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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2022, Vol. 12 ›› Issue (01) : 12 -17. doi: 10.3877/cma.j.issn.2095-2007.2022.01.003

论著

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
郭丽1, 杨一佺2, 郭黎霞3, 吕爱国3, 苗慧3, 韩伟3, 胡建华3, 范肃洁3,†()   
  1. 1. 067000　承德医学院　2019级硕士研究生；056001　邯郸市眼科医院（邯郸市第三医院）眼科
    2. 100730　首都医科大学附属北京同仁医院　北京同仁医院眼科　北京市眼科研究所　眼科学与视觉科学北京市重点实验室
    3. 056001　邯郸市眼科医院（邯郸市第三医院）眼科
  • 收稿日期:2022-01-25 出版日期:2022-02-28
  • 通信作者: 范肃洁
  • 基金资助:
    河北省科技计划项目(16277790D)

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

Li Guo1, Yiquan Yang2, Lixia Guo3, Aiguo Lyn3, Hui Miao3, Wei Han3, Jianhua Hu3, Sujie Fan3,†()   

  1. 1. Master′s degree 2019, Chengde Medical University, Chengde 067000, China; Ophthamology, Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001,China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
    3. Ophthamology, Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001,China
  • Received:2022-01-25 Published:2022-02-28
  • Corresponding author: Sujie Fan
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郭丽, 杨一佺, 郭黎霞, 吕爱国, 苗慧, 韩伟, 胡建华, 范肃洁. 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[J]. 中华眼科医学杂志(电子版), 2022, 12(01): 12-17.

Li Guo, Yiquan Yang, Lixia Guo, Aiguo Lyn, Hui Miao, Wei Han, Jianhua Hu, Sujie Fan. Comparisons of laser peripheral iridoplasty and laser pupilloplasty in the treatment of acute primary angle closure patients[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(01): 12-17.

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。

关键词: 急性原发性前房角关闭, 激光周边虹膜成形术, 激光瞳孔成形术
Objective

The 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.

Methods

81 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.

Results

In 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).

Conclusions

The 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.

Key words: Acute primary angle closure, Laser peripheral iridoplasty, Laser pupilloplasty
图1 激光瞳孔成形术示意图
表1 两组患者基本信息的比较
组别 眼数(只眼) 性别(男/女) 年龄(±s，岁) 术前logMAR视力[M(Q1，Q3)] 术前眼压(±s，mmHg) 发作持续时间[M(Q1，Q3)，h] 发作次数[M(Q1，Q3)，次]
LPIP和LPP联合组 42 6/36 66.2±10.4 1.70(0.68，2.00) 50.95±7.22 16.0(12.0，39.0) 0(0，3.5)
LPIP组 39 9/30 67.3±10.9 1.70(0.90，2.00) 48.08±8.05 24.0(15.0，48.0) 0(0，1.0)
χ2/t/Z值   1.04* -0.44△ -0.51# 1.69△ -0.99# -1.30#
P值   >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
图3 两组患者术前和术后眼压的比较　 *，两组比较差异有统计学意义；1 mmHg＝0.133 kPa
表2 前房角关闭患者术前和术后眼压改变的影响因素
影响因素 相关系数(β) 95%Cl Wald χ2 P值
组别(LPIP和LPP＝1，LPIP组＝2) -9.157 -14.868~-3.446 9.88 <0.05
性别(男＝1，女＝2) 4.625 -2.650~11.900 1.55 >0.05
年龄(岁) -0.432 -0.707~-0.157 9.50 <0.05
术前眼压(mmHg) 0.392 0.019~0.765 4.25 <0.05
发作时间(h) -0.115 -0.198~-0.032 7.43 <0.05
发作次数(次) -0.931 -2.309~0.446 1.76 >0.05
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[1] 张新, 郭黎霞, 吕爱国, 张志宏, 崔宏宇, 杨艳萍, 邵培刚, 范肃洁. 联合激光与传统药物治疗原发性闭角型青光眼急性发作期的临床研究[J]. 中华眼科医学杂志(电子版), 2019, 09(06): 354-359.
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