慢性肾衰患者血液透析前后眼前段结构和眼压变化的量化分析  

Investigation of changes in the biometric structure of the anterior chamber and intraocular pressure in patients with chronic renal failure after hemodialysis

作　　者：赵海岚[1] 戚晓虹[1] 沈维[1] 叶明霞[1] 吴苗琴[1] 

机构地区：[1]浙江省人民医院眼科,浙江杭州310014

出　　处：《中华眼视光学与视觉科学杂志》2011年第2期140-143,共4页Chinese Journal Of Optometry Ophthalmology And Visual Science

摘　　要：目的 探讨慢性肾衰患者血液透析（简称血透）前后前房角宽度（鼻侧、颞侧、上方、下方）、中央前房深度、晶状体厚度和眼压的变化,以及这些改变与患者血透过程中各项血液指标改变的关系.方法 回顾性系列病例研究.选取因慢性肾衰长期在浙江省人民医院进行血透治疗的35名患者（70眼）,分别在血透前及血透后测量眼压、眼部A超（品状体厚度）以及应用索维全景超声生物显微镜进行眼前段结构扫描（中央前房深度、小梁虹膜角、房角开放距离）.根据血透前的前房角镜检查分为窄角组及宽角组,并测量其血透前后的眼压.测量血透前后上述患者尿素氮、肌酐、血浆渗透压、白蛋白及脱水量.采用配对t检验对各项结果进行分析.结果 35名（70跟）慢性肾衰患者血透后的眼压较血透前升高（t=-3.389,P＜0.05）.血透后中央前房深度较血透前显著变浅（t=8.043,P＜0.01）.血透后眼鼻侧、颞侧、上方、下方的小梁虹膜角及房角开放距离均较血透前变小（小梁虹膜角：t＝4.637、8.893、3.575、3.436,房角开放距离：t=3.122、5.372、3.838、2.915,P均＜0.01）,晶状体厚度变厚（t＝-9.132,P＜0.01）.窄角组（14眼）血透后眼压显著增高（t＝-0.045,P＜0.01）,而宽角组（56眼）血透后跟压较血透前差异无统计学意义（t＝-9.515,P＞0.05）.血透后的血尿素氮、肌酐、血浆渗透压较血透前显著降低（t=16.075、13.676、113.063,P均＜0.01）,白蛋白较血透前增高（t＝-7.756,P＜0.01）.结论 由于血透治疗后液体顺渗透压梯度移动至眼内,慢性肾衰患者血透后前房深度较血透前变浅,前房角变窄,晶状体变厚,具有窄房角的患者血透后眼压显著增高.故建议对慢性肾衰患者在血透治疗前进行前房状态评估,并进行相应的处理.Objective To investigate changes in the width of the iridocorneal angle in the four quadrants （nasal, temporal, superior, inferior）, central anterior chamber depth, lens thickness and intraocular pressure （IOP） in patients with chronic renal failure after hemodialysis. Methods Retrospective case series study. Thirty-five patients （70 eyes） with chronic renal failure were measured with tonometry （IOP）, A/B scan （lens thickness） and ultrasound biomicroscopy （central anterior chamber depth, the trabecular iris angle and four directions of the angle opening distance） before and after hemodialysis. The patients were divided into 2 groups based on gonioscopy results： a narrow angle group （14 eyes） and an open angle group （56 eyes）. IOP was measured in the 2 groups before and after hemodialysis. The patients＇ blood urea nitrogen （bun）, creatinine （scr）, albumin （alb）,plasma osmotic pressure and dehydration were also checked before and after hemodialysis. All changes in the parameters were analyzed with a paired t test. Results IOP increased significantly in 35 patients （70 eyes） after hemodialysis （t=-3.389, P〈0.05）. Central anterior chamber depth （t=8.043,P〈0.01）, iridocorneal angle width （t=4.637, 8.893, 3.575, 3.436, P〈0.01 for all）, and angle opening distance （t=3.122, 5.372, 3.838, 2.915, P〈0.01 for all） in 35 patients decreased, with the lens becoming significantly thicker （t=-9.132, P〈0.01） after hemodialysis. The IOP in narrow angle eyes （14 eyes） increased significantly （t=-0.045, P〈0.01） after hemodialysis while the IOP in open angle eyes （56 eyes） showed no significant change （t=-9.515, P〉0.05）. Bun, scr and plasma osmotic pressure decreased in 35 patients （t=16.075, 13.676, 113.063, P〈0.01 for all） and alb increased （t=-7.756, P〈0.01） after hemodialysis. Conclusion Due to the movement of liquid in eyes cause by the osmotic pressure gradient after hemodialysis, the eyes of patients with chronic re

关 键 词：肾透析: 前房 品状体 眼 眼内压 

分 类 号：R692.5[医药卫生—泌尿科学]