"Pendahuluan: Glaukoma primer sudut tertutup akut (GPSTA) adalah penyakit mata yang disebabkan oleh tertutupnya seluruh anyamari trabekulum oleh pangkal iris secara mendadak. GPSTA menycbabkan kcbutaan yang bersifat permanen. Penanganan cepat dan segera adaiah mutlak untuk mencegah kebutaan. Penatalaksanaan awal adaiah menurunkan TIO secepat mungkin dengan pemberian medikamentosa gabungan inisial atau parasentesis yang dilanjutkan dngan Iridektomi Perifer Laser (IPL). Proses infiamasi ras Asia Iebih berat dan TGP-B2 dan TNF-a merupakan petanda iskemia dan inflamasi.
Tujuan: (1) Menilai rcspons parasentesis pada pasien GPSTA; (2) Membandingkan kadar TGP-B2 dan TNF-a humor akuos pasien GPSTA dengan pasien katarak; (3) Menilai efek pemberian deksametason terhadap kadar TGP-B2 dan TNF-a humor akuos pasien GPSTA; (4) Memperhitungkan faktor risiko terhadap suksesnya IPL pada pasien GPSTA.
Bahan dan Cara: Penelitian ini merupakan studi prospektif dengan uji pra-pasca untuk menilai respons parasentesis dan studi komparatif belah lintang untuk membandingkan kadar TGP-B2 dan TNF-a humor akuos pasien GPSTA dengan pasien katarak. Untuk menilai efek deksametason terhadap kadar TGF-B2 dan TNF-a humor akuous dilakukan studi ldinis acak terkontrol tersamar ganda. Untuk mencari faktor risiko yang mempengaruhi keberhasilan IPL dilakukan perhitungan bivariat, dilanjutkan regresi logistik. Subjek penelitian adalah semua pasien GPSTA dengan Iama serangan di bawah 1 bulan.
Hasil penelitian analisis pada 45 mata pasien GPSTA yang menjalani parasentesis, TIO awal turun. Kadar TGF-B2 dan TNF-a humor akuos pasien GPSTA, rnasing-masing, 4 kali dan 3 kali dari pasien katarak. Setelah IPL dan randomisasi antara kelompok kontrol dan deksametason, deksametason menurunkan kadar TGF-B2 dan TNF-a pasien GPSTA secara tidak signifikan. Faktor risiko yang mempengaruhi keberhasilan IPL adalah respons TIO pascaparascntesis dan luas SAP. Inflamasi tidak berpengaruh terhadap IPL, tetapi sekuele yang diakibatkannya mempengaruhi tindakan tersebut, yaitu SAP. Selain itu, faktor respons terhadap tindakan parasentesis juga turut berperan secara signifikan.
Kesimpulan: Tindakan parasentesis menurunkan TIO awal pasien GPSTA. Kadar TGF-B2 dan TNF-a humor akuos tinggi pada pasien GPSTA. Pengaruh deksametason menurunkan kadar TGP-B2 dan TNF-a secara tidak signifikan. Keberhasilan tindakan IPL adalah 95% pada pasien GPSTA yang mempunyai respons baik terhadap parasentesis dengan luas SAP di bawah 4 jam. Sebaliknya, bila pasien GPSTA tidak memberi respons baik pascaparasentesis dan luas SAP 9-12 jam, maka keberhasilan IPL hanya 5%.
Introduction: Acute primary angle closure glaucoma (APACG) is an eye disease caused by sudden closure of trabecular meshwork by the iris root. APACG could cause permanent blindness. Rapid management was essential in preventing blindness. Early management of this disease was done by reducing IOP as quickly as possible by the administration of initial combined medications or paracentesis, followed by laser peripheral iridectomy. Inflammatory process in the Asian race was more severe and TGP-B2 and TNF-a. constituted the signs of ischemia and inflammation.
Objective: (1) To evaluate the response to paracentesis in APACG patients; (2) to compare the TGP-B2 and TNF-a levels of aquous humor in APACG patients and cataract patients; (3) to analyze the effects of the administration of dexamethasone on the TGF-B2 and TNF-a levels of aquous humor in APACG patients; (4) to calculate the risk factors against the success of laser peripheral iridectomy in APACG patients.
Material and methods: This study was a prospective study with pre-post tests design to evaluate the response to paracentesis. Cross-sectional comparative study was perfomied to compare the TGF-B2 and TNF-a. levels of aquous humor in APACG patients and cataract patients. To evaluate the effects of dexamethasone on the TGF-B2 and TNF-a levels of aquous humor, a double-mask, randomized controlled trial was performed. To identify the risk factors affecting the success of laser peripheral iridectomy, a bivariate calculation was done, followed by logistic regression calculation. The subjects of the study were all APACG patients with the duration of attack under one month.
Results: Analysis in 45 eyes of APACG patients undergoing paracentesis showed t.hat early IOP decreased by 49%. The TGF-B2 and TNF-a levels of aquous humor in APACG patients were four and three times as high as those in cataract patients respectively. After laser peripheral iridectomy and randomization between the control group and dexamethasone group, it showed that dexamethasone reduced the TGF-B2 and TNF-a levels of APACG patients insignificantly. The risk factors affecting the success of laser peripheral iridectomy was the response to IOP after paracentesis and the size of peripheral anterior synechiae (PAS). Inflammation did not affect laser peripheral iridectomy; however, the sequele that it caused affected the intervention, i.e. PAS. In addition, the response factor inparacentesis also played a significant role.
Conclusion: Paracentesis could reduce early IOP in APACG patients. The TGF-B2 and TNF-a levels of aquous humor were high in APACG patients. The effect of dexamethasone in reducing the TGF-B2 and TNF-a levels was not significant. The success rate of laser peripheral iridectomy was 95% in APACG patients with good response to paracentesis with the size of PAS under 4 hours. By contrast, if APACG patients did not give a good response to paracentesis and the size of PAS was 9-12 hours, the success rate of laser peripheral iridectomy was only 5%."
