Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial
| Autor: | David S. Friedman, Dolly S. Chang, Paul J. Foster, Mingguang He, Tin Aung, Yuzhen Jiang, Beatriz Munoz, Shengsong Huang |
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| Rok vydání: | 2019 |
| Předmět: |
Male
China Iridectomy Intraocular pressure medicine.medical_specialty genetic structures medicine.medical_treatment Glaucoma Kaplan-Meier Estimate Lasers Solid-State 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Humans Medicine 030212 general & internal medicine Adverse effect Intraocular Pressure Aged Intention-to-treat analysis business.industry Incidence (epidemiology) Hazard ratio Prophylactic Surgical Procedures General Medicine Middle Aged medicine.disease eye diseases Intention to Treat Analysis Surgery Editorial Commentary Female Glaucoma Angle-Closure business |
| Zdroj: | The Lancet. 393:1609-1618 |
| ISSN: | 0140-6736 |
| DOI: | 10.1016/s0140-6736(18)32607-2 |
| Popis: | Background Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. Methods In this randomised controlled trial, bilateral primary angle closure suspects aged 50-70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. Findings Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30-0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. Interpretation Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. Funding Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China. |
| Databáze: | OpenAIRE |
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