激光周边虹膜切除术后房角形态的远期评价

Laser peripheral iridotomy in eyes with angle closure:one year follow up study

目的评价激光周边虹膜切除术(LPI)后远期房角形态的改变,探讨手术预后的相关因素。方法收集2007年1月至2009年12月在我院眼科门诊经房角镜检查明确诊断为房角存在黏连关闭或暗光下可见功能性小梁网≤90度,接受LPI治疗,且坚持门诊随诊一年以上的患者。回顾性分析激光治疗前后患眼的视力,压平眼压,前房角镜,眼底视神经形态,超声生物显微镜(UBM)及视野检查等结果。结果入组患者共37例71眼,其中男14例,女23例,平均年龄(67.4±9.7)岁。激光治疗前患眼的诊断分别是:原发性闭角型青光眼(PACG)14眼,原发性房角关闭(PAC)36眼,可疑原发性房角关闭(PACS)21眼。术后随访一年,66.2%的患眼不用药眼压能控制在21mmHg以下,其中PACS组100%的患眼平均眼压控制在21mmHg以下,而PACG组14.3%的患眼局部用药下平均眼压仍≥21mmHg,各组眼压控制情况存在统计学差异(P<0.05)。激光术后一年复查房角镜,暗光原位下各象限房角开放的比例增加,与激光前比较有统计学差异(P<0.01),且以下方房角改善最明显;动态操作下鼻侧房角开放增多最显著,具有统计学差异(P<0.01)。术前UBM检查,71只患眼平均前房深度(1.98±0.24)mm,虹膜膨隆69眼,睫状体前旋前移28眼。经多因素分析,激光后房角是否加宽与性别、疾病的发展阶段、中央前房深度、睫状体前位等无关,而患病年龄越高,加宽比例越高(P<0.05)。结论 LPI术后多数的患眼房角加宽、眼压得以控制。眼压控制与疾病的发展阶段有关,早期治疗预后更好。在激光术后,对于已存在视神经损伤的PACG患者,睫状体前位的患者以及患病年龄较轻的患者,应该更密切的随访,以早期发现疾病的发展变化并采取相应的药物或手术治疗措施。

Objective To assess the long-term effect of laser peripheral iridotomy(LPI)on anterior chamber angle anatomy in patients with angle closure and identify the prognostic factors for LPI.Methods Patients identified with angle closure by gonioscopy were recruited and received LPI.Ultrasound biomicroscopy was carried out before the intervention.Retrospective clinical data were collected at least one year after the laser treatment.Results A total of 71 eyes of 37 eligible subjects were enrolled,the average age of whom was 67.4±9.7.Among them,14 eyes were diagnosed as primary angle closure glaucoma(PACG),36 eyes were diagnosed as primary angle closure(PAC),and 21 eyes were diagnosed as primary angle closure suspect(PACS).The average intraocular pressure(IOP)during follow up period was under 21 mm Hg without any medication in 66.2% of the eyes.The average IOP was under 21 mm Hg in all the eyes in PACS group,while it was more than 21 mm Hg with topical anti-glaucoma medications in 14.3% of the eyes in PACG group(P<0.05).Based on gonioscopy,the percentage of open angle under dim illumination with primary eye position was significantly increased after LPI in each quadrant(P<0.01),while after indentation,only in the nasal quadrant,the percentage of open angle increased significantly(P<0.01).The average anterior chamber depth(ACD)was(1.98±0.24)mm,iris convexity was found in 69 eyes,and anterior positioned ciliary body was found in 28 eyes.Most of the eyes(76.5%)showed wider angle opening after LPI.Through logistic regression analysis,the increase of angle width was not affected significantly by sex,the severity of the disease,ACD or anterior positioned ciliary body.However,age was the only factor found to be the prognostic factor.Patients with wider angle after LPI were older(P<0.05).Conclusions LPI results in a significant increase in the angle width in most patients with angle closure.The IOPs after LPI are more likely controlled in PACS and PAC group.Patients of PACG,or with anterior positioned ciliary body,or younger age should be followed up more frequently to early detect the progression of the disease.