原发性闭角型青光眼临床前期预防手术对HRT-Ⅱ参数和视野的影响  

Effect of prophylactic surgeries on HRT-Ⅱ parameters and visual field of preclinical primary closed-angle glaucoma patients

作　　者：郭斌[1,2] 杨新光[2] 范钦华[1] 刘钊[3] 于敬妮[2] 陈莉[2] 艾华[2] 

机构地区：[1]解放军81医院眼科,中国江苏省南京市210002 [2]中国陕西省西安市第四医院陕西省眼科医疗中心,710004 [3]西安交通大学医学院,中国陕西省西安市710061

出　　处：《国际眼科杂志》2008年第11期2244-2247,共4页International Eye Science

基　　金：中国陕西省卫生厅科学研究基金(No.06D17)~~

摘　　要：目的:观察正常眼和临床前期原发性闭角型青光眼(pri-mary angle-closure glaucoma,PACG)的海德堡视网膜断层扫描仪(HRT-Ⅱ)视盘参数、视网膜神经纤维层厚度和Humphrey视野计视野指数,并观察预防手术对其影响。方法:PACG临床前期患者57例57眼,其中41例41眼经青光眼干预性处理(手术或激光周边虹膜切开)为T组,另16眼不进行干预性治疗为U组,正常对照(NC)30例60眼,NC组和T组眼在治疗前(0mo)和治疗后6mo时、U组眼在首诊时(0mo)和6mo后分别进行眼科常规检查、HRT-Ⅱ和Humphrey视野计检查。获得视力、眼压、房角、视杯面积(cup area,CA)、视盘面积(disk area,DA)、盘沿面积(rimarea,RA)、视杯容积(cup volume,CV)、盘沿容积(rimvolume,RV)、杯盘面积比(cup/disk area ratio,CDAR)、线性杯盘比(linear cup/disk ratio,LCDR)、平均视杯深度(mean cup depth,MCD)、最大视杯深度(maxi-mum cup depth,maxCD)、视杯形态测量(cup shape meas-ure,CSM)、视杯高度变异轮廓(height variation contour,HVC)、平均视网膜神经纤维层厚度(mean RNFL thick-ness,MRNFLT)、视神经纤维层横截面积(RNFL cross sec-tionalarea)和平均视野缺损(MD)等参数,对比分析NC组和T组眼0mo和6mo时、U组眼在0mo和6mo后的各参数的差异。结果:NC组、T组眼0mo和U组眼0mo之间的视力和眼压差异无统计学意义,T组0mo、6mo和U组0mo、6mo视力、眼压和房角宽度变化差异无统计学意义。NC组和T组眼0mo之间MD差异无统计学意义,而HRT-Ⅱ的CA、RA、CV、CDAR、CSM、HVC、MRNFLT和RCSA存在差异(P<0.05)。T组眼MD绝对值增加率[48.61%(27.67%)]比U组[66.18%(21.33%)]低(P<0.05),CA的增加率要小于U组的增加率(P<0.05),相应,RA的减小幅度要低于U组(P<0.05),T组6mo CDAR较U组6mo小(P<0.05)。U组6mo的CSM、HVC、MRNFLT较T组6mo小(P<0.05)。结论:选择激光或单纯虹膜周边切除的干预性治疗可以延缓临床前期PACG的进展。AIM： To study the structural parameters of the optic nerve head and the retinal nerve fiber layer （RNFL） obtained by using Heidelberg Retina Tomograph-II （ HRT- II） and the perimetric indices of Humphrey perimetry in normal and preclinical primary closed-angle glaucoma （PACG） subjects and to observe the effect of prophylactic surgeries on these parameters of the preclinical PACG patients, METHODS： Fifty-seven patients （57 eyes） and 30 healthy subjects （60 eyes） were enrolled in the study and classified into 3 separate groups： 60 healthy eyes for normal control, 41 PACG eyes to undergo preventive peripheral iridectomy with or without laser, 16 PACG eyes untreated with surgery. Of the normal control eyes, 41 PACG eyes treated with surgery before treatment and 6 months after treatment and 16 PACG eyes untreated at the first diagnosis and 6 months later were examined with ophthalmic routine examinations, HRT-II and Humphrey perimetry. Visual acuity, intraocular pressure, anterior chamber angle width and cup area （CA）, disk area （DA）, rim area （ RA）, cup volume （ CV）, rim volume （ RV）, cup/ disk area ratio （CDAR）, linear cup/disk ratio （LCDR）, mean cup depth （ MCD）, maximum cup depth （ MaxCD）, cup shape measure （CSM）, height variation contour （HVC）, mean RNFL thickness （MRNFLT）, RNFL cross sectional area （RCSA） and mean defect （MD） values were obtained from the result reports. The differences of parameters between normal eyes, 41 treated PACG eyes of pre- and post-treatment and 16 untreated PACG eyes at the first diagnosis and 6 months later were comparatively analyzed with statistic software. RESULTS： Among the normal control group, the treated PACG group before surgery and the untreated PACG group at the first diagnosis, there were no significant differences of visual acuity and intraocular pressure. No statistically significant differences of visual acuity, intraocular pressure and the change of anterior chamber angle width were

关 键 词：青光眼 预防性手术 视野 视网膜神经纤维层 

分 类 号：R779.6[医药卫生—眼科]