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Yuanbo Liang Liang, Yanyun Chen, Sujie Fan, Hailiin Meng, Xing Wang, Ravi Thomas, Shi Song Rong, Ningli Wang; Laser peripheral iridotomy versus trabeculectomy as an initial treatment for primary angle-closure glaucoma: a non-randomized comparative study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6123.
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To compare the efficacy of laser peripheral iridotomy (LPI) versus trabeculectomy as an initial treatment for primary angle-closure glaucoma (PACG) in China.
a non-randomized comparative study. 165 patients with PACG, who had participated in two randomized studies from 2006 to2008 and followed-up for a minimum of 12 months, were included.77 eyes from 54 PACG patients who were initially treated with LPI were divided into two groups: group 1 comprised 23 eyes with peripheral anterior synechia (PAS) < 6 clock hours and group 2 included 54 eyes with PAS ≥ 6 clock hours. 111 PACG patients with PAS≥ 6 clock hours who had undergone primary trabeculectomy during the course of another trial formed group 3.
IOP at each visit was significantly lower in group 3 than in groups 1 and group2 (p< 0.001). Mean IOP during follow-up in group 3 (14.0±3.1mmHg) was significantly lower than in group 1 (17.0±3.2mmHg,p< 0.001) and group 2 (22.3±7.5mmHg,p< 0.001). Long-term IOP fluctuation (defined as maximum minus minimum IOP) in group2 (10.7±9.1mmHg) was larger than that in group3 (6.6±3.8mmHg,p< 0.001) and group 1 (6.3±4.6mmHg,p< 0.001). Eight of 23 (34.8%, CI:14.3%-54.2%) eyes in group 1 and 23 of 54 (42.6%, CI: 29.4%-55.8%) eyes in group 2 required a mean of 1.3 and 1.8 IOP lowering medications, respectively, compared to seven of 111 (6.3%, CI: 1.8%-10.8%) of eyes in group 3 needing a mean of 1.1 medications. Six eyes (7.8%, CI:2%-14%)with a baseline PAS ≥ 6 clock hours that underwent initial LPI required a trabeculectomy. 19 eyes in Group 3 developed transient shallow anterior chamberand 16 eyes experienced transient hypotony.13eyes with shallow anterior chamber developed hypotony. Two lines or more of vision loss were observed in18% of the patients in group 3, and 13.0% in the LPI group. Progression of cataract as determined clinically using LOCS charts occurred in one eye (4.3%, CI:-4.0%-12.6%) in group 1, two eyes (3.7%,CI: -1.3%-8.7%) in group 2, and16 eyes (14.4%,CI: 7.9%-20.9%) in group 3.
Primary trabeculectomyis more effective than LPI in lowering IOP and controlling long-term IOP fluctuation in PACG.In developing countries such as hina,trabeculectomymay need to be considered a primary option for PACG with PAS ≥ 6 clock hours.
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