Prognostic Factors for the Success of Laser Iridotomy for Acute Primary Angle Closure Glaucoma
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To identify the prognostic factors for successful laser iridotomy for acute angle-closure glaucoma (AACG). Methods: We retrospectively reviewed the medical records of 77 eyes of 77 patients with AACG with initial intraocular pressure (IOP) above 40 ㎜Hg. All of the patients received maximum tolerable medical therapy (MTMT) followed by laser iridotomy. In order to comparatively analyze the factors affecting successful laser iridotomy, an increase in IOP on follow-up was defined as increase in IOP greater than 21 ㎜Hg requiring medical or surgical treatment. Results: Successful laser iridotomy was achieved in 59.7% (46/77 eyes). Thirty-one eyes (40.3%) exhibited increased IOP on follow-up, and of these, 30 eyes developed an increase in IOP within six months after the first attack. The success rate was higher (92.9%) in 42 patients who had greater than 30% IOP reduction by MTMT at the first attack compared to the 35 patients whose IOP reduction was less than 30%, of which 24 eyes (72.7%) showed more than 30% IOP reduction after intravenous hyperosmotic agent treatment (p=0.012). The success rate was higher in patients treated within seven days after the development of symptoms than in those treated after seven days (Odds ratio, 4.51; 95% confidence interval, 1.38 to 14.75). Conclusions: Our data suggest that we can expect successful IOP control after laser iridotomy in eyes with AACG if the patient can be treated within seven days after the development of symptoms and if the IOP reduction was more than 30% by MTMT.
Abstract
Purpose: To identify the prognostic factors for successful laser iridotomy for acute angle-closure glaucoma (AACG). Methods: We retrospectively reviewed the medical records of 77 eyes of 77 patients with AACG with initial intraocular pressure (IOP) above 40 ㎜Hg. All of the patients received maximum tolerable medical therapy (MTMT) followed by laser iridotomy. In order to comparatively analyze the factors affecting successful laser iridotomy, an increase in IOP on follow-up was defined as increase in IOP greater than 21 ㎜Hg requiring medical or surgical treatment. Results: Successful laser iridotomy was achieved in 59.7% (46/77 eyes). Thirty-one eyes (40.3%) exhibited increased IOP on follow-up, and of these, 30 eyes developed an increase in IOP within six months after the first attack. The success rate was higher (92.9%) in 42 patients who had greater than 30% IOP reduction by MTMT at the first attack compared to the 35 patients whose IOP reduction was less than 30%, of which 24 eyes (72.7%) showed more than 30% IOP reduction after intravenous hyperosmotic agent treatment (p=0.012). The success rate was higher in patients treated within seven days after the development of symptoms than in those treated after seven days (Odds ratio, 4.51; 95% confidence interval, 1.38 to 14.75). Conclusions: Our data suggest that we can expect successful IOP control after laser iridotomy in eyes with AACG if the patient can be treated within seven days after the development of symptoms and if the IOP reduction was more than 30% by MTMT.
참고문헌 (18)
- Rivera AH, "Laser iridotomy vs surgical iridectomy. Have the indications changed?", Arch Ophthalmol, 103, pp.1350~1354 (1985)
- Robin AL, "Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma: long-term follow-up", Arch Ophthalmol, 100, pp.919~923 (1982)
- Hong C, "Argon laser iridotomy for acute angle closure glaucoma", J Korean Ophthalmol Soc, 24, pp.807~811 (1983)
- Han CW, "Effect of YAG laser iridotomy on IOP in chronic angle closure glaucoma", J Korean Ophthalmol Soc, 36, pp.1730~1736 (1995)
- Lee HB, "Sequential Argon and Nd: YAG laser iridotomies in angle closure glaucoma", J Korean Ophthalmol Soc, 40, pp.2245~2251 (1990)
- Gazzard G, "A prospective ultrasound biomicroscopy evaluation of changes in anterior segment morphology after laser iridotomy in Asian eyes", Ophthalmology, 110, pp.630~638 (2003)
- Buckley SA, "Acute angle-closure glaucoma: relative failure of YAG iridotomy in affected eyes and factors influencing outcome", Br J Ophthalmol, 78, pp.529~533 (1994)
- Fleck BW, "A randomized prospective comparison of operative peripheral iridectomy and Nd:YAG laser iridotomy treatment of acute angle closure glaucoma: 3 year visual acuity and IOP control outcome", Br J Ophthalmol, 81, pp.884~888 (1997)
- Kashiwagi K, "Quantitive evaluation of changes in anterior segment biometry by peripheral laser iridotomy using newly developed scanning peripheral anterior chamber depth analyser", Br J Ophthalmol, 88, pp.1036~1041 (2004)
- Yoon DH, "Glaucoma" (2008), Korean Glaucoma Society
- Kim YY, "Clarifying the nomenclature for primary angle- closure glaucoma", Surv Ophthalmol, 42, pp.125~136 (1997)
- Chung JH, "Long-term IOP outcome after successful laser iridotomy for the acute primary angle-closure glaucoma", J Korean Ophthalmol Soc, 44, pp.1102~1106 (2003)
- Aung T, "Acute primary angle-closure: Long-term intraocular pressure outcome in Asian eyes", Am J Ophthalmol, 131, pp.7~12 (2001)
- 이혜진, "급성폐쇄각녹내장 환자에서 발작안과 반대편안의 레이저홍채절개술 후 안압의 장기 변화", 대한안과학회지, 45(8), pp.13~13 (2004), 대한안과학회
- Oh YG, "The anterior chamber angle is different racial groups, a gonioscopic study", Eye, 8, pp.104~108 (1994)
- Lowe RF, "Clinical types of primary angle-closure glaucoma", Aust N Z J Ophthalmol, 16, pp.245~250 (1988)
- Jong Yun Lee, "Distribution and Characteristics of Peripheral Anterior Synechiae in Primary Angle-Closure Glaucoma", Korean Journal of Ophthalmology, 20(2), pp.104~108 (2006), 대한안과학회
- Kim YY, "Dilated, miotic-resistant pupil and laser iridotomy in primary angle-closure glaucoma", Ophthalmologica, 211, pp.205~208 (1997)