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

Abstract: 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 data, PAS extent, IOP, BCVA, MD decreased significantly in the combined group, and cup-to-disk ratio remained unchanged; PAS extent, IOP, MD deceased significantly in the LPI group, but cup-to-disk ratio and BCVA unchanged. Conclusion PAS extent progression was seen in combined group within 5 years after treatment. Five years after the treatment of PAC or PACG patients with PAS, no significant difference was observed in PAS extent between combined laser group and LPI group. Laser peripheral iridoplasty combined with LPI should not be recommended to release PAS in PACG patients in consideration of the long-term efficacy. (Ophthalmol CHN, 2013, 22: 14-18)   

Key words: primary angle closure glaucoma, laser peripheral iridotomy, laser peripheral iridoplasty, random controlled clinical trial