The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study: Five-Year Results of a Randomized Controlled Trial.

Autor:	Baskaran M; Department of Glaucoma, Singapore Eye Research Institute and Singapore National Eye Center, Singapore, Republic of Singapore; EYE-Academic Clinical Program, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Glaucoma, Medical and Vision Research foundation, Sankara Nethralaya, Chennai, India., Kumar RS; Department of Glaucoma, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates, Cleveland Clinic Lerner College of Medicine, Case Western, Reserve University, Cleveland, Ohio., Friedman DS; Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts., Lu QS; EYE-Academic Clinical Program, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Biostatistics and Epidemiology, Singapore Clinical Research Institute, Singapore, Republic of Singapore., Wong HT; Department of Glaucoma, Tan Tock Seng Hospital, Singapore, Republic of Singapore., Chew PTK; Department of Glaucoma, National University Hospital and the Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore., Lavanya R; Department of Glaucoma, Singapore Eye Research Institute and Singapore National Eye Center, Singapore, Republic of Singapore., Narayanaswamy A; Department of Glaucoma, Singapore Eye Research Institute and Singapore National Eye Center, Singapore, Republic of Singapore., Perera SA; Department of Glaucoma, Singapore Eye Research Institute and Singapore National Eye Center, Singapore, Republic of Singapore; EYE-Academic Clinical Program, Duke-NUS Medical School, Singapore, Republic of Singapore., Foster PJ; National Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology and Moorfields Eye Hospital, London, United Kingdom., Aung T; Department of Glaucoma, Singapore Eye Research Institute and Singapore National Eye Center, Singapore, Republic of Singapore; EYE-Academic Clinical Program, Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Glaucoma, National University Hospital and the Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore. Electronic address: aung.tin@singhealth.com.sg.
Jazyk:	angličtina
Zdroj:	Ophthalmology [Ophthalmology] 2022 Feb; Vol. 129 (2), pp. 147-158. Date of Electronic Publication: 2021 Aug 26.
DOI:	10.1016/j.ophtha.2021.08.017
Abstrakt:	Purpose: To examine the efficacy of laser peripheral iridotomy (LPI) in patients who received a diagnosis of primary angle-closure suspect (PACS). Design: Prospective, randomized controlled trial. Participants: This multicenter, randomized controlled trial (ClinicalTrials.gov identifier, NCT00347178) enrolled 480 patients older than 50 years from glaucoma clinics in Singapore with bilateral asymptomatic PACS (defined as having ≥2 quadrants of appositional angle closure on gonioscopy). Methods: Each participant underwent prophylactic LPI in 1 randomly selected eye, whereas the fellow eye served as a control. Patients were followed up yearly for 5 years. Main Outcome Measures: The primary outcome measure was development of primary angle closure (PAC; defined as presence of peripheral anterior synechiae, intraocular pressure [IOP] of >21 mmHg, or both or acute angle closure [AAC]) or primary angle-closure glaucoma (PACG) over 5 years. Results: Of the 480 randomized participants, most were Chinese (92.7%) and were women (75.8%) with mean age of 62.8 ± 6.9 years. Eyes treated with LPI reached the end point less frequently after 5 years (n = 24 [5.0%]; incidence rate [IR], 11.65 per 1000 eye-years) compared with control eyes (n = 45 [9.4%]; IR, 21.84 per 1000 eye-years; P = 0.001). The adjusted hazard ratio (HR) for progression to PAC was 0.55 (95% confidence interval [CI], 0.37-0.83; P = 0.004) in LPI-treated eyes compared with control eyes. Older participants (per year; HR, 1.06; 95% CI, 1.03-1.10; P < 0.001) and eyes with higher baseline IOP (per millimeter of mercury; HR, 1.35; 95% CI, 1.22-1.50; P < 0.0001) were more likely to reach an end point. The number needed to treat to prevent an end point was 22 (95% CI, 12.8-57.5). Conclusions: In patients with bilateral asymptomatic PACS, eyes that underwent prophylactic LPI reached significantly fewer end points compared with control eyes over 5 years. However, the overall incidence of PAC or PACG was low. (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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