| Objective:The prevalence of Primary Angle Closure Glaucoma(PACG) is higher in china, and the blinding caused by PACG is very serious. The preferred practice for PACG is earlier diagnosis and treated with laser peripheral iridotomy(LPI). Primary angle closure suspect(PACS) is the earliest stage of PACG and the indication of operation and the time of operation for it by LPI is indeterminate. There is a randomized controlled trial carried out by Handan eye hospital(the Third hospital of Handan) in 2005.10-2006.10. The patients who were diagnosed PACS at outpatient clinic were enrolled. LPI was performed in one eye selected randomly for every PACS. Anterior segment morphology was evaluated after LPI in eyes with primary angle closure suspect(PACS). Now,this study has continued 5 years. To quantitatively evaluate the longterm changes in anterior segment morphology and to determine the indication of operation and the time of operation, we will fellow up those patients who were enrolled in this randomized controlled trial. Routine ophthalmic tests, Goldmann applanation tonometry, static and dynamic Goldmann gonioscopy, fundus examination, and automated perimetry(Humphrey Field Analyzer 750 i, Carl Zeiss Meditec, SitaFast strategy, 24-2 threshold test), UBM and A-scan examination were performed at 5 years after LPI.Method:This prospective study was conducted at the department of Ophthalmology in Handan eye hospital(the Third hospital of Handan),Hebei Province, China. The inclusion criteria include:(1) age 40 years or above;(2)none history of any intraocular surgery;(3) nonvisibility of the posterior trabecular meshwork≥180 degrees on static gonioscopy using dim lighting conditions in both eyes; without peripheral anterior synechia(PAS).(4) Intraocular pressure(IOP) <21mmHg. The exclusion criteria were:(1)history of phacoemulsification;(2) severe health problems(cardiovascular disease, lung disease, kidney disease, and advanced cancer) that could potentially prevent patients from attending follow-up;(3) history of any intraocular surgery and/or ocular trauma;(4)severe corneal nebula that could potentially prevent patients from LPI.(5)history or signs of acute angle closure(combination of dilated and fixed pupil, sector atrophy of iris, pigmentary dusting of corneal endothelium, and glaucomflecken);(6)mydriasis is necessary frequently when optic nerve or fundi disease(7)unwillingness to participate in the study or unable to provide consent.(8) high-risk factors of acute PACG(IOP)≥15mmHg after darkroom prone test or mydriasis).(9)counts of endothelial cells<1000 /mm2;(10)using of glucocorticoids;(11)corneal contact lens;(12)Pregnancy or breastfeeding women;(13)allergy to pilocarpine or alcaine(14)contraindication of laser. Routine ophthalmic tests, Goldmann applanation tonometry, static and dynamic Goldmann gonioscopy, fundus examination, and automated perimetry(Humphrey Field Analyzer 750 i, Carl Zeiss Meditec, Sita Fast strategy, 24-2 threshold test), UBM,darkroom prone test and A-scan examination were performed for all patients. Analysis was performed using Statistical Product and Service Solutions(SPSS) 19.0.Results:A total of 42 patients including 10 male(23.8%) and 32 female(76.2%) subjects fulfilled the above inclusion criteria and finished UBM in this study. The mean age of patients was 59.6±7.9 years. The mean follow-up period was(5.2 ± 0.5) years(arranged from 4.6 to 7.0years, the median was 5.1 years).19(45.2%) right eyes and 23(54.8%) left eyes were treated with laser peripheral iridotomy(LPI). A total of 40 patients including 5 male(12.5%) and 35 female(87.5%) subjects fulfilled the above inclusion criteria and finished Ascan in this study. The mean age of patients was 59.0±8.6 years. The mean follow-up period was(5.5 ± 1.0) years(arranged from 4.5 to 7.1 years, the median was 5.1 years). 17(42.5%) right eyes and 23(57.5%) left eyes were treated with laser peripheral iridotomy(LPI).In parameters obtained from UBM image, AOD500, AOD750, TIA500, TIA750, ARA500, and ARA750 were significantly widen at 5 years after LPI than that at presentation in eyes with PACS(all P<0.001). TCPD500 and TCPD750 were significantly increased 5% and 10% respectively, IT500、IT750 were significantly decreased 11% and 6% respectively at 5 years after LPI than that at presentation in eyes with PACS(allP<0.001), and the parameters at 750 μm anterior to the sclera spur were more significantly wide than its 500 μm counterpart. Compared to non-treated eyes, all parameters were significantly increased(allP<0.001) except for IT500 and IT750 at 5 years after LPI. In parameters obtained from A-scan, there were a significantly deeper anterior chamber depth at 1 year and 5 year compared to non-treated eyes(all P<0.05). Lens thickness was significantly thinner at 5 year in LPI eyes compared to non-treated eyes(P=0.034). Anterior chamber depth was significantly decreased at 5 year compared to 1 year in LPI eyes(P=0.023). Lens thickness was significantly thicker at 5 year in LPI eyes compared to baseline(P=0.003). Relative location of lens was significantly moved forward at 1 year(P=0.006) and backward at 5 year(P=0.019) in LPI eyes. In non-treated eyes, anterior chamber depth was significantly decreased in fellow up(F=16.43,P<0.05), Lens thickness was significantly increased in fellow up(F=15.65, P<0.05).Conclusion:LPI can significantly widen the peripheral anterior angle in eyes with PACS and this effectiveness to be sustained at least 5 years after LPI. For PACS diagnosed by ophthalmologist, prophylactic LPI could be performed to avoid the progression of PAC or PACG. |
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