激光周边虹膜切开术及其联合周边虹膜成形术对粘连性房角关闭的疗效对比:5年随访研究  

Comparison between the efficacy of laser peripheral iridotomy with and without laser peripheral iridoplasty in synechial angle closure: a 5-year follow-up study

作　　者：郭春雨[1] 李思珍[2] 蔡啸谷[1] 郭黎霞[3] 范肃洁[3] 崔宏宇[3] 张志宏[3] 张青[1] 孙兰萍[3] 孙霞[1] 梁远波[4] 王宁利[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]南京爱尔眼科医院,210006 [3]河北省邯郸市第三医院眼科,056001 [4]香港中文大学眼科与视觉科学学系

出　　处：《眼科》2013年第1期14-18,共5页Ophthalmology in China

基　　金：卫生公益性行业科研专项经费项目(201002019)

摘　　要：目的 比较单纯激光周边虹膜切开术（laser peripheral iridotomy，LPI）与LPI联合激光周边虹膜成形术治疗存在粘连性房角关闭的原发性房角关闭（primary angle closure，PAC）或原发性闭角型青光眼（primary angle closure glaucoma，PACG）患者术后5年周边虹膜前粘连（peripheral anterior synechiae，PAS）的变化情况。设计 随机对照临床试验。研究对象 河北省邯郸市第三医院眼科连续收治的存在PAS的PAC和PACG患者159例。方法 患者随机分为试验组和对照组。试验组LPI术后3天内加行激光周边虹膜成形术，对照组仅行LPI。术前、术后3天、1年及5年进行静态及动态前房角镜检查。PAS定义为虹膜与前房角外壁的粘连＆ge;0.5个钟点。每例患者仅1眼入组。主要指标 PAS范围。结果 159例患者中术后1年及5年的随访率分别为79.25%（126/159）及57.86%（92/159）。试验组及对照组术前、术后3天、1年及5年的PAS范围分别为5.00（3.00~9.25）及4.5（1.50~8.00）个钟点（Z=-1.3，P=0.19）、3.00（0.50~5.00）及2.00（1.50~8.00）个钟点（Z=-3.08，P〈0.001）、2.50（0.75~6.00）及2.00（0.00~5.00）个钟点（Z=-0.72，P=0.47）、3.5（1.0~8.0）及3.0（0.00~5.25）个钟点（Z=-1.54，P=0.12）。两组之间PAS范围在术后3天有显著差异，而术后1年及5年差异并不显著。术后5年，试验组及对照组最佳矫正视力（BCVA）分别为0.29（0.14~0.82）、0.16（0.02~0.36）（Z=-2.70，P=0.007），眼压控制率、视野MD值、杯盘比等均无统计学差异。术后5年与术前相比，试验组PAS范围、眼压、BCVA、MD值均有明显下降，而杯盘比无明显变化；对照组PAS范围、眼压、MD值均有明显下降，杯盘比及BCVA无明显变化。结论 LPI联合激光周边虹膜成形术治疗存在PAS的PAC或PACG患者，术后PAS仍进展；术后5年时，PAS范围与接受单纯LPI的患者相比无显著差异。从长远看，激光周边虹膜成形术�Objective To compare the long-term efficacy of laser peripheral iridotomy （LPI） with and without laser peripheral iridoplasty in primary angle closure （PAC） or primary angle closure glaucoma （PACG） patients with peripheral anterior synechiae （PAS）. Design Randomized controlled clinical trial. Participants Consecutively included PAC or PACG patients with PAS in Handan Third Hospital, Handan, Hebei. Methods Patients randomly received LPI or LPI combined with laser peripheral iridoplasty which was conducted within 3 days after LPI. Patients underwent static and dynamic gonioscopy preoperatively and 3 days, 1 year and 5 years after laser procedures. PAS was defined as abnormal adhesions of the iris to the angle that are at least half a clock hour in width. Only one eye in each patient was included in the study. Main Outcome Measures PAS extent. Results Among the initially included 159 patients, recruiting rate 1 year and 5 years after the laser therapy was 79.25% （126/159） and 57.86% （92/159）, respectively. PAS extent of the combined group and LPI group preoperatively and 3 days, 1 year and 5 years after the laser procedure were 5.00 （3.00-9.25） and 4.5 （1.50-8.00） clock hours （Z=-1.3, P=0.19） , 3.00 （0.50-5.00） and 2.00 （1.50-8.00） clock hours （Z=-3.08, P=0.001）, 2.50 （0.75-6.00） and 2.00 （0.00-5.00） clock hours （Z=-0.72, P=0.47）, 3.5 （1.0-8.0） and 3.0 （0.00-5.25） clock hours （Z=-1.54, P=0.12）. PAS extent was significantly less in the combined group 3 days after the treatment, while no difference was observed between groups 1 or 5 years after the treatment. Five years after the initial treatment, best corrected visual acuity （BCVA） in the combined group was significantly lower than that in LPI group 0.29 （0.14-0.82） Vs 0.16 （0.02-0.36） （Z=-2.70, P=0.007）. No difference was observed between groups in intraocular pressure （IOP） control rate, visual field mean deviation （MD）, cup-to-disk ratio. Compared with the baseline dat

关 键 词：原发性闭角型青光眼 激光周边虹膜切开术 激光周边虹膜成形术 随机对照临床试验 

分 类 号：R779.63[医药卫生—眼科]