激光周边虹膜切除术治疗原发性闭角型青光眼的远期疗效观察

Long-term outcomes of laser peripheral iridectomy for primary angle closure glaucoma

目的探讨激光周边虹膜切除术（LPI）治疗原发性闭角型青光眼（PACG）的远期疗效及安全性。方法回顾性系列病例研究。收集1992年4月至2002年10月实施LPI治疗且术后随诊时间达5年以上的PACG患者临床资料，根据患者LPI治疗前眼压、视乳头、视野、前房角等情况，将患眼重新分为3组：疑似原发性前房角关闭（PACS）组、原发性前房角关闭（PAC）组、原发性闭角型青光眼（PACG）组，分析LPI治疗后各组患者远期眼压控制、视力及并发症等情况。不同类型的原发性闭角型青光眼之间LPI治疗后眼压控制情况比较采用χ^2检验。结果共收集到符合条件的患者131例（251只眼），其中PACS组18只眼（7．2％），PAC组98只眼（39．0％），PACG组129只眼（51．4％），无法分类的6只眼（2．4％）。PACS组、PAC组、PACG组患者LPI治疗后眼压控制满意率分别为88．9％（16／18）、38．8％（38／98）及10．9％（14／129），眼压控制不满意率分别为5．6％（1／18）、48．0％（47／98）及75．2％（97／129），眼压控制失败率分别为5．6％（1／18）、13．3％（13／98）及14．0％（18／129）。3组患者LPI治疗后眼压控制情况的差异有统计学意义（χ^2=59．08，P=0．000）。251只眼中8只眼（3．2％）在LPI治疗后1周至16年发生青光眼急性发作。全部患者在随诊期间未发生大泡性角膜病变。结论LPI治疗后PACG的眼压控制不如预期的那样好。在大多数青光眼中，LPI可以有效防止闭角型青光眼的急性发作。LPI治疗后PACG、PAC、PACS组患者均存在不同程度的眼压升高危险，需密切随诊，及时处理。

Objective To explore the long-term efficacy and safety of laser peripheral iridectomy for primary angle closure glaucoma （PACG）. Methods It was a retrospective case series study. Data were collected from those patients who received laser peripheral iridectomy （LPI） for acute or chronic PACG from April 1992 through October 2002 at the Peking Union Medical College Hospital. Only patients who were followed for at least 5 years were included in this study. The control of intraocular pressure （IOP） , visual acuity and managements after LPI were analyzed. All of the studied eyes were re-classified into three categories according to the status of anterior chamber angle, optic nerve head and visual field before LPI： primary angle closure suspect （PACS） , primary angle closure （PAC） and primary angle closure glaucoma （PACG）, Satisfactory control of lOP was defined as the IOP was less than 21 mm Hg（1 mm Hg = 0. 133 kPa） without any medications after LPI. No satisfactory control of IOP was defined as the lOP was greater than 21 mm Hg after LPI, yet could be controlled below 21 mm Hg by anti-glaucoma medications. A failure in IOP control was defined as an acute attack of angle closure developed or filtering surgery was required to control IOP after LPI. Chi-square analysis was used for comparison of IOP control in different groups. Results One hundred and thirty one patients （251 eyes） with PACG were eligible for this study. The mean follow-up period was（9.2 ＋ 3.7） years. Of the 251 eyes, 18 eyes （7.2%） were identified as PACS, 98 eyes （39.0%） PAC , 129 eyes （51.4%） PACG, and 6 eyes （2. 4% ） could not be classified owing to the lack of the information on the optic nerve head and visual field before LPI. The rates of satisfactory control of IOP were 27.1% in all eyes, and 88.9% （ 16/18 ）, 38.8% （ 38/98 ） and 10. 9% （14/129） in PACS, PAC and PACG eyes respectively. The rates of no satisfactory control of IOP were 59.8% in all eyes,and 5.6% （1/18） ,48.0% （47/98） and 75.2% （97/129） in PACS, PAC and PACG eyes respectively. The rates of failure in IOP control were 13. 1% in all eyes, and 5.6% （ 1/18 ） ,13.3% （13/98） and 14. 0% （18/129）in PACS, PAC, PACG eyes respectively. The difference in lOP control between PACS, PAC and PACG eyes was statistically significant（ χ^2 = 59.08, P = 0. 000）. Only 8 eyes had an acute attack of angle closure after LPI. No long-term complications after LPI were observed in all eyes. Conclusions The IOP control after LPI in PACG eyes is not so good as expected. However, most of PACG eyes after LPI are free of acute attack of angle closure. PACG eyes should be given close and regular follow-up in a long-term to monitor the IOP control and the progression of PACG after LPI.