目的:本研究旨在评估激光周边虹膜切开术(LPI)预防14年后原发性房角闭合可疑(PACS)患者的疗效,并确定从PACS转换为原发性房角闭合(PAC)的危险因素。
方法:中山角封闭预防研究的扩展随访。
方法:八百八十九名50至70岁的中国患者患有双侧PACS。
方法:每位患者随机选择1只眼睛接受LPI,用未经处理的眼睛作为对照。因为青光眼的风险很低,急性闭角型(AAC)很少发生,尽管在6年访视后报告了LPI的显著获益,但随访时间延长至14年.
方法:PAC的发生率,包括外周前粘连的复合终点,眼内压(IOP)>24mmHg,或AAC。
结果:在14年间,390只LPI治疗的眼睛和388只对照眼睛失去随访。共有33只LPI治疗的眼和105只对照眼达到主要终点(P<0.01)。在他们体内,1只LPI处理的眼睛和5只对照眼睛进展到AAC。在2只LPI治疗的眼睛和4只对照眼睛中发现了原发性闭角型青光眼。进展为PAC的风险比为0.31(95%置信区间,与对照眼相比,LPI治疗的眼睛为0.21-0.46)。在14年的访问中,LPI治疗的眼睛显示更严重的核性白内障,更高的IOP,和更大的角宽度和角膜缘前房深度(LACD)比对照眼。更高的IOP,较浅的LACD,和较大的中央前房深度(CACD)与对照眼终点发展风险增加相关.在治疗组中,眼压较高的眼睛,较浅的LACD,暗室易感刺激试验(DRPPT)后IOP升高或更低,更有可能在LPI后显示PAC。
结论:尽管LPI后PAC发生率减少了三分之二,在14年以上的社区PACS人群中,累积进展风险相对较低.除了IOP,DRPPT后IOP升高,CACD,和LACD,需要更多的危险因素来实现PAC发生的精确预测和指导临床实践。
背景:作者对本文讨论的任何材料都没有专有或商业利益。
This
study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC).
Extended follow-up of the Zhongshan Angle-Closure Prevention
Study.
Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS.
Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit.
Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC.
During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI.
Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.