OCT3评价原发性急性闭角型青光眼患者激光手术前后房角变化

Evaluation of angel changes before and after laser surgery in primary acute angle-closure glaucoma by OCT3

目的利用OCT3作为一种便捷可靠的技术观察急性闭角型青光眼患者激光治疗前后房角的变化,评价治疗的效果。方法72h内首次单眼发作的急性闭角型青光眼患者21例21眼,发作时平均眼压(59.46±16.79)mmHg(1kPa=7.5mm-Hg),基础药物治疗后进行激光虹膜成形术联合激光虹膜切开术,利用StratusOCT3观察发作时激光治疗前后房角的变化,并同时记录眼压变化。结果所有患者在经过基础治疗后眼压水平降至(38.24±9.67)mmHg,激光虹膜切开术后1h、24h、1周眼压分别为(21.36±9.74)mmHg、(18.46±6.54)mmHg、(14.58±5.48)mmHg(P<0.001);OCT3适时检测房角和虹膜形态的变化,显示激光治疗后,组织水肿状况明显好转,虹膜形态由极度膨隆、靠近小梁组织,变为膨隆程度明显降低、根部远离小梁组织。房角开放度由发作时(10.38±4.27)°增加为(28.16±9.77)°,差异有显著统计学意义(P<0.01)。结论相对于传统超生生物显微镜对房角结构的观察,OCT3表现出经济、方便、快捷、准确的优越性,可以更好地适时观察原发性急性闭角型青光眼患者激光治疗前后房角的变化。

Objective To investigate the angle changes before and after laser surgery in patients with primary acute angle-closure glaucoma by optic coherent tomography 3（OCT3）,an simple and reliable technique,and to evaluate the curative effects.Methods Twenty-first cases（21 eyes） with first attack of acute angle-closure glaucoma within 72 hours were included.The average intraocular pressure（IOP） was（59.46±16.79）mmHg（1 kPa=7.5 mmHg） at attack.Iridoplasty and iridectomy were performed after traditional drug treatment.Changes of angle and IOP at attack before and after laser treatment were observed by Stratus OCT3.Results IOP reduced to（38.24±9.67） mmHg after traditional drug treatment,and were（21.36±9.74）mmHg,（18.46±6.54）mmHg and（14.58±5.48）mmHg at 1 hour,24 hours and 1 week after iridectomy,respectively（P〈0.001）.OCT3 could clearly show changes of angle and iris morphology at real time.After laser surgery,edema was obviously improved,iris bombe significantly decreased,and its root was changed from near trabecular tissues to far from trabecular tissues.The degree of anterior chamber angle was widened from（10.38±4.27）°at attack to（28.16±9.77）° after laser surgery（P〈0.01）.Conclusion Compared with traditional ultrasound biomicroscopy,OCT3 is an economic,convenient and accurate method to evaluate angle changes in primary acute angle-closure glaucoma before and after laser surgery.