Surgical treatment for primary angle closure-glaucoma: a Meta analysis

AIM To evaluate the efficacy and safety of trabeculectomy, phacotrabeculectomy plus intraocular lens implantation (phacotrab+IOL group) and phacoemulsification with IOL (phaco+IOL) in primary angle-closure glaucoma(PACG). METHODS: It was a systematic review and meta-analysis, randomized controlled trials(RCT) and clinical controlled trials (CCT) were collected through electronic searches of the Cochrane Library, PubMed, EMbase, Wanfang Database online, Chinese journal Full-text Database, Chinese Scientific Journals Full-text Database (from the date of building the database to October 2010) We also checked the bibliographies of retrieved articles. M the related data that matched our standards were abstracted. The quality of included trials was evaluated according to the Dutch Cochrane Centre. Rev Man 5.0 software was used for Meta-analysis. RESULTS: A total of 5 RCT and 11 CCT involving 1495 eyes were included. The results of meta-analysis showed that phacotrab+IOL group was superior than trabeculectomy(trab group) (MD -3.93,95% CI [-7.31, -0.54]) which was also superior than phaco+IOL group(MD 0.52,95%CI [0.10, 0.95]) in decreasing Intraocular Pressure(IOP). Phacotrab group(MD -1.45,95%CI [-1.68, -1.22])and phaco group (MD-1.12,95% CI [-1.87, -0.37])are both deeper than trab group in the anterior chamber depth. In increasing the coefficient of outflow facility of aqueous humor (C values) there was no statistical difference in the three groups. And there was no statistical difference between phacotrab groups and phaco groups in visual acuity but phacotrab group was superior than phaco group (MD 1.07, 95% CI [0.73, 1.40])in the use of IOP-lowering drugs. There was no statistical difference among three groups. CONCLUSION: Current evidence suggests that phacotrab+IOL group was superior than tab group which was also superior than phaco+IOL group in decreasing IOP. Phacotrab group and phaco group are both deeper than trab group in the anterior chamber depth. Phacotrab group was superior than phaco group in the use of IOP-lowering drugs.

Diffusion tensor imaging of optic nerve and optic radiation in primary chronic angle-closure glaucoma using 3T magnetic resonance imaging

AIM: To evaluate the value of quantitative diffusion tensor imaging (DTI) in assessing the axonal and myelin damage of the optic nerves and optic radiations in patients with chronic primary angle -closure glaucoma (PACG) by using high -field magnetic resonance (MR) imaging (3T). METHODS: Twenty patients with bilateral chronic PACG and twenty age - and sex matched disease -free control subjects were enrolled. Conventional MRI and DTI were performed on all subjects using 3T MR scanner. Mean diffusivity (MD), fractional anisotropy (FA), axial diffusivities (AD) and radial diffusivities (RD) of each optic nerve and each optic radiation were measured by using post -processing software of DTI studio 2.3, and then compared between left eyes and right eyes and between patients group and control group. The pairedsample t- test were used. RESULTS: There was no abnormality in the shape and signal intensity of the optic nerves and optic radiations in patients group and control group on the conventional MRI. No significant differences were observed in the FA, MD, AD and RD between the right and left optic nerves and optic radiations within patients group and control group (P>0.05). The optic nerves and optic radiations of patients with chronic PACG, as compared with control subjects, had significantly higher MD, AD, RD and significantly lower FA (P<0.05). CONCLUSION: The diffusivity of optic nerves and optic radiations in chronic PACG group showed abnormal and diffusivity parameters could be used markers of axonal and myelin injury in glaucoma.

Mechanism and Etiology of Primary Chronic Angle Closure Glaucoma

The ocular anatomic features, pupil-blocking force, status of angle synechiae closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary a-cute angle closure glaucoma (PAACG) by using ultrasonic biometry, computerized anterior ocular segment image processing technique, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG was shallower than that of PCACG; the pupil-blocking force of PAACG was st...

The association between matrix metalloprotease-9 gene polymorphisms and primary angle-closure glaucoma in a Chinese Han population

AIM:To examine the association between the single nucleotide polymorphisms (SNPs)of matrix metalloprotease-9 (MMP-9) gene and primary angleclosure glaucoma(PACG)in a Chinese Han population.METHODS:DNA samples were extracted from peripheral-blood mononuclear cells of 214 PACG patients and 224 healthy controls.Genotyping of rs3918249,rs3918254,rs17577 and rs3787268 in MMP-9was performed using polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP)analysis and the direct sequencing technique.The association between these genetic polymorphisms and risk of PACG was estimated by χ2 test.RESULTS:The distributions of rs3918249,rs3918254,rs17577 and rs3787268 genotypes among cases and healthy controls were compatible with that from HardyWeinberg equilibrium(HWE,P】0.05).The increased frequency of CC and CT genotypes of rs3918254 were observed in PACG patients compared to healthy controls[P=0.006,P corrected(Pcorr)=0.048].The haplotype analysis showed that the CCGG haplotype was nominal associated with PACG(P=0.015),however,the significant was lost when the Bonferroni correction was used(Pcorr=0.105).CONCLUSION:Our results revealed that rs3918254 in MMP-9 may be a susceptible locus to PACG in China,people with the CC and CT genotypes of rs3918254 are more susceptible to PACG.The susceptibility to PACG inChinese Han patients may be not influenced by SNPs rs3918249,rs3787268 and rs17577 in MMP-9.

Phacoemulsification versus combined phacotrabeculectomy in the treatment of primary angle-closure glaucoma with cataract: a Meta-analysis

AIM： To compare the efficacy and safety of phacoemulsification（Phaco） against combined phacotrabeculectomy（Phacotrabe） in primary angle-closure glaucoma（PACG） with coexisting cataract.·METHODS： By searching electronically the Pub Med,EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by Rev Man 5.0.· RESULTS： Five randomized controlled trials were selected and included in Meta-analysis with a total of468 patients（468 eyes） with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure（IOP） lowing effect [preoperative IOP： weighted mean difference（WMD）=0.58, 95% confidence intervals（95% CI,-0.53 to 1.69）, P =0.31; postoperative IOP： WMD =1.37,95% CI（0.45 to 2.28）, P =0.003], a lower number of antiglaucoma medications [risk ratio（RR）=0.05, 95% CI（0.02 to 0.18）, P 〈0.00001] needed postoperatively and less serious damage of optic nerve [RR =0.48, 95% CI（0.21 to 1.07）, P =0.07], but a higher risk of complications[odds ratio（OR）=0.04, 95% CI（0.01 to 0.16）, P 〈0.00001]compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity（BCVA） [WMD =-0.05, 95% CI（-0.14 to 0.05）, P =0.32] and loss of visual field [RR=1.06, 95% CI（0.61 to1.83）, P =0.83].·CONCLUSION： Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the securitydecline. Considering the number of sample size, our results remains to be further studied.

The safety and efficacy of modified minimally invasive trabeculectomy for the treatment of primary chronic angle-closure glaucoma

Background: Primary chronic angle-closure glaucoma(PCACG) is one of the main types of glaucoma in China. Trabeculectomy is the most commonly used glaucoma filtration surgery for glaucoma in the world. Conventional trabeculectomy is prone to anesthesia-related complications intraoperative and operationrelated complications postoperative in PCACG treatment. Modified minimally invasive trabeculectomy maybe can reduce the incidence of complications.Methods: We conducted a prospective case series study and performed modified fornix-based trabeculectomy in 27 patients(30 eyes) under topical anesthesia; we then observed intraoperative anesthesia and cooperation ef ect, intraoperative and postoperative complications, preoperative and postoperative visual acuity, intraocular pressure(IOP), visual field, and the use of ocular hypotensive drugs. The patients were followed up for at least 12 months.Results: All operations were completed successfully with no intraoperative complications. All 27 patients(30 eyes) were followed up for at least 12 months. No significant decrease in visual acuity was observed at days 1 or 7 and at months 1, 3, 6, and 12 after operation; however, a signii cant decrease in IOP was observed at days 1 and 7 and at months 1, 3, 6, and 12 after operation. Moreover, no significant progression in visual field mean defect was observed at month 12 after operation, and the number of ocular hypotensive drugs required was significantly reduced at months 6 and 12 after operation. By month 12 after operation, the overall success rate was 93.33%(28/30).Conclusions: Modii ed minimally invasive trabeculectomy is safe and ef ective for the treatment of PCACG.

Primary Chronic Angle-closure Glaucoma in Chinese——A Clinical Exploration of Its Pathogenesis And Natural Course

Fourty-three cases (86 eyes) of primary chronic angle-closure glaucoma were randomly selected. An additional 44 cases (77 eyes) of primary acute angle-closure glaucoma and 30 normal subjects (34 eyes) were also randomly enrolled as control groups for comparison in the clinical study. Ultrasonic biometric measurements of the anterior chamber depth, lens thickness and axial length of the eyeball were performed. Using an potic microgauge attached to the slit-lamp, the entrance of anterior chamber angle was...

Increased aquaporin-1 levels in lens epithelial cells with primary angle-closure glaucoma

AIM： To determine the levels of aquaporin-1（AQP-1） in the lens epithelial cells（LECs） of primary glaucoma and to clarify its correlation with lens thickness.METHODS： This study comprised 64 eyes of 64 patients with primary glaucoma, who were divided into 3 groups： 25 eyes of 25 patients with acute primary angle-closure glaucoma（APACG）, 19 eyes of 19 patients with chronic primary angle-closure glaucoma（CPACG） and 20 eyes of 20 patients with primary open angle glaucoma（POAG）. This study also included 12 eyes of 12 patients with senile cataract as controls. The levels of AQP-1 in LECs were examined by real-time quantitative polymerase chain reaction（RT-q PCR） and immunohistochemistry. The lens thickness was measured by A-scan ultrasonography. RESULTS： The AQP-1 m RNA levels of LECs were 0.84±0.27, 0.69±0.34, 0.44±0.19 and 0.51±0.21 in APACG, CPACG, POAG and senile cataract group, respectively. The levels of AQP-1m RNA were significantly higher in PACG groups compared with those in senile cataract and POAG group（all P〈0.05）. The immunohistochemistry showed the AQP-1 expression were strong-positive in PACG groups, but weak-positive in senile cataract and POAG group. A positive correlation was found between AQP-1 m RNA levels and the lens thickness（r=0.645, P〈0.001）. CONCLUSION： These findings show that the higher expression of AQP-1 in LECs may contribute to increased lens thickness, which might be associated with the occurrence and development of PACG.

Evaluating correlation between the ocular biometry and genetic variants of MYOC and ABCA1 with primary angleclosure glaucoma in a cohort from northern China

AIM: To investigate whether the gene variants in MYOC and ABCA1 are associated with primary angle-closure glaucoma(PACG) and anterior chamber depth(ACD) and axial length(AL) in samples from northern China. METHODS: The present case-control association study consisted of 500 PACG patients and 720 unrelated controls. Each participant was genotyped for eleven single nucleotide polymorphisms(SNPs) in MYOC and ABCA1 genes(rs12076134, rs183532, rs235875 and rs235913 in MYOC, rs2422493, rs2487042, rs2472496, rs2472493, rs2487032, rs2472459 and rs2472519 near ABCA1) using an improved multiplex ligation detection reaction(iMLDR) technique. The genetic association analyses were performed by PLINK using a logistic regression model. The association between genotypes and ocular biometric parameters was performed by SPSS using generalized estimation equation. Bonferroni corrections wereimplemented and the statistical power was calculated by the Power and Sample Size Calculation. RESULTS: Two SNPs rs183532 and rs235875 as well as a haplotype TTC in MYOC were nominally associated with PACG despite the significance was lost after Bonferroni correction. No association was observed between ABCA1 and PACG, neither did the association between these variants and ACD as well as AL. CONCLUSION: The present study suggests MYOC and ABCA1 do not play a part in the pathogenesis of PACG as well as the regulation of ocular biometric parameters in a northern Chinese population. Further investigations with large sample size are needed to verify this consequence.

The effect of lens parameters on the development of the primary angle-closure glaucoma

Objective ：To investigate the role the lens dimensions played on the pathogenesis of primary angle-closure glaucoma. Methods：38 eyes of 20 patients with primary angle-closure glaucoma （PACG） and 35 eyes of 22 normal individuals without ocular abnormalities were examined. The anatomical parameters of the lens and other structures of the anterior segment were calculated using B ultrasound, computer image processing and ultrasound biomicroscopy （UBM）. The parameters were compared between the patients and normal subjects. Correlation analysis was used to determine the relationship between the radii of curvature of the anterior lens surface （RCALS） and the other parameters of the anterior segment. Results：Compared with the normal eyes, the eyes of PACG had thicker lens, steeper curvature of anterior lens surface, decreased depth of the anterior chamber, narrower chamber angle, and more anterior position of the ciliary bodies and lens. All these differences were significant（P 〈 0.05 or P 〈 0.01）. In the PACG group, the RCALS had significantly negative correlation with the central and peripheral lens thickness （P 〈 0.01 and P 〈 0.05 respectively）, and had positive correlation with relative lens position, anterior chamber depth（ACD）, angle-open distance at 500 um（AOD500）, trabecular iris angle （TIA） and trabecular ciliary processes distance（TCPD, P 〈 0.05 or P 〈 0.01 ）. Conclusion：The occurrence of PACG is relevant to the abnormal anatomical structures of the anterior segment. Among all factors, the lens parameters play an important role in the pathogenesis. Increased lens thickness, relative more anterior position of lens, especially steepened curvature of anterior lens surface are predisposing factors of the pathologic phenomenon in PACG including pupillary blockage, shallow anterior chamber, secondary closure of chamber angle and elevation of intraocular pressure.

Refractive errors and biometry of primary angle-closure disease in a mixed Malaysian population

AIM： To assess the refractive status, anterior chamber depth （ACD） and axial length （AL） of patients with primary angle-closure disease （PACD）. METHODS： Retrospective cohort. Data was collected from charts of all PACD patients treated from April 2013 to December 2015. Analysis was done on 137 patient charts with complete biometric data. Patient demographics, PACD type, refractive status （spherical equivalent）, ACD and AL were studied. RESULTS： The median age of 137 subjects [53 with primary angle-closure suspects （PACS）, 27 with primary angle- closure （PAC） and 57 with primary angle-closure glaucoma （PACG）] was 68y （range 21-88y）. The majority was Chinese （n=68; 49.6%） and most of them were women （n=75; 54.7%）. The distribution of myopia （n=51; 37.2%） and hyperopia （n=49; 35.8%） was similar. The ACD was shallower in myopes compared to hyperopes （P=-0.02） and emmetropia （P=-0.049） but the AL was not significantly different between groups. There were no patients blind from PACG. CONCLUSION： Both myopia and hyperopia can occur in PACD. Despite a shallower ACD in angle closure myopes, the AL was not different between groups.

Studies of Primary Angle Qosure Glaucoma in China

The resent researches on primary angle closure glaucoma (PACG) in China were reviewed. The prevalence of PACG (0.41%) in chinese is between the Caucasian and Eskimos, and chronic type is the dominant type in PACG. However, with the economic development and medical care improvements, the prevalence condition of PACG may change; several researches discovered that the mechanism of PACG, especially the chronic type, is not only because of pupil-blocking but also closely related to the mechanism of crowding of peripheral iris and the anterior location of the ciliary body. We supposed that PACG can be divided into several subtypes based on this machnism. Also, we believe that the use of ultrasound biomicroscopy (UBM) and ophthalmic laser in China has promoted the research of PACG and improved the level of prevention and treatment of PACG. Eye Science 1997; 13 : 120- 124.

Association between choroidal thickness and anterior chamber segment in eyes with narrow or open-angle

AIM: To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS: The subfoveal choroidal thickness was measured with enhanced depth -imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52 +/- 7.04y for narrow-angle subjects and 60.76 +/- 7.23y for open angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow -angle parameters. RESULTS: There were no differences in subfoveal choroidal thickness between open - and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 mu m from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the sclera! spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (beta=-0.496, P=0.016) only with anterior chamber depth in the open angle group and with age (beta=-0.442, P=0.003) and 11500 (beta=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. CONCLUSION: Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.

Comparison of combined phacotrabeculectomy with trabeculectomy only in the treatment of primary angle-closure glaucoma

Background Trabeculectomy has become a mainstream treatment in intraocular pressure （lOP） reduction for primary angle-closure glaucoma （PACG）; combined trabeculectomy and cataract surgery was reported to reduce lOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract. Methods This is a comparative case series study. Thirty-one patients （31 eyes） with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone, lOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final lOP less than 21 mmHg without lOP-lowering medication. Results After 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding lOP reduction （（20.59±7.94） vs. （24.85±14.39） mmHg, P=0.614）, complete success rate （88% vs. 71%, P=0.370）, formation rate of functioning blebs （65% （11/17） vs. 93% （13/14）, P=0.094）, and complications （41% （7/17） vs. 57% （8/14）, P=0.380）. lOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group. Conclusion Phacotrabeculectomy and trabeculectomy treatments exhibit similar lOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Decision-making Impairments in Primary Angle-closure Glaucoma Patients

Background： Primary angle-closure glaucoma （PACG） is a common eye disease and a common cause of blindness. Inappropriate medical decisions severely affect the prognosis. This study investigated decision-making under risk in PACG patients.Methods： Thirty patients with first acute attack of PACG before surgery and thirty healthy controls were included in the study. Decision-making under risk was evaluated with the game of dice task （GDT）. The results of Eysenck Personality Questionnaire （EPQ） and GDT between PACG patients and healthy controls were compared. Results： Risky decisions in PACG patients were more than those in healthy controls as measured by mean score ofGDT （ 12.47 ±5.72 vs. 4.33± 3.30, P 〈 0.001）. Higher neuroticism score in EPQ was found in PACG patients compared to healthy controls （14.97 ± 3.93 vs. 9.90 ± 4.49, P 〈 0.001 ）. Neuroticism scores in EPQ were associated with decision-making performance （r = 0.417, P = 0.001 ）. Conclusions： Neuroticism positively correlated with risky decisions. Decision-making might be influenced by neuroticism. Future studies will show whether therapy compliance will be improved by emotional management and psychological intervention in PACG patients.

Comparison of measurements of anterior chamber angle via anterior segment optical coherence tomography and ultrasound biomicroscopy

BACKGROUND Glaucoma is an irreversible optic neuropathy with the loss of visual field and decrease of vision.The variable clinical manifestations may result in differential diagnostic difficulties.The early screening and diagnosis of glaucoma are currently experiencing a demand for anterior segment analysis tools that can gather more information with one short measurement.Therefore,we analyzed the agreement,difference,and correlation of chamber angle parameters such as angel opening distance at 500μm(AOD500)and trabeculo-iris space area at 500μm^2(TISA500)measured by anterior segment optical coherence tomography(ASOCT)and ultrasound biomicroscopy(UBM).AIM To compare the differences,correlation,and agreement in measuring AOD500 and TISA500 by AS-OCT and UBM.METHODS Both AS-OCT and UBM were performed to measure AOD500 and TISA500 in 45 subjects(72 eyes).All subjects without glaucoma were collected from October 2015 to August 2016 at the Ophthalmology Department of the Fourth Affiliated Hospital of China Medical University.Data of the two groups(AOD500 and TISA500)were compared by nonparametric tests.Pearson correlative analysis and Bland-Altman analysis were used to compare the correlation and agreement.RESULTS There were no significant differences between AS-OCT and UBM in measuring AOD500(P1=0.110,P2=0.633,P3=0.078,and P4=0.474)and TISA500(P1=0.584,P2=0.889,P3=0.297,and P4=0.550)of the four quadrants of the anterior chamber angle.There was a high correlation in measuring AOD500(r1=0.562,r2=0.671,r3=0.635,and r4=0.720;P<0.001)and TISA500(r1=0.584,r2=0.889,r3=0.297,and r4=0.550;P<0.001).There was a good agreement in measuring AOD500 and TISA500 by the two modalities.CONCLUSION There is a high correlation and agreement between AOD500 and TISA500 measurements by AS-OCT and UBM.They are interchangeable under some circumstances.AS-OCT proves to be a better early screening tool for glaucoma.

Bilateral simultaneous primary acute angle-closure glaucoma

Dear Editor,Acute primary angle-closure glaucoma(PACG)is an important cause of blindness in East Asia.1 It is estimated that the overall prevalence of PACG will increase from 1.44%to 2.01%from 2020 to 2050.2 Acute PACG is typically related to increased high intraocular pressure(IOP),with symptoms including red eye,blurred vision,nausea,vomiting,and headache.Delay in timely IOPlowering treatment can result in permanent optic nerve damage and vision loss.

超声乳化吸除术联合房角分离术治疗PACG滤过术后眼压失控的临床疗效观察

目的探讨超声乳化吸除术(Phaco)+人工晶状体(IOL)植入联合房角分离术治疗原发性闭角型青光眼(PACG)滤过术后眼压失控的临床疗效。方法回顾性病例研究。对2020年8月至2022年5月收治的24例(25只眼)PACG滤过术后眼压失控患者,采用Phaco+IOL植入联合房角分离术治疗,比较术前、术后1 d、1周、1个月、3个月、6个月的眼压情况,术前及6个月最佳矫正视力(BCVA)、房角粘连性关闭(PAS)范围变化情况。记录术中、术后并发症情况。结果术后1 d、1周、1个月、3个月、6个月眼压、PAS范围均显著低于术前,差异具有统计学意义(均P<0.05);术后6个月视力较术前21例(22只眼)BCVA提高,3例(3只眼)BCVA无变化;术中10只眼发生前房出血,术后6只眼发生短暂性前房出血,15只眼发生前房渗出,8只眼发生角膜水肿。结论Phaco+IOL植入联合房角分离术治疗PACG滤过术后眼压失控能够有效降低眼压,提高患者视力,是安全有效的治疗方法。

噻吗洛尔滴眼液在急性房角关闭危象序贯治疗中的疗效

目的观察噻吗洛尔滴眼液在急性房角关闭危象序贯治疗中的疗效。方法前瞻性随机双盲病例对照研究。连续纳入2021年4月至2023年10月河北大学附属医院诊断为急性房角关闭危象(acute angle-closure crisis,AACC)的患者,收集其病例资料并以随机数字表法分为应用噻吗洛尔组(A组)与安慰剂组(B组)。所有患者序贯应用药物治疗、前房穿刺、激光周边虹膜成形术,以治疗后2 h、4 h、6 h为治疗节点,记录并统计在各个节点2组患者的眼压下降值、AACC得到控制的眼数及所需时间。结果在序贯治疗后2 h、4 h、6 h的3个节点,A组的眼压下降值分别为(13.87±13.85)mmHg(1 mmHg=0.133 kPa)、(28.42±12.87)mmHg、(35.69±8.51)mmHg,AACC得到控制的眼数分别为23眼(29.87%)、51眼(66.23%)、71眼(92.20%);B组的眼压下降值分别为(15.88±14.95)mmHg、(28.17±13.63)mmHg、(33.90±13.59)mmHg,AACC得到控制的眼数分别为30眼(36.59%)、58眼(70.73%)、75眼(91.46%);治疗有效的患者中,AACC控制的时间A组为(3.29±1.31)h,B组为(3.38±1.34)h。2组患者在序贯治疗各个节点的眼压下降值、AACC缓解的眼数及病情缓解所需时间差异均无统计学意义(P>0.05)。结论在AACC的序贯治疗过程中,噻吗洛尔滴眼液对于提高治疗成功率无明显帮助。

Efficacy of laser peripheral iridoplasty and iridotomy on medically refractory patients with acute primary angle closure： a three year outcome

Background Argon laser peripheral iridoplasty （ALPI） is proved to be effective in lowering intraocular pressure （lOP） of patients with mild acute primary angle closure （APAC）. It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed peripheral iridotomy （LPI） on patients with refractory APAC, therapy. to evaluate the IOP-lowering efficacy of ALPI and laser who have previously responded poorly to intensive medical Methods Thirty-six patients （8 men and 28 women） were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber （AC） angle, and lOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity （VA）, best corrected VA （BCVA）, lOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes. Results All patients were affected unilaterally, with average age of （54.6±11.7） （range, 37.0-75.0） years old. The mean lOP value of the affected eyes dropped from （31.6±7.7） （range, 21.0-39.0） mmHg at enrollment to （18.4±8.7） （range, 10.0-27.0） mmHg 2 hours after ALPI. At follow-up day 7, the mean lOP value maintained at （14.8±4.2） （range, 9.0-21.0） mmHg, which was significantly different （P=0.000） compared with baseline. The average decrease of lOP in the APAC eyes was （16.8±7.4） （range, 12.0-21.0） mmHg. At follow-up three years later, the mean lOP of the APAC eyes stabilized at （16.3±3.2） （range, 9.0-20.0） mmHg with at least 180° of AC angle opened. Conclusion ALPI and LPI lower the lOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.