Efekti Nd:YAG laser iridotomije na intraokularni pritisak, oštrinu vida, promene u vidnom polju i morfologiju papile vidnog živca kod bolesnika sa primarno zatvorenim komornim uglom

Abstract

Uvod/Cilj: Prikazati značaj Laser periferne iridotomije (LPI) kod bolesnika sa akutnim primarnim zatvaranjem komornog ugla (APAC) u prevenciji progresije u primarni glaukom zatvorenog ugla (PACG) kao i pojavi APAC na parnom oku. Metode: U istraživanje je uključeno 40 bolesnika. LPI je rađena obostrano, na oku sa APAC i na parnom zdravom oku. Starost pacijenata je od 40-79 godina kod kojih je bio prisutan pupilarni blok na jednom oku i praćene su promene oštrine vida, intraokularnog pritiska (IOP), prisustva perifernih prednjih sinehija (PAS), širine komornog ugla, ekskavacije papile očnog živca (Ver C/D rat), vidnog polja (MD) indeksa, dužine trajanja simptoma, komplikacije i progresija bolesti. Rezultati: Prosečna oštrina vida na zahvaćenim očima pre LPI je bila 0,33±0,21 dok je nakon godinu dana bila 0,67±0,22 . Širina komornog ugla na zahvaćenom oku je bila 0,15± 0,36, a na parnom oku 1,2±0,41. Nakon 12 meseci na oku sa APAC 0,85 ± 0,36, a na parnom oku 1,9 ± 0,36 . Prosečna vrednost IOP na oku sa APAC je bila 56,05 ± 5,07 mmHg, a nakon godinu danaa 18,1±4,53 . Promena Ver C/D rat na oku bez progresije je bila 0,4 ± 1. Nakon 12 meseci na oku sa progresijom je bila 0,65 ± 0,06 . Prisustvo PAS nije bilo statistički značajno, kao ni pojava komplikacija, za razliku od dužine trajanja simptoma i vrednosti IOP pre početka lečenja. GHT test je bio pozitivan kod 15 pacijenata na zahvaćenom oku sa APAC. Bez medikamentozne terapije je bilo 40 % pacijenata od kojih je kod 3 pacijenta urađena trepanotrabekulektomija. Zaključak: Istovremena LPI je pokazala efikasnost u terapiji kod pacijenata sa APAC, kao i prevenciji na parnom zdravom oku.

Introduction/Aim. To point out the importance of Laser Peripheral Iridotomy (LPI) in patients with acute primary angle closure (APAC) in preventing primary angle closure glaucoma (PACG) progression and APAC in the fellow eye. Methods. The research included 40 patients. LPI was performed bilaterally, on the APAC affected eye and the healthy fellow eye. The patients ranging in age from 40 to 79 years who had the pupillary block in an eye and were monitored for changes in visual acuity, intraocular pressure (IOP), the presence of peripheral anterior synechiae (PAS), optic nerve papillary excavation (Ver C/D rat), visual field (MD) index, duration of symptoms, complications and disease progression. Results. The average visual acuity of the affected eyes before LPI was 0,33±0,21while after one year it was 0,67±0,22. The angle width of the affected eye was 0.15 ± 0.36, and 1.2 ± 0.41 of the fellow eye. After 12 months, the measurements taken were 0.85 ± 0.36 for the affected eye and 1.9 ± 0.36 for the fellow eye. The mean value of IOP in the affected eye was 56,05 ±5,07 mmHg, while after one year it was18,1±4,53. The change in Ver C/D ratio in the eye without progression was 0.4±1. After 12 months in the eye with progression it was 0.65±0.06.The presence of PAS was not statistically significant, nor was the occurrence of complications in contrast to the duration of symptoms and values of IOP before treatment.The GHT results were positive in 15 patients on the APAC affected eye. Drug therapy was not administered in 40 % of patients, of which 3 patients underwent trabeculectomy. Conclusion. Concomitant LPI has shown efficacy in patients with APAC, as well as for prevention in healthy fellow eyes.