急性发作的原发性闭角型青光眼中慢性闭角型青光眼的构成比及治疗效果  

The constitution of chronic PACG in PACG with acute attack and its treatment effects

作　　者：李思珍[1] 梁远波[2] 王宁利[3] 孙霞[3] 范肃洁[4] 孙兰萍[4] 刘文茹[4] SUCIJANTI 

机构地区：[1]南京爱尔眼科医院,210006 [2]温州医科大学附属眼视光医院,325027 [3]首都医科大学附属北京同仁医院北京同仁眼科中心,100730 [4]邯郸市眼科医院,056005

出　　处：《眼科》2015年第4期234-239,共6页Ophthalmology in China

基　　金：国家科技支撑计划课题(2007BAI18B00);卫生部卫生行业科研专项(201002019)

摘　　要：目的调查急性发作的原发性闭角型青光眼(PACG)中慢性闭角型青光眼(CPACG)急性发作(简称"慢闭急发")和急性闭角型青光眼(APACG)发作眼(简称"急闭发作")的比率,了解两者之间是否存在解剖结构和治疗效果的差异。设计病例对照研究。研究对象确诊急性发作期的PACG患者159例(159眼)。方法入选患者在急性发作期接受初步检查后立即给予降眼压药物或激光虹膜周边成形术治疗。角膜恢复透明后行眼压、眼底、垂直杯盘比(VCDR)、视野、A超、UBM、房角镜、角膜内皮细胞计数等检查。VCDR≥0.6者为慢闭急发,VCDR<0.6者为急闭发作。眼压控制后所有病例均接受激光周边虹膜切开术(LPI)治疗。随访1年。治疗后眼压≤21 mm Hg者为眼压控制,随访观察;>21 mm Hg为眼压失控,先联合降眼压药物治疗,无效则行小梁切除术治疗。主要指标VCDR、眼压、发作持续时间(AD)、虹膜前粘连(PAS)范围、前房深度(ACD)、晶状体厚度(LT)、眼轴(AL)、眼压控制率等。结果所有病例(AD≤720 h)中VCDR≥0.6者占15%。AD≤168 h病例中VCDR≥0.6者占11.2%。随着AD延长VCDR≥0.6比率上升。AD≤168 h的病例中,对慢闭急发与急闭发作比较:AD分别为15(10,52)h、23(12,72)h(P=0.508);慢闭急发的PAS范围8.0(3.0,11.5)钟点,显著高于急闭发作2.0(0.0,6.0)钟点(P=0.004);ACD和LT无显著性差异,但是慢闭急发的AL(22.31±0.72 mm)大于急闭发作者(21.73±0.98 mm)(P=0.004)。急性发作期治疗中两组眼压相近。LPI术后完成1年随访的病例为73.6%(92/125)。LPI眼压控制率:慢闭急发55.6%(5/9)低于急闭发作的79.5%(66/83)(P=0.104)。结论急性发作PACG中慢性闭角型青光眼仅占十分之一。慢闭急发者比急闭发作者具有更大范围的PAS、更长的眼轴。慢闭急发LPI的治疗效果劣于急闭发作。Objective To determine the constituent ratio of chronic PACG（CPACG） and acute PACG（APACG） in PACG with acute attack, and compare the difference of the results of treatment. Design Case-controlled study. Participarts Consecutive PACG patients（159 patients, 159 eyes） with acute attack. Methods Subjects were recruited and received one of two treatment options： immediate laser peripheral iridoplasty（LPIP） or intraocular pressure（IOP）-lowering medications. After the IOP was controlled, all the patients received examination： IOP, fundus examination, vertical cup-to-disc ratio（VCDR）, visual field test, A-scan, UBM, gonioscopy, endocellium cell cunt（ECC）, etc. All patients were divided into two groups CPACG（VCDR ≥ 0.6） and APACG（VCDR0.6）, and received laser peripheral iridotomy（LPI）. There was no further treatment if IOP ≤ 21 mm Hg and IOP-lowering medicine would be added if IOP21 mm Hg. Filtering surgery would be performed when medicine did not decrease IOP effectively. Main OutcomeMeasures VCDR, IOP, acute attack duration（AD）, peripheral anterior synechia（PAS） extent, visual acuity, ECC, anterior chamber depth（ACD）, lens thickness（LT）, ocular axis length（AL）, means defect（MD） of visual field and IOP-control-ratio. Results APACG（VCDR0.6） occupied 85% in PACG with acute attack and CPACG（VCDR ≥ 0.6） 15%, however APACG occupied 88.8% and CPACG 11.2% in PACG with AD ≤ 168 h. PACG with AD ≤ 168 h were further analyzed. There was no significant difference in AD between CPACG 23 h（12, 72） and APACG 15 h（10, 52）（P=0.508）. PAS extents in CPCG 8.0（3.0, 11.5） clocks were wider than APACG 2.0（0.0, 6.0） clocks（P=0.004）. There was no significant difference in ACD and LT, but AL in CPACG（22.31±0.72 mm） were longer than in APACG（21.73±0.98 mm）（P=0.004）. There was no significant difference in IOP between CPACG and APACG at the treatment of the acute stage. 73.6 %（92/125） patients accomplished 1 year＇s follow-

关 键 词：原发性闭角型青光眼 急性发作 激光虹膜周边切开术 

分 类 号：R779.6[医药卫生—眼科]