原发性闭角型青光眼激光周边虹膜切开术后前房角形态变化的一年观察  

Alterations of angle structure in eyes with primary angle closure glaucoma after laser peripheral iridotomy:one year results

作　　者：林仲[1] 李思珍[1] 牟大鹏[1] 唐炘[1] 王宁利[1] 梁远波[1] 范肃洁[2] 刘文茹[2] 孙兰萍[2] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科学与视觉科学重点实验室,100730 [2]河北省邯郸市眼科医院,056001

出　　处：《眼科》2011年第1期38-43,共6页Ophthalmology in China

基　　金：国家科技部十一五科技支撑计划(2007BAI18B08)

摘　　要：目的定量观察原发性闭角型青光眼(PACG)激光周边虹膜切开术(LPI)后前房角形态变化及周边虹膜前粘连(PAS)对LPI术后效果的影响。设计前瞻性病例系列。研究对象河北省邯郸市眼科医院连续的25例(39眼)PACG患者。方法患眼行LPI治疗。术前、术后2周、6个月、12个月时行眼科常规检查及超声生物显微镜(UBM)检查。根据末次随访时眼压情况分为眼压控制不良组(A组)及眼压控制良好组(B组)。各随访时间点的UBM参数进行重复测量的方差分析,组间比较采用配对t检验及Wilcoxon检验。主要指标UBM图像中测量的前房角参数。结果平均随访时间为(386.4±36.7)天。LPI术后2周、6个月及12个月的房角开放距离(AOD)、小梁虹膜夹角(TIA)、虹膜隐窝面积(ARA)较术前增加均有统计学意义(P均<0.001)。小梁睫状突距离(TCPD)术后12个月较术前增加具有统计学意义(P<0.001)。B组AOD500、TIA500、ARA500及TCPD均大于A组(P均<0.05),而PAS钟点范围少于A组(P=0.01)。结论 LPI能显著增宽PACG患者的周边前房角,但PAS的范围对LPI的效果起到明显的制约作用。Objective To quantitatively evaluate the long-term changes in anterior segment morphology after laser peripheral iridotomy（LPI） in eyes with primary angle closure glaucoma（PACG）.Design Prospective case series.Participants Thirty-nine eyes with PACG of 25 consecutive patients in Handan Eye Hospital,Hebei were enrolled.Methods LPI were performed for the affected eyes.Routine ophthalmic tests and UBM examination were performed at presentation and at 2 weeks,6 months and 12 months after LPI.Eyes were divided into group A（IOP control poor） and group B（IOP control well） according to the controlling situation of IOP at last follow-up time.Parameters at each follow-up time were analyzed using repeated measures analysis of variance while t-tests and wilcoxon tests were performed between the two groups.Main Outcome Measures Parameters of anterior chamber on UBM images.Results The mean follow-up time was 386.4±36.7 days.Angle opening distance（AOD）,trabecular-iris angle（TIA） and angle recess area（ARA） were significantly wider at 2 weeks,6 months and 12 months after LPI than that at baseline（P0.001）.Trabecular-ciliary process distance（TCPD） were significantly wider at long-term after LPI than that at baseline（P0.001）.AOD500,TIA500,ARA500 and TCPD in group B were significantly wider than that of in group A（P0.01,P0.05 respectively） while the extent of peripheral anterior synechiae（PAS） were less than that of in group A（P=0.01）.Conclusions LPI can significantly widen the anterior angle in eyes with PACG and this efficacy is restricted by PAS extent.

关 键 词：原发性闭角型青光眼 激光周边虹膜切开术 超声生物显微镜 周边虹膜前粘连 

分 类 号：R779.6[医药卫生—眼科]