Management of acute primary angle-closure glaucoma: a long-term follow-up of the results of peripheral iridectomy used as an initial procedure.

For the past 12 years peripheral iridectomy has been used as the initial surgical procedure after an acute attack of angle-closure glaucoma. The operation has been performed 2 to 5 days after the pressure has been controlled medically and has been followed routinely by prophylactic peripheral iridectomy in the fellow eye. Peripheral iridectomy for primary acute angle-closure glaucoma controlled the condition without any need for further medical or surgical therapy in 72% of cases. Careful and frequent follow-up within the first 4 postoperative months is essential to prevent further field loss, which can occur very rapidly if the pressure is not adequately controlled. If the pressure remains uncontrolled, further surgery should not be delayed. It was impossible to decide which patients would eventually need trabeculectomy when they first attended in the acute attack. Peripheral iridectomy as a prophylactic procedure was entirely effective in preventing an acute angle-closure attack in the fellow eye.     

The long-term effects of iridectomy for primary acute angle-closure glaucoma

Forty-nine eyes were treated with iridectomy for primary acute angle-closure glaucoma. Forty asymptomatic, normotensive fellow eyes were similarly treated. The duration of follow-up after surgery was 52.3 +/- 3.6 months. Thirty-seven (76%) of the eyes with acute attacks were cured by iridectomy alone and required no medical therapy. Twelve eyes (24%) developed increased intraocular pressure following iridectomy, but only one eye (2%) required filtering surgery. Eighty-eight percent of the asymptomatic, normotensive fellow eyes required no subsequent therapy, and none developed visual field defects. Visual acuity was unchanged in 22 of 49 (45%) of the acutely involved eyes and decreased more than six lines in 11 (22%) eyes. In the 40 fellow eyes, visual acuity was unchanged in 63% and decreased more than six lines in only one (2%) eye.     

Laser peripheral iridoplasty as initial treatment of acute attack of primary angle-closure: a long-term follow-up study

PURPOSE: To study the long-term clinical course and complications of patients with acute primary angle-closure treated with immediate laser peripheral iridoplasty followed by laser peripheral iridotomy. PATIENTS AND METHODS: Consecutive patients with acute primary angle closure treated with immediate laser peripheral iridoplasty, followed by laser peripheral iridotomy, at the Prince of Wales Hospital from July 1997 through January 2000 were followed up to document the clinical course of their disease and any complications from the laser treatment. Visual acuity, intraocular pressure, gonioscopic findings, corneal and lens clarity, iris appearance, pupillary reaction, and progression of glaucomatous optic neuropathy were evaluated. RESULTS: Thirty eyes of 29 Chinese patients with acute primary angle closure treated initially with either argon or diode laser peripheral iridoplasty were recruited. The mean follow-up period was 33.0 +/- 9.3 months. Twenty-one eyes (70%) had no further attack and maintained normal intraocular pressure without medications, and 9 eyes (30%) developed chronic angle-closure glaucoma with peripheral anterior synechiae. All eyes had pigmented laser marks on the peripheral iris, but none had peripheral corneal burn. CONCLUSIONS: Long-term follow-up data indicated that 30% of Chinese eyes with acute primary angle closure successfully treated with immediate laser peripheral iridoplasty followed by laser peripheral iridotomy developed peripheral anterior synechiae and an increase in intraocular pressure. There were minimal long-term complications on the cornea and the lens from the laser treatment.     

小梁切开联合虹膜根切术治疗原发性闭角型青光眼

目的 观察外路小梁切开术联合虹膜周边切除治疗原发性闭角型青光眼的疗效.方法 对31例(31眼)原发性闭角型青光眼行外路小梁切开及虹膜周边切除术.其中急性闭角型青光眼22例,慢性闭角型青光眼9例.术后1周,1、3、6个月观察患者眼压和房角情况.结果 术后1个月和3个月,不用降眼压药眼压≤21 mm Hg(1 mm Hg=0.133 kPa)者分别为29例和27例,完全成功率分别为93.5%和87.1%.19例(19眼)随访6个月,不用降眼压药眼压≤21 mm Hg者16例(84.2%).术后房角检查显示上方120°范围房角开放和小梁组织切开的裂隙.术后并发症:前房出血31眼,均自行吸收,后弹力层损伤6眼、虹膜根部断离2眼、虹膜后粘连4眼.结论 外路小梁切开联合周边虹膜切除术能有效治疗原发性闭角型青光眼.     

慢性闭角型青光眼周边虹膜切除和滤过性手术前后眼前段结构参数的对比研究

目的观察原发性慢性闭角型青光眼(CPACG)周边虹膜切除和小梁切除术手术前后眼前段结构参数的改变。设计前瞻性比较性病例系列。研究对象中山眼科中心连续CPACG患者45例53眼。方法患者周边虹膜粘连范围≤6个钟点者行周边虹膜切除术,>6个钟点者行小梁切除术,术前及术后3个月行眼前段光学相干断层扫描(AS-OCT)检查。比较两种术式术前及术后的眼前段AS-OCT检查参数。主要指标中央前房深度(ACD)、前房角开放距离(AOD)、小梁网虹膜间面积(TISA)、前房角隐窝面积(ARA)、前房宽度(ACW)、前房面积(ACA)、前房容积(ACV)和晶状体矢高(CLR)。结果周边虹膜切除术后ARA(0.078±0.036 mm2)、ACA(15.409±2.892 mm2)及ACV(91.021±22.387 mm3)较术前(ARA 0.065±0.024 mm2,ACA 13.945±2.633 mm2,ACV83.445±21.791 mm3)明显增加(t=-8.015～-2.727,P=0.000～0.042),但手术前后AOD、TISA、ACD、ACW和CLR无变化(t=-1.374～0.561,P=0.102～0.774)。小梁切除手术前后各眼前段生物学参数的变化均无统计学意义(t=-1.700～-0.002,P=0.388～0.998)。结论原发性慢性闭角型青光眼周边虹膜切除术术后前房角隐窝面积、前房面积和前房容积增加,但小梁切除术后眼前段参数无明显改善。     

激光虹膜周边切除术治疗慢性闭角型青光眼的远期疗效

目的观察慢性闭角型青光眼患者接受激光虹膜周边切除术（LPI）治疗的远期效果。方法对长期随访的66例（116眼）接受LPI的慢性闭角型青光眼患者进行回顾性研究,观察术前及术后的患者情况。结果20眼（17％）术后未用药,眼压控制在〈21mmHg;49眼（42％）经药物控制眼压正常;47眼（41％）用药情况下,眼压〉21mmHg,其中35眼接受进一步手术治疗。以术前眼压21mmHg为界将患眼分为2组。2组的LPI单独起作用者分别为17眼和3眼（χ^2=6．136,P=0．013）,青光眼失控者分别为15眼和32眼,差异有统计学意义（χ^2=26．68,P〈0．01）。结论对LPI术后慢性闭角型青光眼患者,尤其是术前眼压控制差的患者应密切随诊,以防止视功能进一步损害。     

非穿透性小梁切除联合周边虹膜切除术治疗原发性闭角型青光眼

目的观察非穿透性小梁切除联合周边虹膜切除术治疗原发性闭角型青光眼的临床效果。方法对15例18眼原发性开角型青光眼患者行非穿透性小梁切除联合周边虹膜切除术,术中应用丝裂霉素C,术后观察视力、前房反应、眼压、滤过泡情况,随访6月。结果15例18眼术前眼压23.3~48.7mmHg,平均(36.8±11.6)mmHg(1kPa=7.5mmHg),术后1d(6.2±2.6)mmHg(4.2~8.3mmHg),术后1周(7.3±3.5)mmHg(4.6~10.8mmHg),术后2周(9.6±4.2)mmHg(8.2~14.0mmHg),术后1月(12.7±4.7)mmHg(8.5~15.6mmHg),术后2月(11.5±4.2)mmHg(8·0~14.8mmHg),术后3月(12.2±4.4)mmHg(8.0~16·2mmHg),术后4月(11.9±4.6)mmHg(8.0~15·8mmHg),术后5月(12.3±5.4)mmHg(8.2~17.7mmHg),术后6月(14.6±6.1)mmHg(8.5~20.7mmHg)。术后视力均达到或高于术前水平。18眼均有功能型滤泡。术中、术后均未出现浅前房及前房炎症反应。1例术中少量前房出血,于术后第1d全部吸收。结论非穿透性小梁切除联合周边虹膜切除术能安全、有效地治疗原发性闭角型青光眼。     

Laser iridectomy in the management of chronic angle-closure glaucoma

Nineteen eyes of 16 patients (12 men and four women ranging in age from 41 to 75 years) underwent laser peripheral iridectomy for treatment of uncontrolled chronic angle-closure glaucoma (25 to 62 mm Hg). Five of eight eyes (62.5%) with glaucomatous cupping but full visual fields attained postiridectomy intraocular pressures of less than 22 mm Hg with medical therapy. Seven of nine eyes (77.7%) that had both glaucomatous optic disk damage and visual field loss before iridectomy had controlled intraocular pressures with medical therapy after iridectomy. Because laser iridectomy is safer than trabeculectomy, we recommend that it be the initial procedure in the treatment of chronic angle-closure glaucoma.     

Treatment of primary angle-closure glaucoma by argon laser iridotomy: a long-term follow-up

Argon laser iridotomy was performed in a total of 140 eyes of 104 patients with primary angle-closure glaucoma. A total of 69 eyes were treated by the long-burn technique and followed for an average period of 2.7 years; 71 eyes were treated by the short-burn technique and followed for an average period of 1.7 years. The effects on the IOP control and various factors of glaucoma were similar between both techniques, and the results of iridotomy were analyzed for all eyes. The IOP was controlled at or lower than 20 mmHg in 29% without medication, in 52% with reduced or the same medication as the preoperative treatments, and in 13% with increased medication. However, in 6% the IOP could not be controlled. The incidence of IOP control by iridotomy alone was significantly higher in eyes with peripheral anterior synechia (PAS) less than half the angle circumference than in eyes with more extensive PAS. Visual acuity loss occurred in 51%, and the loss by more than three lines of the acuity chart was seen in 19%; the visual loss was thought to be due to cataract progression or development. No significant differences were found in the visual field, cup-disk ratio, the extent of PAS or tonographic C-value before and after iridotomy. The IOP control and visual acuity loss were comparable with those seen after surgical iridectomy. Because of the absence of significant complications and ease of performance, iridotomy may replace surgical iridectomy in the treatment of angle-closure glaucoma.     

激光虹膜周切术治疗早期闭角型青光眼临床观察

目的：观察早期闭角型青光眼患者激光虹膜周边切除术（laser peripheral iridectomy,LPI）的近、远期临床疗效。方法：对急性闭角型青光眼临床前期21例21眼和慢性闭角型青光眼早期15例15眼患者行LPI,随访1a,观察中央前房深度,房角宽度及眼压等情况。结果：急性闭角型青光眼临床前期和慢性闭角型青光眼早期LPI术后中央前房深度加深,房角增宽,眼压下降,但随访1a后慢性闭角型青光眼早期患者中央前房深度有所变浅、眼压回升,其中3例需药物控制眼压,1例药物控制眼压失败需行滤过性减压手术。结论：LPI治疗急性闭角型青光眼临床前期效果满意,慢性闭角型青光眼早期患者应注意LPI适应证的选择,对所有LPI患者,应密切随诊,以防止视功能进一步损害。     

Trabeculectomy as the initial procedure in primary congenital glaucoma

PURPOSE: To estimate the effectiveness of trabeculectomy performed in buphthalmic eyes. MATERIAL AND METHODS: 42 eyes of 24 children, 14 boys and 10 girls. There were 18 children (32 eyes) operated on at the age from 7 days to 12 months (group I) and 6 patients (10 eyes) at the age from 3 to 7 years (group II) with primary congenital glaucoma. Corneal diameter ranged from 11.5 to 15 mm in infants, in 10 eyes of 6 children elder than 2 years it was from 13 to 15 mm. The axial length of eyeballs was from 19 to 23.5 mm. Forty five trabeculectomies were performed, in 3 cases they were repeated two and six years after the first procedure. Follow up was from 1 year to 22 years, mean 82 months, 7 years of group I, 6 years of group II. RESULTS: 29 of 42 eyes (64.2%) with intraocular pressure varied between 8 and 21 mm Hg, other eyes required additional local antiglaucoma treatment. Normal IOP was obtained in 95.2% of eyes. Trabeculectomy normalized IOP in 68.9% eyes of infants (group I), whereas in elder children the percentage came up to 50 (group II). In other eyes pharmacological agents decreased IOL to values below 21 mm Hg, in the group I in 97% of eyes and in the group II in 90% of cases. CONCLUSION: Trabeculectomy performed as a first procedure in primary congenital glaucoma is effective in infants and older children with buphthalmos in long-term follow-up. The necessity to perform this operation in very small children and even neonates does not always mean poor prognosis, and intraocular pressure can be stabilized at safe level for many years.     

Efficacy of latanoprost as an adjunct to medical therapy for residual angle-closure glaucoma after iridectomy.

Residual primary angle-closure glaucoma (PACG) after iridectomy is an important issue among Asians, especially Chinese. In this study, we tested the effectiveness of latanoprost as an intraocular pressure (IOP) lowering agent in cases of residual PACG. Twenty-six eyes of 26 PACG patients with persistently elevated IOP after iridectomy, despite treatment with conventional IOP lowering drugs (beta blockers and pilocarpine) were included. Latanoprost 0.005%, one drop daily, was added adjunctively to all eyes. Measurement of IOP at baseline and after the start of treatment with latanoprost indicated a significant IOP reduction. The IOP decreased by about 21% (p < 0.005) during the first 3 months, and showed a reduction of about 36% at the end of 1 year. At the 1-year follow up, the IOP was well controlled (below 20 mmHg) in all eyes. These findings show that, in combination with beta blockade and pilocarpine, latanoprost can ameliorate residual PACG after iridectomy and could potentially forestall the need for further therapeutic intervention.     

Evaluation of laser iridectomy in angle-closure glaucoma: provocative tests.

An argon laser iridectomy was performed on 18 eyes of 14 patients with closed-angle glaucoma. The intraocular pressure (IOP) was controlled in all but one eye within normal limits. Variable amounts of pigment were found on gonioscopy in all cases. The mydriasis test was positive in one eye (5.5%) after homatropine and in 5 eyes (28%) after tropicamide drops. 80% of the positive results occurred in lightly pigmented irides. The dark-prone position test was positive in 7 eyes (38%), 71% of the positive results occurring in heavily pigmented irides. Tomography was also performed; the possibility of trabecular damage is discussed.     

Effect of peripheral iridectomy on intraocular pressure in chronic primary angle closure glaucoma

In 67 eyes of 46 patients with chronic primary angle closure glaucoma, the effect of peripheral iridectomy in lowering the intraocular pressure was investigated retrospectively. In the majority of cases the pressure was reduced. For the whole population the mean reduction was 3.9 mmHg (SD 6.7 mmHg). The presence or extent of peripheral anterior synechiae showed no significant correlation with the amount of pressure reduction. A peripheral iridectomy is still recommended as first step in the treatment of primary angle closure glaucoma.     

YAG激光虹膜周切术治疗药物难控制性急性闭角型青光眼

目的:探讨YAG激光周边虹膜切除术在药物难控制急性闭角型青光眼治疗中的作用。方法:回顾分析我院住院患者共124例124眼,其中男51例,女73例,入院诊断符合急性闭角型青光眼发作期临床特征,且药物治疗24h后眼压仍>21mmHg的急性闭角型青光眼患者,其中控制眼压为21~35mmHg者51眼(41.1%),眼压36~50mmHg者37眼(29.8%),50mmHg以上者36眼(29.1%)。视力范围为光感~0.3。所有患者均在表面麻醉下行YAG激光周边虹膜切除术治疗,术后继续观察眼压、视力、前房深度变化,眼压控制稳定后分别进行小梁切除术、青光眼白内障联合人工晶状体植入术,或单纯白内障超声乳化吸出联合人工晶状体植入术。结果:患者124例124眼急性闭角性青光眼患者行YAG激光虹膜周切术后,第2d检测眼压≤21mmHg者28眼(22.6%),眼压为22~35mmHg者60眼(48.4%),眼压36~50mmHg者25眼(20.2%),眼压>50mmHg者11眼(8.9%);激光术后视力增加3行者33眼（26.6%）,2行者31眼(25.0%),视力增加1行者44眼(35.5%),视力不增加者16眼(12.9%);119眼前房深度增加(96.0%); YAG激光虹膜周切术后并发前房出血98眼(79.0%)。眼压控制稳定后分别进行小梁切除术37眼,青光眼白内障联合人工晶状体植入术43眼,白内障超声乳化吸出联合人工晶状体植入术44眼。观察随访3~9mo,眼压控制≤18mmHg者95眼,眼压≤25mmHg者24眼,眼压为26~35mmHg者5眼,未见前房积血、黄斑囊样水肿等并发症。结论:YAG激光虹膜周切术在药物难控制性急性闭角型青光眼治疗中能明显降低眼压,为各种青光眼手术的治疗提供安全可靠的条件,有助于视功能保护和恢复,提高疗效。     

应用OCT评价激光周边虹膜成形联合切除术治疗临床前期原发性闭角型青光眼的有效性

目的：应用光学相干断层扫描技术(OCT)评价激光周边虹膜成形联合切除术(LPI)治疗临床前期原发性闭角型青光眼(PACG)的有效性。

方法：选取PACG临床前期患者31例58眼进行激光周边虹膜成形联合切除术,应用OCT和眼科A超采集激光治疗前、治疗后1wk,2mo患眼的前房角形态、房角开放度(OA)以及眼前节生物参数：中央前房深度(ACD)、晶状体厚度(LT)、前房拥挤率(CCR)、晶状体位置(LP)。

结果：激光治疗前、治疗后1wk,2mo不同时间,眼压、OA、ACD、CCR、LP比较差异具有统计学意义(F=16.845、30.498、38.705、86.671、46.195,P<0.05); LT差异无统计学意义(F=0.756,P=0.471)。激光治疗后1wk,2mo两两比较：仅CCR差异具有统计学意义(P<0.05),OA、ACD、LP差异无统计学意义(P=0.067、0.359、0.406)。

结论：OCT可以观测和量化PACG前房角,CCR可以更加敏感的反应出前房的结构改变,LPI治疗早期PACG是有效的。