Laserska periferna iridotomija kod bolesnika sa akutnim primarno zatvorenim komornim uglom

  • Svetlana Paunović University Clinical Center Kragujevac, Clinic of Ophthalmology, Kragujevac, Serbia
  • Milan Paunović University Clinical Center Kragujevac, Pediatric Surgery Clinic, Kragujevac, Serbia
  • Sunčica Srećković University Clinical Center Kragujevac, Clinic of Ophthalmology, Kragujevac, Serbia
  • Nenad Petrović University Clinical Center Kragujevac, Clinic of Ophthalmology, Kragujevac, Serbia
  • Mihailo Jovanović University of Kragujevac, Faculty of Medical Sciences, Department of Ophthalmology, Kragujevac, Serbia
  • Dušan Todorović University Clinical Center Kragujevac, Clinic of Ophthalmology, Kragujevac, Serbia
  • Tatjana Šarenac Vulović University Clinical Center Kragujevac, Clinic of Ophthalmology, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP210320055P
Ključne reči: glaukom, zatvorenog ugla, lečenje laserom, hirurgija, oftalmološka, procedure

Sažetak


Uvod/Cilj. Glaukom je veoma rasprostranjen širom sveta zbog čega je važno ispitati dodatne načine lečenja osoba sa glaukomom, a posebno prevenciju njegove progresije. Cilj rada bio je da se utvrdi značaj laserske periferne iridotomije (LPI) u lečenju bolesnika sa akutnim primarno zatvorenim komornim uglom (APZK) u prevenciji progresije u primarni glaukom zatvorenog ugla, kao i pojavi APZK na parnom oku. Metode. Istraživanjem je obuhvaćeno 40 bolesnika, 80 očiju, lečenih u periodu od 2017. do 2021. godine, što je ujedno bio i period praćenja u studiji.  Kod svakog bolesnika rađena je LPI obostrano ˗i na oku sa APZK i na parnom zdravom oku. Praćeni su bolesnici starosti 40–79 godina, koji su imali blokadu zenice u jednom oku. Kod svih bolesnika urađena je LPI na oba oka i praćene su promene širine komornog ugla gonioskopijom. Intraokularni pritisak (IOP) je meren aplanacionom tonometrijom i Vertical Cup/Disc ratio (Ver C/D rat) indirektnom oftalmoskopijom na biomikroskopu, korišćenjem lupe od +90 D. Rezultati. Kod svih 40 bolesnika urađena je LPI na oba oka. Širina komornog ugla na oku sa APZK pre terapije iznosila je 0,15 ± 0,36, a na parnom oku 1,20 ± 0,41. Nakon 12 meseci na oku sa APZK izmerena širina komornog ugla je iznosila 0,85 ± 0,36, a na parnom oku 1,90 ± 0,36 (Wilcoxon test ranga, р < 0,01 statistički značajna razlika). Prosečna vrednost IOP na oku bez progresije bolesti pre terapije bila je 53,61 ± 3,73 mmHg, na oku sa progresijom bolesti 60,10 ± 4,37 mmHg. Nakon 12 meseci na oku bez progresije izmerena vrednost bila je 14,92 ± 1,22 mmHg, a na oku sa progresijom 23,40 ± 2,53 mmHg (t-test za nezavisne uzorke, p < 0,01). Promena Ver C/D rat na oku bez progresije bila je 0,40 ± 0,10, na oku sa progresijom 0,45 ± 0,05, a nakon 12 meseci na oku bez progresije ostala je nepromenjena, dok je na oku sa progresijom bila 0,65 ± 0,06 (t-test za nezavisne uzorke, p < 0,01). Zaključak. Istovremena primena LPI bila je efikasna u lečenju bolesnika sa APZK i na bolesnom i na parnom oku.

Reference

1.      Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006; 90(3): 262‒7.

2.      Ohnell H, Bengtsson B, Heijl A. Making a correct diagnosis of glaucoma: Data from EMGT. J Glaucoma 2019; 28(10): 859‒64.

3.      Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol 2001; 85(11): 1277‒82.

4.      Foster PJ, Aung T, Nolan WP, Machin D, Baasanhu J, Khaw PT, et al. Defining "occludable" angles in population surveys: drainage angle width, peripheral anterior synechiae, and glaucomatous optic neuropathy in east Asian people. Br J Ophthalmol 2004; 88(4): 486‒90.

5.      Seah SK, Foster PJ, Chew PT, Jap A, Oen F, Fam HB, et al. Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey. Arch Ophthalmol 1997; 115(11): 1436‒40.

6.      Wang W, Song H, Liu Z. Computational Study on the Biomechanics of Pupil Block Phenomenon. Biomed Res Int 2019; 2019: 4820167.

7.      Gupta R, Kumar R, Chauhan L. Anterior chamber morphology changes in eyes with narrow angles by Scheimpflug imaging: pilocarpine versus laser peripheral iridotomy. Int Ophthalmol 2021; 41(6): 2099–108. 

8.      Lachkar Y, Bouassida W. Drug-induced acute angle closure glaucoma. Curr Opin Ophthalmol 2007; 18(2): 129‒33.

9.      Singh P, Rijal AP. Effectivity of Nd Yag PI in treatment of acute primary angle closure glaucoma. Nepal Med Coll J 2014; 16(1): 45‒9.

10.   Liao C, Zhang J, Jiang Y, Huang S, Aung T, Foster PJ, et al. Long-term effect of YAG laser iridotomy on corneal endothelium in primary angle closure suspects: a 72-month randomised controlled study. Br J Ophthalmol 2021; 105(3): 348–53. 

11.   Ahmadi M, Naderi Beni Z, Naderi Beni A, Kianersi F. Efficacy of neodymium-doped yttrium aluminum garnet laser iridotomies in primary angle-closure diseases: superior peripheral iridotomy versus inferior peripheral iridotomy. Curr Med Res Opin 2017; 33(4): 687–92. 

12.   Yan C, Han Y, Yu Y, Wang W, Lyu D, Tang Y, et al. Effects of lens extraction versus laser peripheral iridotomy on anterior segment morphology in primary angle closure suspect. Graefes Arch Clin Exp Ophthalmol 2019; 257(7): 1473–80. 

13.   Kumar H, Mansoori T, Warjri GB, Somarajan BI, Bandil S, Gupta V. Lasers in glaucoma. Indian J Ophthalmol 2018; 66(11): 1539–53. 

14.   Moghimi S, Bijani F, Chen R, Yasseri M, He MG, Lin SC, et al. Anterior segment dimensions following laser iridotomy in acute primary angle closure and fellow eyes. Am J Ophthalmol 2018; 186: 59–68. 

15.   Park HS, Kim JM, Shim SH, Kim HT, Bae JH, Choi CY, et al. Diurnal intraocular pressure changes in eyes affected with acute primary angle closure and fellow eyes after laser peripheral iridotomy. Jpn J Ophthalmol 2015; 59(5): 318–24. 

16.   Waisbourd M, Shafa A, Delvadia R, Sembhi H, Molineaux J, Henderer J, et al. Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project. J Glaucoma 2016; 25(10): e821‒5.

17.   Lim LS, Aung T, Husain R, Wu YJ, Gazzard G, Seah SK. Acute primary angle closure: configuration of the drainage angle in the first year after laser peripheral iridotomy. Ophthalmology 2004; 111(8): 1470‒4.

18.   Moghimi S, Chen R, Johari M, Bijani F, Mohammadi M, Khodabandeh A, et al. Changes in Anterior Segment Morphology After Laser Peripheral Iridotomy in Acute Primary Angle Closure. Am J Ophthalmol 2016; 166: 133‒40.

19.   Rao A, Rao HL, Kumar AU, Babu JG, Madhulata U, Arthi J, et al. Outcomes of laser peripheral iridotomy in angle closure disease. Semin Ophthalmol 2013; 28(1): 4‒8.

20.   Pandav SS, Kaushik S, Jain R, Bansal R, Gupta A. Laser peripheral iridotomy across the spectrum of primary angle closure. Can J Ophthalmol 2007; 42(2): 233‒7.

21.   Gupta B, Angmo D, Yadav S, Dada T, Gupta V, Sihota R. Quantification of Iridotrabecular contact in primary angle-closure disease. J Glaucoma 2020; 29(8): 681–8.

22.   Pearce FC, Thomas R, Wong NJ, Walland MJ. Long-term progression after laser peripheral iridotomy in Caucasian primary angle closure suspects. Clin Exp Ophthalmol 2018; 46(7): 828–30. 

23.   Radhakrishnan S, Chen PP, Junk AK, Nouri-Mahdavi K, Chen TC. Laser peripheral iridotomy in primary angle closure: a report by the American Academy of Ophthalmology. Ophthalmology 2018; 125(7): 1110–20. 

24.   Day AC, Cooper D, Burr J, Foster PJ, Friedman DS, Gazzard G, et al. Clear lens extraction for the management of primary angle closure glaucoma: surgical technique and refractive outcomes in the EAGLE cohort. Br J Ophthalmol 2018; 102(12): 1658‒62.

25.   Baig N, Kam KW, Tham CC. Managing Primary Angle Closure Glaucoma - The Role of Lens Extraction in this Era. Open Ophthalmol J 2016; 10: 86‒93.

26.   He M, Jiang Y, Huang S, Chang DS, Munoz B, Aung T, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomized controlled trial. Lancet 2019; 393(10181): 1609‒18.

27.   Lai J, Choy BN, Shum JW. Management of primary angle-closure glaucoma. Asia Pac J Ophthalmol (Phila) 2016; 5(1): 59–62. 

28.   Husain R, Do T, Lai J, Kitnarong N, Nongpiur ME, Perera SA, et al. Efficacy of phacoemulsification alone vs phacoemulsification with goniosynechialysis in patients with primary angle-closure disease: a randomized clinical trial. JAMA Ophthalmol 2019; 137(10): 1107–13.

29.   Aung T, Ang LP, Chan SP, Chew PT. Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes. Am J Ophthalmol 2001; 131(1): 7‒12.

30.   Tan AM, Loon SC, Chew PT. Outcomes following acute primary angle closure in an Asian population. Clin Exp Ophthalmol 2009; 37(5): 467‒72.

31.   Weinreb RN, Moghimi S. Prophylactic laser iridotomy in primary angle closure suspects. Lancet 2019; 393(10181): 1572‒4.

32.   Koh V, Keshtkaran MR, Hernstadt D, Aquino MCD, Chew PT, Sng C. Predicting the outcome of laser peripheral iridotomy for primary angle closure suspect eyes using anterior segment optical coherence tomography. Acta Ophthalmol 2019; 97(1): e57‒e63.

Objavljeno
2023/05/03
Broj časopisa
Vol. 80 Br. 04 (2023): Vojnosanitetski pregled
Rubrika
Originalni članak