原发性慢性闭角型青光眼房角粘连与视野缺损的关系  

Relationship between the peripheral anterior synechiae and the visual field defects in chronic primary angle-closure glaucoma

作　　者：朱芹[1] 欧阳珊[1] 李睿姝[1] 马瑛娜[1] 高维奇[1] 

机构地区：[1]哈尔滨医科大学附属第一医院眼科,哈尔滨150001

出　　处：《中国实用眼科杂志》2011年第12期1319-1321,共3页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨原发性慢性闭角型青光眼相关的危险因素及房角粘连与视野缺损的关系。方法2008年9月至2010年9月经诊疗的原发性慢性闭角型青光眼病人80例（101只眼）及正常人90名（101只眼），分析其眼压、前房深度、眼轴长度及房角粘连程度与视野缺损的关系。其中有18例21只眼行虹膜周边激光切开术，24例32只眼行小梁切除联合虹膜根部切除术，一周后观察其变化情况。结果原发性慢性闭角型青光眼组中房角均有不同程度粘连（0～360度），治疗前眼压平均值（41．49±11．996）mmHg，前房深度（2．0208±0．2274）mm，眼轴长（22．16±0．575）mm；正常眼组眼压平均值（15．06±2．697）mmHg，前房深度（2．6378±0．3155）mm，眼轴长（23．2411±1．1350）mm，两组间比较，差异有统计学意义（P〈0．01）。在青光眼组视野平均缺损与房角粘连程度成正相关；眼压随房角粘连程度逐渐升高。虹膜周边激光切开术治疗一周后，房角粘连部分改善，眼压平均值（16．57±4．094）mmHg，前房深度（2．1310±0．1839）mm。小梁切除联合虹膜根部切除术一周后复查，多数房角粘连者得到了改善，眼压平均值（13．91±2．668）ramHg，前房深度（2．136±0．1462）mm，与治疗前相比，各参数均有统计学意义（P〈0．01）。结论本组病人与正常眼相比，具有眼轴短、前房浅的特点，容易发生房角粘连。视野缺损的程度与房角粘连程度成正相关，房角粘连范围愈广，视野缺损倾向愈大。眼压也与房角粘连程度成正相关，粘连的范围愈大，眼压值趋向愈高。提示房角粘连是慢闭发展的重要因素。虹膜周边激光切开术和小梁切除联合虹膜根部切除术都可以改善前房深度，但房角粘连范围大于180。时，小梁切除术效果更明确，虹膜周边激光切开相对无效。Objective investigate the risk factors of chronic primary angle-closure glaucoma （CPACG） and the relationship between the peripheral anterior synechiae and the visual field defects. Methods From Sept,2008 to Oct. 2010,80 cases （101eyes） with chronic primary angle-closure glaucoma and 90 normal persons （101eyes） were studied. The examination for eyes included the intraocular pressure（IOP）,the anterior chamber depth （ACD）,the axial length （AL）,peripheral anterior synechiae （PAS） and the visual field. 18 cases （21eyes） with CPACG treated with laser for peripherial iridectomy （LPI）,The trabeculectomy performed in 24 cases （32eyes） with CPACG.Results PAS was com- monly found in the eyes with CPACG,whose average IOP was 41.49±11.996mmHg,the average ACD was 2.02± 0.23mm;There was no PAS in normal eyes,whose average IOP was 15.06 ± 2.70mmHg, the average ACD was 2.64 ±0.32mm. The difference between two groups was significant （P 〈0.01 ）. The mean defect of visual field and the peripheral anterior synechiae in CPACG was positive correlation. The intraocular pressure gradually increased with the degree of peripheral anterior synechiae. After one week of treatement with laser,the average IOP was 16.57 ± 4.09mmHg,the averaage ACD was 2.13± 0.18mm,after one week of trabeculectomy,the average IOP was 13.91 ± 2.67mmHg,the average ACD was 2.14± 0.15mm. The peripheral anterior synechiae could partly improved. The resuits had statistically significant differences between treated and untreated group. Conclusions Compared with the normol eyes,the eyes with CPACG was shallow ACD. PAS occurred easy in those eyes. The intraocular pressure was positive correlation to PAS. With the expanding of the PAS,the IOP become higher, and the mean defect of the visual field become more serious, The trabeculectomy and LPI could all reduce the IOP and deepen the ACD. But the former is more effective when the PAS 〉180 degree.

关 键 词：房角 青光眼 视野 眼压 

分 类 号：R775[医药卫生—眼科]