95%置信区间，每 1000 眼年 0.11-1.77 次）。
即使在接受了 6 年以上重复药物散瞳的高危人群中，PACS 发生 AAC 发作的风险也极低。预防性 LPI 降低了这一微小但真实的风险。本试验在 ISRCTN.com 注册，注册号为 ISRCTN45213099。
