| Objective: In this study,primary acute angle-closure glaucoma was treated with 577 nm and 532 nm laser peripheral iridoplasty(ALPI)combined with YAG laser iridotomy(LPI).We evaluated their differences,clinical efficacy and safety,to provide data support for laser treatment of primary acute angle-closure glaucoma in the future.Methods: The 30 eyes(28 patients)of the first acute exacerbation of primary acute angle-closure glaucoma treated at the Affiliated Hospital of Yan'an University from September 2015 to February 2017 were randomly selected,of which 15 eyes were treated with 577 nm laser peripheral iridoplasty Combined with YAG laser peripheral iridectomy(treatment group A),15 eyes were treated with 532 nm laser peripheral iridoplasty combined with YAG laser peripheral iridectomy(treatment group B).All treatments were approved by the patients and their dependents,and signed the informed consent before treatment.Using UBM(Tianjin Sovi)measured the related parameters of preoperative,postoperative 3 d and 3 mo : ACD(Anterior chamber depth),AOD500(Anterior opening distance),ACA500(Anterior chamber angle),IT3(Lris thickness).Using corneal confocal microscope(Germany Heidelberg)measured the corneal endothelial quantity of preoperative and postoperative.The preoperative,postoperative 1 hour,postoperative 1 day,postoperative 1 week,postoperative 1month,postoperative 3 months intraocular pressure(IOP)were monitored by non-contact tonometer.We observe the postoperative complications,the usage of eye drops.The visual field of postoperative 3 day and postoperative 3 months analyzed by automatic computerized visual field examination and analysis system(TEC-3F).All of the above operations and inspections are done by one person.All data were analyzed by SPSS 20.0 software.The time-dependent variables such as intraocular pressure(IOP)and UBM parameters were analyzed by variance analysis of repeated measurement data.Further analysis of changes in the two time points in the group was performed by paired t test.Changes in corneal endothelium count before and after treatment were compared by paired t test,The two groups of corneal endothelium loss compared with independent samples t test,and the same applies to visual field.Result: 1.intraocular pressure: the two groups of intraocular pressurein on the preoperative,postoperative 1h,1d,1mo,3mo using repeated measurements of variance analysis: tgroups of different time periods change was statistically significant(P < 0.05),is a downward trend in general;and there was no significant difference between the two groups(P> 0.05).2.Corneal endothelium count: measured in both groups before and after surgery 3d corneal endothelium count.There was no significant difference in the corneal endothelium count between the two groups(P> 0.05).The corneal endothelium loss between the two groups was compared with the independent sample t test.There was no significant difference in corneal endothelium loss between the two groups(P> 0.05).3.UBM related parameters: 3.1.The ACD,AOD500,ACA500 and IT3 of the two groups were measured before and after operation,postoperative 3d,postoperative 3 months.(1)The changes of ACD values in different time periods were statistically significant(P <0.05),but there was no significant difference between the two groups(P> 0.05).(2)The changes of AOD500 values in different time periods were statistically significant(P <0.05),but there was no significant difference between the two groups(P> 0.05).(3)The changes of ACA500 values in different time periods were statistically significant(P <0.05),but there was no significant difference between the two groups(P> 0.05).(4)The changes of IT3 values in different time periods were not statistically significant(P <0.05),and there was no significant difference between the two groups(P> 0.05).3.2.Group A:(1)the ACD postoperative 3 d more preoperative significantly increased,with statistical significance(P < 0.05);3 mo after surgery with postoperative changes in 3 d has no statistical significance(P > 0.05).(2)AOD500 postoperative 3 d more preoperative increases obviously,was statistically significant(P < 0.05);3 mo after surgery with postoperative changes in 3 d has no statistical significance(P > 0.05).(3)ACA500 postoperative 3 d more preoperative increases obviously,was statistically significant(P < 0.05);3 mo after surgery with postoperative changes in 3 d has no statistical significance(P > 0.05).(4)IT3 3 d the preoperative,postoperative was statistically significant(P < 0.05);3 mo after surgery with postoperative 3 d increases,was statistically significant(P < 0.05);3 mo after surgery with preoperative decreases,and three of the quadrant(nasal side,above,below),no statistical significance(P > 0.05),a quadrant(temporal)was statistically significant(P < 0.05).3.3.Group B:(1)the ACD postoperative 3 d more preoperative obviously increase,with statistical significance(P < 0.05),postoperative 3 mo more postoperative changes in 3 d has no statistical significance(P > 0.05).(2)AOD500 postoperative 3 d more preoperative increases obviously,was statistically significant(P < 0.05),postoperative 3 mo more postoperative changes in 3 d has no statistical significance(P > 0.05).(3)ACA500 postoperative 3 d more preoperative increases obviously,was statistically significant(P < 0.05),postoperative 3 mo more postoperative changes in 3d has no statistical significance(P > 0.05).(4)IT3 3d the preoperative,postoperative was statistically significant(P < 0.05),postoperative 3 mo more postoperative 3 d.4.There was no significant change in the visual field of 3 months after surgery than 3d.5.In this study,30 eyes without serious complications,1h postoperative anterior chamber inflammatory cells were rated as 0.5 +.6.After the operation according to the situation of successive stop antihypertensive eyedrops,in 30 eyes,1 eyes(treatment group A))after the surgery,in addition to elevated intraocular pressure stop antihypertensive drugs eye drops,and then added with antihypertensive drugs to control eye drops,the rest can be after discontinuation of 1wk.Conclusion: 1.There was no significant difference in efficacy and safety between 577 nm and 532 nm laser peripheral iridoplasty combined with YAG laser peripheral iridectomy in the treatment of acute angle closure glaucoma.2.577 nm and 532 nm laser peripheral iridoplasty combined with YAG laser peripheral iridectomy in the treatment of acute angle-closure glaucoma,can effectively deepen the patient's anterior chamber depth,open angle,open anterior chamber distance,thereby reducing clinical medication,protect visual function.And there are higher security.3.There was no significant decrease in corneal endothelial count before and after treatment with 577 nm and 532 nm laser peripheral iridectomy combined with YAG laser peripheral iridectomy. |
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