激光瞳孔成形术与激光周边虹膜成形术治疗急性原发性前房角关闭的临床研究

目的比较激光周边虹膜成形术(LPIP)和(或)激光瞳孔成形术(LPP)对急性原发性前房角关闭(APAC)的临床效果。 方法回顾性分析2020年1月至2020年12月于邯郸市眼科医院(邯郸市第三医院)行LPIP和(或LPP)治疗的APAC患者81例(81只眼)。其中，男性15例(15只眼)，女性66例(66只眼)；年龄41~94岁，平均年龄(66.7±10.6)岁。按照激光治疗的方式分为联合组和LPIP组。联合组患者先后给予LPIP和LPP；LPIP组只行LPIP。以术后眼压≤30 mmHg(1 mmHg＝0.133 kPa)为治疗初步有效。年龄和眼压经单样本Kolmogorov-Smirnov检验，符合正态分布，以±s表示，组间比较采用独立样本t检验；视力、疾病发作持续时间及既往发作次数不符合正态分布，以中位数和四分位数表示，将Snellen视力换算成logMAR视力以便于统计学处理，组间比较采用Mann-Whitney U秩和检验。激光治疗的初步有效率和性别以例数和百分比表示，组间比较采用χ²检验。两组患者术前、术后1 h及术后2 h视力和眼压的比较采用单因素方差分析。两组患者术前与术后2 h眼压变化幅度的影响因素采用广义线性回归模型分析。 结果联合组患者42例(42只眼)。其中，男性6例(6只眼)，女性36例(36只眼)。LPIP组患者39例(39只眼)。其中，男性9例(9只眼)，女性30例(30只眼)。两组患者性别比较的差异无统计学意义(χ²＝1.04，P>0.05)。联合组和LPIP组患者术前眼压分别为(50.95±7.22)mmHg和(48.08±8.05)mmHg。两组患者术前眼压比较的差异无统计学意义(t＝1.69，P>0.05)。两组患者术前logMAR视力分别为1.70(0.68，2.00)和1.70(0.90，2.00)；发作持续时间分别为16.0(12.0，39.0)h和24.0(15.0，48.0)h；既往发作次数分别为0(0，3.5)次和0(0，1.0)次。经Mann-Whitney U秩和检验，术前两组患者视力、发作持续时间及既往发作次数比较的差异均无统计学意义(Z＝-0.51，-0.99，-1.30；P>0.05)。联合组患者术后1 h和术后2 h的logMAR视力分别为0.50(0.20，0.80)和0.35(0.10，0.93)；LPIP组术后1 h和术后2 h的logMAR视力分别为0.90(0.40，1.90)和0.90(0.40，1.90)。两组患者术后1 h和术后2 h的视力均提高。两组术后1 h和术后2 h患者视力比较的差异均有统计学意义(Z＝-2.16，-2.42；P<0.05)。联合组术后1 h和术后2 h患者的眼压分别为(30.83±13.49)mmHg和20.0(14.0，35.5)mmHg；LPIP组术后1 h和术后2 h患者的眼压分别为(34.79±1.70)mmHg和38.0(15.0，45.0)mmHg。两组患者术后1 h比较的差异无统计学意义(Z＝-1.31，P>0.05)；术后2 h比较的差异有统计学意义(Z＝-2.14，P<0.05)。联合组与LPIP组术后1 h的初步有效率分别为52.4%和35.9%，比较的差异无统计学意义(χ²＝2.23，P>0.05)；术后2 h初步有效率分别为71.4%和41.0%，比较的差异有统计学意义(χ²＝7.62，P<0.05)。经广义线性回归模型分析，APAC患者眼压变化幅度与术前眼压呈正相关，其相关性有统计学意义(β＝0.392，P<0.05)；与组别、年龄及发作持续时间呈负相关，其相关性有统计学意义(β＝-9.157，-0.432，-0.115；P<0.05)。 结论LPIP和LPP联合治疗APAC患者，能通过解除瞳孔阻滞和周边前房角开放，快速降低眼压，是一种有效的APAC治疗手段，值得临床推广。

Comparisons of laser peripheral iridoplasty and laser pupilloplasty in the treatment of acute primary angle closure patients

ObjectiveThe aim of this study was to compare the clinic effect of laser peripheral iridoplasty (LPIP) and (or) laser pupilloplasty (LPP) on acute primary angle closure (APAC) patients. Methods81 cases (81 eyes) of APAC patients treated with LPIP and (or) LPP from January 2020 to December 2020 were analyzed retrospectively. There were 15 males (15 eyes) and 66 females (66 eyes) with the average age of (66.7±10.6 )years (ranged from 41 to 94 years-old). According to the method of laser treatment, they were divided into combined group and LPIP group. Patients in combined group were given LPIP and LPP successively; LPIP group only were treated by LPIP. The treatment with intraocular pressure (IOP)≤30 mmHg (1 mmHg=0.133 kPa) after laser treatment was defined as initial effective. The changes of IOP and visual acuity before and after laser treatment were compared. Age and IOP accorded with normal distribution by single sample Kolmogorov-Smirnov test, expressed as ±s, independent sample t-test was used for inter-group comparison. Visual acuity, duration of disease attack and number of previous attacks did not conform to the normal distribution, which were expressed in the median (quartile). Snellen visual acuity was represented as logMAR for statistical analysis. Mann-Whitney U rank sum test was used for comparison between groups. The initial effective rate and gender were expressed in the number and percentage, and χ² test was used for comparison between groups. The visual acuity and IOP of two groups before and after laser treatment for 1 h and 2 h were compared by one-way ANOVA. The influencing factors of IOP before and after laser treatment for 2 h were analyzed by generalized linear regression model. ResultsIn the combined group, there were 42 cases (42 eyes), 6 males (6 eyes) and 36 females (36 eyes). In the LPIP group, there were 39 cases (39 eyes), 9 males (9 eyes) and 30 females(30 eyes). There was not a significant difference in gender between two groups (χ²=1.04, P>0.05). Preoperative IOP of patients in combined group and LPIP group were (50.95±7.22)mmHg and (48.08±8.05)mmHg. There was not a significant difference in preoperative IOP between two groups (t=1.69, P>0.05). The preoperative visual acuity of two groups were 1.70 (0.68, 2.00) and 1.70 (0.90, 2.00); the duration of attack were 16.0 (12.0, 39.0)h and 24.0 (15.0, 48.0)h; the previous attack times were 0 (0, 3.5) times and 0 (0, 1.0) times. There were not a significant difference in visual acuity, attack duration and previous attack times between two groups before operation by Mann-Whitney U rank sum test (Z=-0.51, -0.99, -1.30; P>0.05). The logMAR visual acuity of patients in the combined group at 1 h and 2 h after laser treatment were 0.50 (0.20, 0.80) and 0.35 (0.10, 0.93); the logMAR visual acuity of patients in LPIP group after laser treatment for 1 h and 2 h were 0.90 (0.40, 1.90) and 0.90 (0.40, 1.90). The logMAR visual acuity of patients in two groups decreased after laser treatment for 1 h and 2 h. There were significant differences between two groups after laser treatment for 1 h and 2 h (Z=-2.16, -2.42; P<0.05). The IOP of combined group after laser treatment for 1 h and 2 h were (30.83±13.49) mmHg and 20.0 (14.0, 35.5) mmHg; IOP of patients in LPIP group after laser treatment for 1 h and 2 h were (34.79±1.70)mmHg and 38.0 (15.0, 45.0)mmHg.There was not a significant difference between two groups after laser treatment for 1 h (Z=-1.31, P>0.05); the difference was statistically significant after treatment for 2 h (Z=-2.14, P<0.05). The initial effective rates of combined group and LPIP group after laser treatment for 1 h were 52.4% and 35.9%, respectively; there was not a significant difference between two groups (χ²=2.23, P>0.05). After laser treatment for 2 h, the initial effective rates of two groups were 71.4% and 41.0%, respectively; the difference between two groups was statistically significant (χ²=7.62, P<0.05). The analysis of generalized linear regression model showed that changes of IOP in APAC patients were positively correlated with preoperative IOP with a significant difference between them (β=0.392, P<0.05), and negatively correlated with group, age and attack time with significant differences between them (β=-9.157, -0.432, -0.115; P<0.05). ConclusionsThe combination of LPIP and LPP can quickly reduce IOP of APAC patients by relieving pupil block and broadening the peripheral angle, which is an effective treatment of APAC and deserves clinical promotion.