原发性急性闭角型青光眼视网膜神经纤维层厚度变化研究

Changes in retinal nerve fiber layer thickness afteracute primary angle closure glaucoma attack

目的观察原发性急性闭角型青光眼（APACG）首次发作后6个月内视网膜神经纤维层厚度（RNFLT）变化规律。方法用光学相干断层扫描仪（OCT）测量首次单侧发作的APACG患者（24例）在眼压控制后3d内、2周、1月、3月和6月时的双眼RNFLT，比较双眼各时间点RNFLT。对侧眼在发作眼眼压控制后3d内及6月时的RNFLT与正常人（55名55只眼）比较。结果发作眼平均RNFLT在眼压控制后3d内（121.49±23．84）μm，较对侧眼明显增加（P〈0．01）；2周（107．22±24．72）μm和1月（93．58±18，37）μm与对侧眼的差异无统计学意义（P=0.31和0．08）；3月（84．10±19．89）μm和6月（78．98±19．17）μm较对侧眼明显减少（P〈0．01）。发作眼不同时间点的RNFLT变化均有统计学意义（P〈0．01—0、048）。对侧眼在发作眼眼压控制后3d内及6月的RNFLT和正常人比较差异无统计学意义（P=0．13～0．98）。结论APACG发作后RNFL厚度即有明显增加，发作后2周至1个月RNFL厚度趋向正常，1个月后RNFL厚度逐渐变薄，至术后6个月RNFL厚度较对侧眼和正常人明显减少。

Objective To detect changes in retinal nerve fiber layer （RNFL） thickness in the first 6 months after acute primary angle closure glaucoma （APACG） attack. Methods Twenty-four subjects with a single unilateral APACG attack and 55 eyes from 55 normal subjects were included in our study. The RNFL thickness was accessed in both eyes using optical coherence tomography （OCT） within 3 days, 2 weeks, 1, 3 and 6 months after intraocular pressure （IOP） control. The RNFL thickness was compared within the attacked eyes and the fellow eyes. And at the first and last visits, the RNFL thickness was compared between normal controls and2unaffected fellow eyes. Results Comparing with the unaffected fellow eyes , the mean RNFL thickness for the attacked eyes increased significantly within 3 days （ 121.49±23.84） μm after lOP control （P 〈0.01）. At2 week （ 107.22± 24.72） μm and 1 month （93.58± 18.37） μm, there was no difference between the affected eyes and the unaffected fellow eyes for the mean RNFL thickness （P =0.31 and 0.08）. At 3 months （84.10± 19.89） μm and 6 month （78.98± 19.17） μm, the mean RNFL thickness for the attacked eyes decreased significantly （P 〈0.01 ）. There were significant differences for the changes of RNFL thickness in the attacked eyes among the 5 visits （P 〈0.01-0.048）. No significant difference was demonstrated comparing of the mean RNFL thickness for unaffected fellow eyes with those of the normal subjects at first and last visits （P =0.13-0.98）. Conclusions After an APACG episode, the RNFL thickness of attacked eyes significantly increased, and then decreased over time in the first 6 months after IOP control.