摘要
目的探讨原发性闭角性青光眼(primary angle-closure glaucoma,PACG)我国传统治疗方案与美国眼科学会推荐首选治疗方案两种治疗模式对治疗结局的影响。设计回顾性病例系列。研究对象2005年10月至2007年3月邯郸市眼科医院连续诊治的急性闭角型青光眼(acute angle closure glaucoma,AACG)148眼和慢性闭角型青光眼(chronic angle closure glaucoma,CACG)245眼。方法利用以激光周边虹膜切开术(laser peripheral iridotomy,LPI)作为首选治疗后1~18个月的随访数据,分析激光治疗后眼压控制的情况。分析比较我国传统治疗方案即以房角周边前粘连(peripheral anterior synechiae,PAS)>6个钟点作为小梁切除术的指征可能存在的过度治疗(即激光治疗后眼压可以控制)和治疗不足(即激光治疗后眼压不能控制,需进一步用药或手术治疗)的比例。主要指标过度治疗和治疗不足的比例。结果按照我国传统治疗方案中PACG的处理原则,45只AACG眼将行小梁切除术,而其中46.7%(21/45)的患眼行激光治疗眼压即可控制;CACG中将有89只眼需行小梁切除术,其中约49.4%(44/89)的患眼可仅行LPI。采用激光治疗模式,AACG中激光治疗后眼压不能控制的病例将从传统治疗模式的10.8%(16/148)上升为29.7%(44/148),CACG激光治疗后眼压不能控制的将从18.4%(45/245)上升为42.4%(104/245)。结论按照我国传统滤过手术治疗原则治疗PACG存在严重的过度治疗。如果完全以LPI作为首选治疗,将导致治疗不足或失败的比例明显增加,约为我国传统滤过手术治疗模式的2~3倍。因此,结合房角粘连程度和视神经损害的有无确定PACG的滤过手术指征,可避免或减少过度治疗与治疗不足。
Objective To compare the Chinese conventional practice patterns of primary angle-closure glaucoma （PACG） with American Academy of Ophthalmology recommended practice patterns in a setting of tertiary eye hospital in China. Design Retrospec- tive case series. Participants 148 eyes with acute angle closure glaucoma （AACG） and 245 eyes with chronic angle closure glaucoma （CACG） between October 2005 and March 2007 at Handan Eye Hospital. Methods All eyes were undergone laser peripheral iridotomy （LPI）, with a follow up time of 1-18 months. Based the database, we assumed to treat the patients with Chinese conventional practice patterns, to see the proportions of overtreatment and the potential undertreatment. Main Outcome Measures The ratio of overtreatment and undertreatment. Results In accordance with conventional practice patterns for PACG in China, 45 AACG eyes and 89 CACG eyes will take trabeculectomy, among which 46.7% （21/45） of AACG eyes and 49.4% （44/89） of CACG eyes can be well controlled by LPI, respectively. With laser preferred strategy, the rate of inadequate treatment will be increased from 10.8%（ 16/148 ）to 29.7% （44/148） in AACG eyes and from 18.4% （45/245） to 42.4% （I04/245） in CACG eyes. Conclusion Filtery surgery in PACG is seriously overdone in China with conventional practice patterns. The rate of inadequate treatment will be increased remarkablely with laser preferred practice pattern, about 2-3 times compared with the traditional mode of filtration surgery. Therefore, taking both the degree of PAS and optic nerve damage into the consideration of choosing filtration surgery or not for PACG patients, may be utmost to avoid excessive treatment and reduce the inadequate treatment.
出处
《眼科》
CAS
CSCD
北大核心
2017年第1期15-20,共6页
Ophthalmology in China
基金
浙江省卫生创新人才培养计划(2016025)
