周边虹膜前粘连范围对激光周边虹膜成形术治疗原发性闭角型青光眼急性发作期效果的影响

The effect of peripheral anterior synechia extent on intraocular pressure control of laser peripheral iridoplasty in acute primary angle-closure glaucoma

目的评价周边虹膜前粘连(peripheral anterior synechia,PAS)范围对激光周边虹膜成形术(laser peripheral iridoplasty,LPIP)治疗原发性闭角型青光眼急性发作期效果的影响。设计前瞻性比较性病例系列。研究对象邯郸市眼科医院就诊的急性发作期原发性闭角型青光眼患者116例(116眼)。方法 84例接受LPIP治疗(LPIP组),32例接受降眼压药物治疗(药物组)。在治疗后1、2、6小时测量眼压。眼压控制后进行视力、房角镜、眼底、角膜内皮细胞计数检查。主要指标眼压、PAS范围。结果 LPIP组和药物组PAS范围与发作持续时间均具有较强相关性(r=0.579, 0.288,P<0.05)。LPIP组PAS与术后2 h、6 h眼压具有较强相关性(r=0.296,0.334,P<0.05)。PAS范围在发作持续时间≤24 h者(2.3±2.9个钟点)显著小于发作持续时间>24 h者(6.2±4.0个钟点)(P<0.001)。药物组PAS≤6个钟点者与PAS>6个钟点者治疗后各时间点眼压无显著性差异。LPIP组PAS≤6个钟点者术后1 h(28.4±15.1 mmHg)、2 h(22.0±13.1 mmHg)、6 h(17.9±8.52 mmHg)眼压均低于PAS>6个钟点者(35.5±15.5、29.6±11.4、24.9±10.4 mmHg)(P=0.066、0.020、0.003)。结论急性发作的原发性闭角型青光眼PAS范围≤6个钟点的病例采用LPIP治疗其效果优于PAS范围>6个钟点者。

Objective To evaluate the effects of peripheral anterior synechia(PAS)on acute attack stage of acute primary angleclosure glaucoma(APACG)cases who received argon laser peripheral iridoplasty(LPIP).Design prospective comparative case series.Participants 116 patients(116 eyes)with acute stage of primary angle-closure glaucoma in Handan Eye Hospital.Methods 84 eyes received LPIP treatment(LPIP group)and 32 eyes received medical treatment(medical group).Intraocular pressure(IOP)at 1,2 and 6 hours(IOP1 h,IOP2 h,and IOP6 h)were measured after treatment.IOP,fundus examination,gonioscopy,endocellium cell count(ECC)was measured after the IOPs were controlled.Main outcome Measures IOP and PAS extent.Results Strong correlation was found between PAS and attack duration(AD)in LPIP group and medical group(r=0.579,0.288;P<0.05).Strong correlation was found between PAS and IOP2 h,IOP6 h in LPIP group(r=0.296,0.334;P<0.05).PAS extent in AD≤24 h group(2.3±2.9 clocks)was smaller than AD>24 h group(6.2±4.0 clocks)(P<0.001).There was no difference in IOP1 h,IOP2 h and IOP6 h between PAS≤6 clocks group and PAS>6 clocks group in APACG received medical treatment.IOPI h(28.4±15.1),IOP2 h(22.0±13.1)and IOP6 h(17.9±8.52)in PAS≤6 clocks group were lower than those(35.5±15.5,29.6±11.4,24.9±10.4,P=0.066,0.020,0.003)in PAS>6 clocks group.Conclusions APACG with PAS≤6 clocks has better IOP control than those with PAS>6 clocks in LPIP.