激光周边虹膜切开术阻止色素播散综合征进展的远期效果

摘要

Objective To evaluate the long-term efficacy of laser peripheral iridotomy (LPI) in preventing deterioration in eyes with pigment dispersion syndrome (PDS).Methods A cohort study.Nineteen patients with PDS were treated with LPI and followed up periodically in Beijing Tongren Eye Center from May 2006 to April 2007.One eye of each patient was chosen randomly for the study.Main investigating items included iris configuration,intraocular pressure (IOP),anterior chamber pigmentation,and visual field analysis.The average follow-up period was (6.5 ± 0.3) years.A paired sample t test was used to determine whether there is a significant difference between average values of pre-and post-LPI IOP and mean deviation of Humphrey visual field analysis in these PDS eyes.Results The average age of the 19 patients were (35.8 ±7.1) years on admission.The initial IOP of the 19 eyes was (24.7 ±2.2) mmHg(1 mmHg =0.133 kPa)before LPI.The mean deviation (MD) of Humphrey visual field analysis (VFA) were (-1.82 ± 1.26) dB(-4.34--0.28 dB).All 19 eyes had concave iris and heavy trabecular pigmentation.The iris became fiat in all PDS eyes after the laser treatment.At the last follow-up visit,the average IOP was 14.8 ± 2.0 (12-20) mmHg,which was statistically lower than that of baseline (t =11.49,P ＜ 0.01).Extent of trabecular pigmentation reduced obviously in 16 eyes.No deterioration or new visual field defect was detected in any of the PDS eyes.MD of the last VFA was-1.79 ± 1.21 (-4.39--0.21 dB).There was no statistical difference between MD of the last VFA and baseline (t =-0.26,P =0.798).Conclusion The long-term follow-up results showed that LPI prevents progression effectively in eyes with PDS.%目的 评价激光周边虹膜切开术(LPI)阻止色素播散综合征进展的远期效果.方法 队列研究.2006年5月至2007年4月对首都医科大学附属北京同仁医院北京同仁眼科中心连续19例色素播散综合征患者实施LPI,术后定期随访.每例按照随机数字表法选择一只眼作为观察眼.观察虹膜形态、眼压、房角色素颗粒沉积程度和视野变化.平均随访(6.5±0.3)年.对于患者LPI治疗前和末次随访的眼压以及Humphrey视野平均缺损值的比较,采用配对t检验.结果 19例患者初诊时平均年龄(35.8±7.1)岁.LPI治疗前平均眼压(24.7±2.2)mmHg(1 mmHg=0.133 kPa);Humphrey视野平均缺损(-1.82±1.26)dB(-4.34 ～-0.28 dB).入选时所有19只眼均存在明显的虹膜后凹、小梁网色素颗粒沉积.LPI治疗后,19只眼的虹膜后凹均恢复平坦.末次随访时眼压为(14.8±2.0)(12 ～20) mmHg,与基线资料比较显著降低,差异有统计学意义(t=11.49,P＜0.01);16只眼房角色素颗粒沉积程度减轻;均未出现视野缺损或进展,末次视野平均缺损(-1.79±1.21)(-4.39～-0.21)dB,与基线资料比较,差异无统计学意义(t=-0.26,P=0.798).结论 远期随访结果显示,LPI能有效阻止色素播散综合征患者病情进展.