The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study
The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study
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DOI：
10.1016/j.ophtha.2021.08.017
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发表时间：
2022-01-19
期刊：
影响因子：
13.7
通讯作者：
Aung, Tin
中科院分区：
文献类型：
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作者：
Baskaran, Mani;Kumar, Rajesh S.;Aung, Tin
目的：检查激光周边虹膜切开术 (LPI) 对诊断为原发性闭角疑似 (PACS) 的患者的疗效。设计：前瞻性、随机对照试验。参与者：这项多中心、随机对照试验（ClinicalTrials.gov 标识符，NCT00347178）招募了来自新加坡青光眼诊所的 480 名年龄超过 50 岁的双侧无症状 PACS 患者（定义为房角镜检查时有 >2 个象限的对位角闭合）。方法：每位参与者随机选择一只眼睛接受预防性 LPI，而另一只眼睛作为对照。患者每年接受一次随访，为期 5 年。主要结果指标：主要结果指标是 5 年内出现原发性闭角型青光眼 (PAC；定义为周围性前粘连、眼压 [IOP] > 21 mmHg 或两者兼有或急性闭角型 [AAC]) 或原发性闭角型青光眼 (PACG)。结果：在 480 名随机参与者中，大多数是中国人 (92.7%) 和女性 (75.8%)，平均年龄为 62.8 +/- 6.9 岁。与对照眼（n = 45 [9.4%]；IR，每 1000 眼年 21.84；P = 0.001）相比，接受 LPI 治疗的眼睛在 5 年后达到终点的频率较低（n = 24 [5.0%]；发病率 [IR]，每 1000 眼年 11.65 例）。与对照眼相比，LPI 治疗眼进展为 PAC 的调整后风险比 (HR) 为 0.55（95% 置信区间 [CI]，0.37-0.83；P = 0.004）。年龄较大的参与者（每年；HR，1.06；95% CI，1.03-1.10；P < 0.001）和基线 IOP 较高的眼睛（每毫米汞柱；HR，1.35；95% CI，1.22-1.50；P < 0.0001）更有可能达到终点。为预防终点而需要治疗的人数为 22 人（95% CI，12.8-57.5）。结论：在双侧无症状 PACS 患者中，与对照眼相比，接受预防性 LPI 的眼睛在 5 年内达到的终点明显更少。然而，PAC 或 PACG 的总体发生率较低。美国眼科学会 2022 年眼科；129:147-158 (c) 2021
Purpose: To examine the efficacy of laser peripheral iridotomy (LPI) in patients who received a diagnosis of primary angle-closure suspect (PACS). Design: Prospective, randomized controlled trial. Participants: This multicenter, randomized controlled trial (ClinicalTrials.gov identifier, NCT00347178) enrolled 480 patients older than 50 years from glaucoma clinics in Singapore with bilateral asymptomatic PACS (defined as having >2 quadrants of appositional angle closure on gonioscopy). Methods: Each participant underwent prophylactic LPI in 1 randomly selected eye, whereas the fellow eye served as a control. Patients were followed up yearly for 5 years. Main Outcome Measures: The primary outcome measure was development of primary angle closure (PAC; defined as presence of peripheral anterior synechiae, intraocular pressure [IOP] of >21 mmHg, or both or acute angle closure [AAC]) or primary angle-closure glaucoma (PACG) over 5 years. Results: Of the 480 randomized participants, most were Chinese (92.7%) and were women (75.8%) with mean age of 62.8 +/- 6.9 years. Eyes treated with LPI reached the end point less frequently after 5 years (n = 24 [5.0%]; incidence rate [IR], 11.65 per 1000 eye-years) compared with control eyes (n = 45 [9.4%]; IR, 21.84 per 1000 eye-years; P = 0.001). The adjusted hazard ratio (HR) for progression to PAC was 0.55 (95% confidence interval [CI], 0.37-0.83; P = 0.004) in LPI-treated eyes compared with control eyes. Older participants (per year; HR, 1.06; 95% CI, 1.03-1.10; P < 0.001) and eyes with higher baseline IOP (per millimeter of mercury; HR, 1.35; 95% CI, 1.22-1.50; P < 0.0001) were more likely to reach an end point. The number needed to treat to prevent an end point was 22 (95% CI, 12.8-57.5). Conclusions: In patients with bilateral asymptomatic PACS, eyes that underwent prophylactic LPI reached significantly fewer end points compared with control eyes over 5 years. However, the overall incidence of PAC or PACG was low. Ophthalmology 2022;129:147-158 (c) 2021 by the American Academy of Ophthalmology