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

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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. 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)

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