激光周边虹膜切除术后急慢性闭角型青光眼患者和正常人24h眼压波动的比较

A comparison of 24-hour variations of intraocular pressure among patients with acute angle closure glaucoma,chronic angle closure glaucoma after Nd:YAG laser peripheral iridectomy and normal eyes

目的对激光周边虹膜切除术后急慢性闭角型青光眼和正常人昼夜眼压波动进行比较。方法收集闭角型青光眼患者44例(急性闭角型青光眼25例,慢性闭角型青光眼19例)以及年龄和性别相匹配的正常人20例。临床前期或先兆期或早期闭角型青光眼患者均进行Nd:YAG激光周边虹膜切除术,采用Goldmann压平式眼压计由一名医师对所有入选病例均进行24h眼压波动的检测,6个时间点分别为2pm、6pm、10pm、5am、7am、10am,同时依据眼压高峰值出现的时间点和波动的幅度对昼夜眼压波动规律进行分类。结果三组间昼夜眼压波动幅度差异有显著性(P=0.000),急性闭角型青光眼患者(0.92±0.27kPa)和慢性闭角型青光眼患者(1.11±0.36kPa)昼夜波动幅度明显高于正常对照组(0.44±0.11kPa),在2pm、6pm,慢性闭角型青光眼比急性闭角型青光眼眼压高峰值出现的频率更多,慢性闭角型青光眼和正常对照组有相似的昼夜波动类型,正常对照组眼压波动为平坦形。高峰值出现的时点与原发性青光眼的类型高度相关。结论激光周边虹膜切除术后急慢性闭角型青光眼患者眼压昼夜波动幅度仍明显大于正常对照组。慢性闭角型青光眼患者眼压高峰值多出现于2pm、6pm;而急性闭角型青光眼眼压高峰值多出现于5am、7am、10am。眼压高于2.79kPa且昼夜波动幅度>0.80kPa未出现于正常对照组。

Objective To compare the circadian rhythm of intraocular pressure among patients with acute angle closure glaucoma, chronic angle closure glaucoma after Nd： YAG laser peripheral iridectomy and normal eyes. Methods 44 patients with angle closure glaucoma （of 25 with acute angle closure glaucoma, group A; of 19 with chronic angle closure glaucoma, group B） and 20 healthy subjects （control group） were enrolled in this study. Age and sex were matched in these three groups and case - control studies had been performed. Patients with preclinical or early stage angle closure glaucoma underwent Nd： YAG laser peripheral iridectomy. A Goldmann applanation tonometer was used to detect 24 - hour variations of intraocular pressure in all subjects at 2pm, 6pm, 10pm, 5am, 7am and 10am, while the circadian rhythm of intraocular pressure was classified according to the peak time of intraocular pressure and the variation range. Results In comparison of these three groups, the circadian variations of intraocular pressure differed significantly （ P = 0. 000）, the circadian variation ranges in patients with acute angle closure glaucoma （0.92 ± 0.27kPa） and in patients with chronic angle closure glaucoma （1.11 ± 0.36kPa） were higher than that in the control group （0.44 ± 0. llkPa）. At 2pm and 6pm, the peak of intraocular pressure occurred more frequently in chronic angle closure glaucoma than acute angle closure; patients with chronic angle closure glaucoma and normal subjects had similar circadian variation type, the variation type of intraocular pressure in normal subjects was flat. The peak time was typically asspciated with classification of primary glaucoma. Conclusion The circadian variation ranges of ocular pressure in patients with acute or chronic angle closure glaucoma after Nd： YAG lair peripheral iridectomy were higher than normal subjects. The peak ocular pressure in chronic angle closure glaucoma occurred more frequently at 2pm and 6pm, but acute angle closure glaucoma occurred at 5am, 7am and 10am. The ocular pressure over 2.79kPa as well as circadian variation range over 0.80kPa was not found in normal subjects.