Purpose

To examine the efficacy and complications of laser peripheral iridotomy (LPI) in subjects with primary angle closure (PAC).

Methods

Literature searches in the PubMed and Cochrane databases were last conducted in August 2017 and yielded 300 unique citations. Of these, 36 met the inclusion criteria and were rated according to the strength of evidence; 6 articles were rated level I, 11 articles were rated level II, and 19 articles were rated level III.

Results

Reported outcomes were change in angle width, effect on intraocular pressure (IOP) control, disease progression, and complications. Most of the studies (29/36, 81%) included only Asian subjects. Angle width (measured by gonioscopy, ultrasound biomicroscopy, and anterior segment OCT) increased after LPI in all stages of angle closure. Gonioscopically defined persistent angle closure after LPI was reported in 2% to 57% of eyes across the disease spectrum. Baseline factors associated with persistent angle closure included narrower angle and parameters representing nonpupillary block mechanisms of angle closure, such as a thick iris, an anteriorly positioned ciliary body, or a greater lens vault. After LPI, further treatment to control IOP was reported in 0%-8% of PAC suspect (PACS), 42% to 67% of PAC, 21% to 47% of acute PAC (APAC), and 83%-100% of PAC glaucoma (PACG) eyes. Progression to PACG ranged from 0% to 0.3% per year in PACS and 0% to 4% per year in PAC. Complications after LPI included IOP spike (8–17 mmHg increase from baseline in 6%–10%), dysphotopsia (2%–11%), anterior chamber bleeding (30%–41%), and cataract progression (23%–39%).

Conclusions

Laser peripheral iridotomy increases angle width in all stages of primary angle closure and has a good safety profile. Most PACS eyes do not receive further intervention, whereas many PAC and APAC eyes, and most PACG eyes, receive further treatment. Progression to PACG is uncommon in PACS and PAC. There are limited data on the comparative efficacy of LPI versus other treatments for the various stages of angle closure; 1 randomized controlled trial each demonstrated superiority of cataract surgery over LPI in APAC and of clear lens extraction over LPI in PACG or PAC with IOP above 30 mmHg.

中文翻译：

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激光周边虹膜切开术在原发性角膜闭合术中的应用

目的

以检查激光周边虹膜切开术（LPI）在原发性闭角（PAC）患者中的疗效和并发症。

方法

最近一次在PubMed和Cochrane数据库中进行文献检索是在2017年8月，获得了300篇独特的引文。其中，有36个符合纳入标准，并根据证据强度进行了评级。I级为6篇，II级为11篇，III级为19篇。

结果

报告的结果是角度宽度的变化，对眼内压（IOP）控制的影响，疾病进展和并发症。大多数研究（29 / 36，81％）仅包括亚洲受试者。LPI后所有角度闭合阶段的角宽度（通过角膜镜检查，超声生物显微镜检查和前节OCT测量）均增加。据报道，在整个疾病谱中，有2％至57％的眼睛在LPI后用镜检查确定了持续性闭角。与持续性闭角相关的基线因素包括狭窄的角度和代表非瞳孔闭锁机制的参数，例如虹膜粗大，睫状体位于前方或晶状体较大。LPI后，据报道有0％-8％的PAC嫌疑人（PACS），42％到67％的PAC，21％到47％的急性PAC（APAC）进一步控制IOP，和83％-100％的PAC青光眼（PACG）眼睛。在PACS中，向PACG的进展每年从0％到0.3％不等，而在PAC中，每年从0％到4％不等。LPI后的并发症包括IOP峰值（比基线增加8–17 mmHg，增加6％–10％），验光困难（2％–11％），前房出血（30％–41％）和白内障进展（23％–39） ％）。

结论

激光外围虹膜切开术在初次角膜闭合的所有阶段均增加了角宽度，并具有良好的安全性。大多数PACS眼不接受进一步的干预，而许多PAC和APAC眼以及大多数PACG眼都需要进一步的治疗。在PACS和PAC中，进展为PACG的情况并不常见。LPI与其他治疗方法在角闭合不同阶段的比较功效方面的数据有限。1项随机对照试验均显示，白内障手术在APAC中优于LPI，在IOP高于30 mmHg的PACG或PAC中，白内障摘除术优于LPI。