预防性激光周边虹膜切除术对不同房角关闭机制原发性闭角型青光眼的疗效  

Prophylactic laser peripheral iridotomy for primary angle closure glaucoma with different angle closure mechanisms

作　　者：崔骁 张睿[1] 孙伟峰[1] 秦海峰[1] 许冰[1] 沈炜[1] CUI Xiao;ZHANG Rui;SUN Wei-feng;QIN Hai-feng;XU Bing;SHEN Wei(Department of Ophthalmology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院眼科,上海200433

出　　处：《海军军医大学学报》2022年第11期1335-1338,共4页Academic Journal of Naval Medical University

摘　　要：目的应用超声生物显微镜(UBM)评价原发性闭角型青光眼(PACG)患者行预防性激光周边虹膜切除术(LPI)治疗后房角的变化,分析不同房角关闭机制患者的疗效。方法选择2018年3月至2021年10月在海军军医大学(第二军医大学)第一附属医院确诊PACG并行LPI治疗的患者23例(35只眼),对所有患者在LPI治疗前和治疗后1周进行标准眼科临床检查和UBM检查。根据UBM图像,将房角关闭机制分为瞳孔阻滞型、高褶虹膜型和混合型。结果LPI前,35只眼中有30只(85.7%)表现为瞳孔阻滞型,5只(14.3%)表现为高褶虹膜型。LPI后,原表现为瞳孔阻滞型的30只眼中18只表现为瞳孔阻滞型,12只表现为混合型,并且LPI后瞳孔阻滞型和混合型的房角开放度均较LPI前增加(20.2°±4.2°vs 6.6°±1.8°,12.4°±3.9°vs 6.3°±1.7°,P均<0.05);原表现为高褶虹膜型的5只眼仍表现为高褶虹膜型,且其房角开放度较LPI前无明显变化(8.3°±1.7°vs 6.7°±2.1°,P>0.05)。结论瞳孔阻滞型PACG患者行LPI后房角开放效果较好,而高褶虹膜型患者行LPI后效果不佳,提示高褶虹膜是PACG患者房角关闭的重要机制并影响LPI疗效。Objective To evaluate the angle changes in patients with primary angle closure glaucoma(PACG)after prophylactic laser peripheral iridotomy(LPI)using ultrasound biomicroscopy(UBM),and analyze the treatment effect on patients with different angle closure mechanisms.Methods Basic standard examination and UBM were performed before and 1 week after LPI on 23 patients(35 eyes)who were diagnosed with PACG in The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Mar.2018 to Oct.2021.Based on the UBM results,the angle closure mechanisms were divided into pupillary block type,plateau iris type,and mixed type.Results Among the 35 eyes,30(85.7%)eyes showed pupillary block type and 5(14.3%)showed plateau iris type before LPI.After LPI,18 of the 30 eyes showing pupillary block before LPI showed pupillary block type and 12 showed mixed type,and the degree of angle opening was increased(20.2°±4.2°vs 6.6°±1.8°in reclassified pupillary block type and 12.4°±3.9°vs 6.3°±1.7°in reclassified mixed type,both P<0.05);the 5 eyes showing plateau iris type before LPI had no change in classification or the degree of angle opening(8.3°±1.7°vs 6.7°±2.1°,P>0.05).Conclusion The effect of opening angle after LPI is better in PACG patients with pupillary block type,but not in patients with plateau iris type,suggesting that plateau iris plays an important role in angle closure mechanisms in PACG patients and affects the effect of LPI.

关 键 词：原发性闭角型青光眼 激光周边虹膜切除术 超声生物显微镜 瞳孔阻滞 高褶虹膜 

分 类 号：R775.2[医药卫生—眼科]