原发性急性闭角型青光眼首选LPI治疗的五年疗效及与其PAS范围的关系

doi:10.13281/j.cnki.issn.1004-4469.2021.01.003

眼科 ›› 2021, Vol. 30 ›› Issue (1): 11-19.doi: 10.13281/j.cnki.issn.1004-4469.2021.01.003

原发性急性闭角型青光眼首选LPI治疗的五年疗效及与其PAS范围的关系

李思珍1 郭春雨2 梁远波3 范肃洁4 蔡啸谷5 孙霞5 郭黎霞4 孙兰萍4 Sucijanti6 韩伟4 王宁利5

1东南大学附属南京同仁医院 210006；2 University of Michigan School of Public Health，USA 48109；3温州医科大学附属眼视光医院 325027；4河北省邯郸市眼科医院 056005；5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研究所 100730；6南京医科大学 211166

出版日期:2021-01-22 发布日期:2021-01-21
基金资助:
“十一五”国家科技支撑计划课题（2007BAI18B00）；卫生部卫生行业科研专项（201002019）

Five years’ results of LPI on acute primary angle closure glaucoma and PAS extent influence evaluation

Li Sizhen1, Guo Chunyu2, Liang Yuanbo3, Fan Sujie4, Cai Xiaogu5, Sun Xia5, Guo Lixia4, Sun Lanping4, SUCIJANTI6, Han Wei4, Wang Ningli5

1 Nanjing Tongren Hospital, Nanjing, 210006, China; 2 University of Michigan School of Public Health, Michigan, 48109, USA; 3 The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, 325027, China; 4 Handan Eye Hospital, Handan, 056005, China; 5 Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital University of Medical Science, Beijing 100730, China; 6 Nanjing Medical University, Nanjing 211166, China.

Online:2021-01-22 Published:2021-01-21
Supported by:
National Science and technology support program of the 11th Five Year Plan (2007bai18b00); Ministry of Health's Health Industry Research Project (201002019)

摘要/Abstract

摘要： 目的研究原发性急性闭角型青光眼（acute primary angle closure glaucoma，APACG）首选激光虹膜周边切开术（laser peripheral iridectomy，LPI）治疗后5年的眼压控制情况以及周边虹膜前粘连（peripheral anterior synechia，PAS）范围对眼压控制率的影响。设计前瞻性队列研究。研究对象 2004年10月至2006年10月邯郸眼科医院年龄40岁以上APACG急性发作并接受循序性治疗模式者182例。方法患者首先采用LPI，眼压控制≤21 mmHg者随访观察，>21 mmHg者增加局部降眼压药物治疗，用药后眼压控制良好者继续观察随访，不能控制者行小梁切除术治疗。所有患者均随访5年。主要指标眼压、PAS范围。结果随访5年的124例APACG患者年龄（68.3±7.3）岁、女性105例（84.7%）。治疗后5年总体眼压控制（≤21 mmHg）率90.3%（112/124），LPI眼压控制率68.5%（85/124），LPI联合药物眼压控制率81.4%（101/124）；小梁切除手术率12.1%（15/124）。按PAS范围（钟点数）分为0、1~3、4~6、7~9、10~12五组，LPI眼压控制率依次为92.6%、74.3%、84.2%、56.3%、40.0%；LPI联合药物眼压控制率依次为96.3%、91.4%、89.5%、68.8%、55%；小梁切除手术率依次为0%、5.7%、5.3%、18.8%、35%。PAS范围≤6个钟点组LPI眼压控制率和LPI联合药物眼压控制率为82.72%（67/81）、92.59%（75/81）显著高于PAS范围>6个钟点组47.22%（17/36）、61.11%（22/36）（P<0.001）。PAS范围>6个钟点组小梁切除手术率27.7%（10/36）显著高于PAS≤6个钟点组3.7%（3/81）（P<0.001）。结论 APACG治疗的5年结果显示首选LPI的治疗模式总体成功率可达90.3%。 LPI眼压控制率和LPI联合药物眼压控制率随PAS范围的增加而降低，小梁切除手术率则逐渐升高。APACG滤过手术以6个钟点为界，具有临床指导意义，但会导致较高的滤过手术率。（眼科，2021，30：11-19）

关键词: 急性原发性闭角型青光眼, 激光虹膜周边切除术, 虹膜周边前粘连

Abstract: Objective To investigate the intraocular pressure(IOP) control rate and the influence of peripheral anterior synechia (PAS) extent on acute primary angle closure glaucoma (APACG) patients receiving laser peripheral iridotomy (LPI) 5 years before. Design Prospective cohort study. Participants Consecutive 182 cases of APACG patients with acute attack from 10/2005 to 10/2006 in Handan Eye Hospital were recruited and received “Sequential Treatment, ST”. Methods Laser peripheral iridotomy (LPI) were firstly used after initial treatment of onset of APACG. The APACGs whose IOP≤21 mmHg after LPI were followed up and those IOP>21 mmHg were treated with topical anti-glaucoma drugs. If the IOPs were remaining beyond 21 mmHg with the additional drugs, trabeculectomy would be performed to decrease the IOPs. All patients would be followed up for five years. Main outcome Measures IOP and PAS extent. Results 124 APACG patients with age 68.3±7.3 years and female 105 cases (84.7%) were finished 5 years follow up. Total IOP control rate (≤21 mmHg) was 90.3 %( 112/124). IOP control rate of LPI was 68.5 %( 85/124). IOP control rate of LPI combined drugs was 81.4 %( 101/24). Rate of trabeculectomy was 12.1%(15/124). IOP control rate of LPI in five groups PAS 0, PAS 1-3, PAS 4-6, PAS 7-9, PAS 10-12 was 92.6%, 74.3%, 84.2%, 56.3%, 40.0% respectively, and IOP control rate of LPI combined drugs in groups was 96.3%, 91.4%, 89.5%, 68.8%, 55% respectively. Trabeculectomy rate of those groups was 0%, 5.7%, 5.3%, 18.8%, 35% respectively. As the PAS extent increased, the IOP control rates of LPI or LPI combining drugs decreased but trabeculectomy rates increased. The IOP control rate of LPI or LPI combining drugs in PAS≤6 o’clock (180 degree) group was 82.72% (67/81), 92.59%(75/81) higher than those 47.22%(17/36), 61.11% (22/36) in PAS>6 o’clock group (P<0.001). Trabeculectomy rates of PAS≤6 o’clock group (3.7%) was lower than PAS >6 o’clock group (27.7%) (P<0.001). Conclusions Sequential treatment has a high total IOP control rate ( 90.3%) for APACG. As the PAS extent increased, the IOP control rate of LPI and LPI combining drugs decreased, however the filtration rate increased. If APACG in PAS>6 o’clock group received filtration surgeries based on Chinese PACG treatment guideline, that would lead to a higher filtration surgical rate. (Ophthalmol CHN, 2021, 30: 11-19)

Key words: acute primary angle closure glaucoma, laser peripheral iridotomy, peripheral anterior synechia

李思珍郭春雨梁远波范肃洁蔡啸谷孙霞郭黎霞孙兰萍 Sucijanti 韩伟王宁利. 原发性急性闭角型青光眼首选LPI治疗的五年疗效及与其PAS范围的关系[J]. 眼科, 2021, 30(1): 11-19.

Li Sizhen, Guo Chunyu, Liang Yuanbo, Fan Sujie, Cai Xiaogu, Sun Xia, Guo Lixia, Sun Lanping, SUCIJANTI, Han Wei, Wang Ningli . Five years’ results of LPI on acute primary angle closure glaucoma and PAS extent influence evaluation[J]. Ophthalmology in China, 2021, 30(1): 11-19.

[1]	李思珍梁远波王宁利孙霞范肃洁孙兰萍刘文茹 SUCIJANTI . 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[J]. 眼科, 2019, 28(1): 23-28.
[2]	王洪涛, 王宁利, 李树宁, 牟大鹏. 临床前期急性闭角型青光眼眼前部巩膜厚度测量[J]. 眼科, 2013, 22(4): 249-252.

原发性急性闭角型青光眼首选LPI治疗的五年疗效及与其PAS范围的关系

Five years’ results of LPI on acute primary angle closure glaucoma and PAS extent influence evaluation

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