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

doi:10.3877/cma.j.issn.2095-2007.2022.01.003

Abstract

Abstract:

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

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.

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References 24

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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

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

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

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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