Comparison of New Visual Disturbances after Superior versus Nasal/Temporal Laser Peripheral Iridotomy A Prospective Randomized Trial-猫眼课题宝

DOI：

10.1016/j.ophtha.2017.09.015

发表时间：

2018-03-01

期刊：

OPHTHALMOLOGY

影响因子：

13.7

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Srinivasan, Kavitha;Zebardast, Nazlee;Ramulu, Pradeep Y.

目的：探讨激光周边虹膜切开术(LPI)的位置对术后虹膜难视症状的影响。设计：多中心、随机、前瞻性、单掩蔽试验。参与者：559例30岁及以上的南印度患者，诊断为原发性闭角型青光眼(PACS)或双眼原发性闭角型青光眼(PACG)。主要观察指标：新发的视觉障碍症状。结果：上级LPI(285例)和鼻侧/颞部LPI(274例)患者在年龄(P=0.6)、性别(P=0.7)以及PACS与PAC或PACG的分布(P=0.7)方面匹配。两组使用相似的初始激光能量设置(P=0.30)，尽管更好的LPI需要更多的射程(P=0.006)和更大的总能量(P&lt；0.001)。两组术后前房反应(P=0.7)和LPI面积(P=0.9)差异无统计学意义。在LPI前表现出一种或一种以上吞咽困难症状的患者所占比例(鼻侧/颞侧15.8%vs.13.9%；P=0.1)或任何个体吞咽困难症状(P&gt；0.2)没有组间差异。在LPI治疗后，8.9%的患者报告了一种或更多的新症状，最常见的是2.7%、4.3%和4.3%的患者出现线性视觉困难、眩光和模糊。与接受鼻腔/颞叶LPI的患者相比，接受高级LPI的患者描述新出现的一种或更多视觉障碍症状的可能性并不更高(8.4%比9.5%；P=0.7)，也没有任何新的个体症状的出现频率在不同组之间存在差异(P&gt；=0.3)。在多因素Logistic回归分析中，LPI位置、LPI面积和总激光能量均不能预测术后再发虹膜困难的几率(P&gT；0.1)。结论：相对于视力困难，激光周边虹膜切开术可能是安全的，无论位置、LPI大小和激光能量使用多少。(C)2017年度美国眼科学会

Purpose: To determine whether laser peripheral iridotomy (LPI) location affects postoperative dysphotopsia symptoms.Design: Multicenter, randomized, prospective, single-masked trial.Participants: Five hundred fifty-nine South Indian patients 30 years of age or older diagnosed as primary angle-closure suspects (PACSs) or with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) in both eyes.Methods: Patients were randomized to either bilateral superior or bilateral nasal/temporal LPI. Occurrence of new visual disturbances was evaluated before and 2 weeks after LPI using a questionnaire based on the 7-item dysphotopsia symptoms described by Spaeth et al.Main Outcome Measures: New-onset dysphotopsia symptoms.Results: Superior LPI (n = 285) and nasal/temporal LPI (n = 274) patients were matched for age (P = 0.6), gender (P = 0.7), and distribution of PACS versus PAC or PACG (P = 0.7). Similar initial laser energy settings were used in both groups (P = 0.3), although superior LPIs required more shots (P = 0.006) and greater total energy (P < 0.001) than nasal/temporal LPIs. No significant differences in postoperative anterior chamber reaction (P = 0.7) or LPI area (P = 0.9) were noted between the 2 groups. No group differences were noted regarding the proportion of patients demonstrating 1 or more dysphotopsia symptoms before LPI (15.8% for superior vs. 13.9% for nasal/temporal; P = 0.1) or any individual dysphotopsia symptom (P > 0.2 for all). After LPI, 8.9% of all patients reported 1 or more new symptoms, the most common consisting of linear dysphotopsias, glare, and blurring in 2.7%, 4.3%, and 4.3% of patients, respectively. Patients undergoing superior LPI were not more likely to describe the new onset of 1 or more dysphotopsia symptoms as compared with patients undergoing nasal/temporal LPI (8.4% vs. 9.5%; P = 0.7), nor did the frequency of any new individual symptoms differ by group (P >= 0.3 for all). In multivariate logistic regression analysis, neither LPI location nor LPI area nor total laser energy predicted higher odds of new postoperative dysphotopsias (P > 0.1 for all).Conclusions: Laser peripheral iridotomy likely is safe with respect to visual dysphotopsias regardless of location, LPI size, and amount of laser energy used. (C) 2017 by the American Academy of Ophthalmology

Comparison of New Visual Disturbances after Superior versus Nasal/Temporal Laser Peripheral Iridotomy A Prospective Randomized Trial

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