闭角型青光眼激光周边虹膜切除术伴与不伴周边虹膜成形术后前房角变化的1年观察

One-year results of anterior chamber angle changes in primary angle closure glaucoma after laser peripheral iridotomy with and without iridoplasty

目的使用超声生物显微镜(UBM)定量比较闭角型青光眼(PACG)激光周边虹膜切除术(LPI)伴与不伴周边虹膜成形术(LPIP)后前房角的变化。方法 33例与22例PACG患者被随机分至LPI组(A组)与LPI联合LPIP组(B组)。对患者在激光术前、术后2周、6个月与12个月时进行UBM检查。对两组UBM参数(房角开放距离、小梁虹膜夹角和房角隐窝面积)进行两因素的重复测量方差分析比较。结果两组房角宽度均较术前明显增宽,A组术前与术后的房角开放距离、小梁虹膜夹角与房角隐窝分别为(56.0±40.6)μm、(115.8±57.3)μm,(5.7±4.3)°、(12.3±5.9)°与(0.013±0.010)mm2、(0.029±0.014)mm2;B组术前与术后的房角开放距离、小梁虹膜夹角与房角隐窝分别为(28.9±18.7)μm、(101.7±45.5)μm,(3.1±2.1)°、(11.1±4.8)°与(0.007±0.005)mm2、(0.025±0.011)mm2,差异具有统计学意义(P<0.01);两组房角宽度增幅间差异并无统计学差异(P>0.05)。结论单独使用LPI与LPI联合LPIP均能显著增宽前房角。然而单独与联合两种术式增宽前房角的效果差异无统计学意义。

Objective To quantitatively compare the anterior chamber angle changes after laser peripheral iridotomy( LPI) with or without laser peripheral iridoplasty( LPIP) in primary angle closure glaucoma( PACG) using ultrasound biomcroscopy. Methods A randomized,controlled clinical trial was conducted. Thirty-three and 22 patients were randomized to iridotomy( Group A) and iridotomy plus iridoplasty group( Group B). UBM parameters in angle widths( angle opening distance,AOD; trabecular-iris angle,TIA and angle recess area,ARA) examination were performed at enrollment and 2 weeks,6 months and 12 months after laser treatment. The changes of UBM parameters were compared between groups using two-way repeated measurements of analysis of variance. Results The angle widths of both group after laser treatment were significantly wider than that before treatment( AOD,TIA and ARA before and after laser treatment were( 56. 0 ± 40. 6) μm,( 115. 8 ± 57. 3) μm,( 5. 7 ± 4. 3) degree,( 12. 3 ± 5. 9) degree and( 0. 013 ± 0. 010) mm2,( 0. 029 ± 0. 014) mm2respectively in group A; and were( 28. 9 ± 18. 7) μm,( 101. 7 ± 45. 5) μm,( 3. 1 ± 2. 1) degree,( 11. 1 ± 4. 8) degree and( 0. 007 ± 0. 005) mm2,( 0. 025 ± 0. 011) mm2respectively in group B; P < 0. 01. No significant difference of changes of UBM parameters were found between groups( P >0. 05). Conclusion Both iridotomy alone or combined with iridoplasty can significantly widen the anterior angle,but the effect of difference was not remarkable different between the two laser treatments( alone or combined).