Glaucoma Services Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Semin Ophthalmol. 2024 Apr;39(3):235-241. doi: 10.1080/08820538.2024.2312946. Epub 2024 Feb 25.
To evaluate the long-term efficacy of selective laser trabeculoplasty (SLT) in eyes with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG) following a laser peripheral iridotomy (LPI).
In this prospective cross-sectional study, 45 eyes of 34 patients with PAC/PACG diagnosis, uncontrolled intraocular pressure (IOP), and visible pigmented trabecular-meshwork (TM) at least 180° on gonioscopy following a LPI were recruited. Following a detailed baseline ophthalmic evaluation, all eligible eyes underwent SLT, and the patients were examined on day1, at 1 week, 1-, 3-, and 6-months, and 1-, 2-, 3-, 4-, and 5-year subsequently. The main outcomes measured were IOP, number of IOP-lowering agents, and complications.
The mean age of the cohort was 57.80 ± 6.44 years, the male-female ratio was 8:26, and 17 eyes were PACG, and 28 were PAC. The baseline IOP was 23.81 ± 1.78 mm Hg, and was significantly declined at all follow-ups ( < .0001). The cumulative probability of overall success was 91% and 84% at 2-, and 5-year, respectively. At 5-year SLT provided drug-freedom in 80% of PAC and 23% of PACG eyes. Six eyes had IOP spike at 1-week and two patients underwent repeat SLT after 1-year. No other complications, such as pain/discomfort, inflammation, an increase in peripheral anterior synechiae and cystoid-macular-edema, were noted.
SLT appears a safe and cost-effective procedure in PAC/mild- moderate PACG eyes with uncontrolled IOP after laser iridotomy. The long-term effectiveness of SLT as adjuvant treatment was good, but need large sized randomized studies for more validation.
评估激光周边虹膜切开术（LPI）后原发性闭角型青光眼（PAC）和原发性闭角型青光眼（PACG）患者行选择性激光小梁成形术（SLT）的长期疗效。
这是一项前瞻性的横断面研究，共纳入 34 名患者的 45 只眼，这些患者均诊断为 PAC/PACG，LPI 后眼压（IOP）控制不佳，房角镜检查至少 180°可见色素性小梁网（TM）。所有符合条件的患者均行 SLT，详细的基线眼科评估后，在术后第 1 天、第 1 周、第 1、3、6 个月和第 1、2、3、4、5 年进行随访。主要观察指标为眼压、降眼压药物的数量和并发症。
该队列的平均年龄为 57.80±6.44 岁，男女比例为 8:26，17 只眼为 PACG，28 只为 PAC。基线 IOP 为 23.81±1.78mmHg，所有随访时 IOP 均显著下降（ < .0001）。总体成功率的累积概率分别为 91%和 84%，在 2 年和 5 年时。5 年时 SLT 使 80%的 PAC 眼和 23%的 PACG 眼达到无药物治疗。6 只眼在第 1 周时眼压升高，2 例患者在第 1 年后行重复 SLT。未观察到其他并发症，如疼痛/不适、炎症、周边前粘连和囊样黄斑水肿增加。
对于 LPI 后眼压控制不佳的 PAC/轻度至中度 PACG 眼，SLT 是一种安全且具有成本效益的治疗方法。SLT 作为辅助治疗的长期效果良好，但需要更大规模的随机研究来进一步验证。
