激光周边虹膜切开术对原发性闭角型青光眼高危者的二年干预效果

目的 观察激光周边虹膜切开术（laser peripheral iridotomy，LPI）对原发性闭角型青光眼（primary angle clouse glaucoma，PACG）高危者的2年干预效果。设计 队列研究。研究对象 PACG高危者52例（104眼）。方法 PACG高危者随机分成干预组和观察组两组，每组26例（52眼），干预组行LPI， 观察组仅随访观察。于LPI术前、术后2周、6及12个月、2年进行眼科常规检查及超声生物显微镜（UBM）检查。主要指标 眼压、UBM图像中前房角参数。结果 干预组LPI术前眼压为（16.89±3.01） mm Hg，最后随访眼压为 （15.20±2.39） mm Hg；LPI术后中央前房深度、房角开放距离、小梁虹膜夹角、房角开放象限数均较术前增加，差异均有显著性（P均<0.01）。观察组随访1年时眼压变化无显著差异，但房角开放距离、小梁虹膜夹角、房角开放象限数均较前减少，差异均有显著性（P均<0.05）；随诊2年时眼压（17.31±2.27）mm Hg,  较前增高（P<0.05）。干预组无一例发展为PACG，观察组2例（2眼）PACG急性发作。 结论 LPI能有效改善前房角结构，并可有效防止PACG高危者发展为PACG。

The two years efficacy of early intervention by laser peripheral iridotomy on high-risk primary angle-closure glaucoma

 Objective To observe the impact of early intervention with YAG laser peripheral iridotomy (LPI) on high-risk patients of primary angle clouse glaucoma (PACG). Design Cohort study． Participants 52 patients (104 eyes) with high-risk PACG. Method The patients with high-risk PACG were randomly divided into two groups. One group [26 patients (52 eyes)] was treated with LPI, and another group ［26 patients (52 eyes)］ was control group in which, the patients wasn't given any intervention. Following up for 2 years, routine ophthalmic examination and UBM were performed at the first visit (before LPI), 2 weeks, 6, 12 months and 2 years after LPI, respectively. The parameters of anterior chamber were measured and calculated by UBM. Main Outcome Measures Intraocular pressure(IOP), the parameters of anterior chamber measured by UBM. Results The average postoperative IOP in the intervention group was (15.20±2.39) mm Hg in the final follow-up, which was lower than pre-operation (16.89±3.01 mm Hg); The central anterior chamber depth, the mean angle-opening distance, the trabecular iris angle and the mean chamber angle width was increased after LPI (all P＜0.01). There was no significant change in IOP in the control group  at 12 months visit (P＞0.05), but  the angle-opening distance, the trabecular iris angle and the mean chamber angle width was decreased (all P＜0.05)； The average intraocular pressure in the control group was (17.31±2.27) mm Hg in the final follow-up, which was higher than pre-operation (P＜0.05); there were two cases (2 eyes) suffered PACG acute attacks in control group, while there was no PACG in the intervention group after two year's follwing up. Conclusion LPI can effectively prevent the development of high-risk PACG to PACG and improve the anterior chamber and anterior chamber angle structures.