Ophthalmology, Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
Department of Vitreo-retinal surgery, B.P Koirala lions center for Ophthalmic studies,Institute of Medicine, Kathmandu, Nepal.
BMJ Open Ophthalmol. 2023 Aug;8(1). doi: 10.1136/bmjophth-2023-001339.
Prophylactic laser peripheral iridotomy (LPI) and cataract surgery are considered the primary treatments for primary angle closure suspect (PACS) as they have proven effectiveness in widening the iridocorneal angle and addressing the underlying anatomical issues associated with this condition. The objective of this study is to compare the impact of LPI and cataract surgery on anterior chamber angle parameters, aiming to fill the existing research gap.
A prospective comparative study was conducted, involving 76 eyes of 61 patients. The study focused on patients diagnosed with PACSs and early cataract. The patients received treatment either through LPI or cataract surgery. Comprehensive eye examination was performed, including gonioscopy and anterior segment parameters were measured using anterior segment ocular coherence tomography (ASOCT). Follow-up examinations were conducted at 1 week and 1 month after the procedures, which included ASOCT and gonioscopy performed during the 1-month follow-up.
All anterior chamber angle parameters increased significantly after treatment in both groups, including trabecular iris angle (TIA), angle opening distance at 250, 500 and 750 µm (AOD 250, AOD500, AOD750), trabecular iris surface area at 500 and 750 µm (TISA500, TISA750) and angle recess area at 500 and 750 µm from scleral spur (ARA500, ARA750) (p<0.05 for all). Moreover, all these parameters were greater after cataract surgery than after LPI (p<0.05 for all).
Compared with LPI, cataract extraction resulted in a wider anterior chamber angle. Moreover, no residual angle closure was observed after cataract extraction, which could morphologically prevent the progress of angle closure. Thus, cataract extraction is superior to LPI in PACSs with early cataract in widening the anterior chamber angle.
预防性激光周边虹膜切开术（LPI）和白内障手术被认为是原发性闭角型青光眼疑似患者（PACS）的主要治疗方法，因为它们已被证明可有效扩大房角并解决与该疾病相关的潜在解剖问题。本研究的目的是比较 LPI 和白内障手术对前房角参数的影响，旨在填补现有研究空白。
进行了一项前瞻性对比研究，共纳入 61 例 76 只眼的患者。该研究专注于诊断为 PACS 和早期白内障的患者。患者接受 LPI 或白内障手术治疗。进行全面的眼部检查，包括房角镜检查，并使用眼前节光学相干断层扫描（ASOCT）测量眼前节参数。在手术后 1 周和 1 个月进行随访检查，其中包括在第 1 个月随访时进行的 ASOCT 和房角镜检查。
两组患者治疗后所有前房角参数均显著增加，包括小梁虹膜角（TIA）、250、500 和 750μm 处房角开口距离（AOD250、AOD500、AOD750）、500 和 750μm 处小梁虹膜表面面积（TISA500、TISA750）和巩膜突 500 和 750μm 处房角隐窝面积（ARA500、ARA750）（所有 p 值均<0.05）。此外，白内障手术后的所有这些参数均大于 LPI 后（所有 p 值均<0.05）。
与 LPI 相比，白内障摘除术后前房角更宽。此外，白内障摘除术后未观察到残余的房角关闭，这可以从形态上防止房角关闭的进展。因此，白内障摘除术在伴有早期白内障的 PACS 中扩大前房角方面优于 LPI。
