原发性闭角型青光眼合并白内障患者眼前节生物测量

Evaluation of biological measurement of ocular anterior segment in patients with primary angle closure glaucoma with cataract

目的采用眼前节光学相干断层扫描(SL-OCT)、超声生物显微镜(UBM)及传统的A型超声3种不同的检测方法观察原发性闭角型青光眼(PACG)合并白内障患者的眼前节解剖结构,评价3种检测方法的临床应用价值。方法研究设计为诊断试验。对PACG合并白内障的患者30例42眼行白内障超声乳化联合人工晶状体(IOL)植入术,于术前、术后1个月分别用SL-OCT、UBM及A型超声对眼前节进行测量,分析手术前后SL-OCT、UBM及A型超声测量的眼前节参数的变化,并比较3种不同的检查方法对眼前节测量参数间的差异,同时监测手术前后视力及眼压的情况。结果 SL-OCT、UBM、A型超声检测显示所有患者术后1个月中央前房深度(ACD)明显增加,与术前比较差异均有统计学意义(t=-15.695、t=-15.367、t=-6.981,P<0.01);术后1个月SL-OCT和UBM检测500μm房角开放距离(AOD500)、小梁虹膜夹角与术前比较差异均有统计学意义(P<0.01);术后1个月周边部、中周部、瞳孔缘区虹膜厚度(IT)与术前比较差异均无统计学意义(P>0.05)。术前和术后1个月SL-OCT、UBM和A型超声3种检测方法测得的ACD差异均有统计学意义(F=21.060,P<0.01;F=21.012,P<0.01),术前和术后1个月SL-OCT和UBM检测的AOD500、小梁虹膜夹角差异均有统计学意义(P<0.01),而IT差异无统计学意义(P>0.05)。术前及术后3d、7d、1个月眼压逐渐下降,视力逐渐改善,差异均有统计学意义(F=35.792,P=0.000;F=124.891,P=0.000)。结论 SL-OCT、UBM和A型超声可以客观、准确地提供PACG合并白内障患者眼前节的解剖参数,为选择白内障超声乳化联合IOL植入术的手术时机提供参考依据。

Background Eyes that are predisposed to primary angle closure usually have a shallow anterior chamber.Phacoemulsification for primary closed-angle glaucoma complicated with cataract may have a good outcome on these eyes.Objective Anterior eye segment in patients with primary angle closure glaucoma associated with cataract was studied using high-speed slit lamp OCT（SL-OCT）,ultrasound biomicroscope（UBM）,and A-ultrasound.This study was to perform the biological measurement of the anterior eye segment in order to determine the timing of cataract phacoemulsification.Methods This is a diagnostic test.Phacoemulsification and intraocular lens implantation was performed in 42 eyes of 30 patients with primary angle closure glaucoma associated with cataract.The changes of ocular anterior segment,including periphery,mid-periphery and pupil edge areas were examined using SL-OCT,UBM,and A-ultrasound before and one month after the surgery respectively.The visual acuity and intraocular pressure（IOP） were recorded preoperatively and postoperatively.The measured outcomes of ocular anterior segment structure by SL-OCT,UBM and A-ultrasound were compared.Oral informed consent was obtained from the all patients prior to the medical examination.Results The anterior chamber depth（ACD）,distance of 500 μm from the scleral spur（AOD500） and trabecular iris angle obtained by SL-OCT or UBM were significantly increased 1 month after surgery,showing statistically significant differences in comparison with before surgery（t=-15.695,P0.01;t=-17.124,P0.01;t=-12.255,P0.01）.No significant differences were found in the iris thickness（IT） before and after surgery by SL-OCT or UBM（P0.05）.The ACD value measured by SL-OCT was higher in comparison with that by OCT and UBM before surgery（F=21.060,P=0.000） and after surgery（F=21.012,P=0.000）.The differences of IOP and visual acuity between before and after surgery were statistically significant（F=35.792,P=0.000;F=124.891,P=0.000）.Conclusion SL-OCT,UBM and A-ultrasound all provide the objective and accurate parameters of the anterior eye segment for the patients with primary open-angle glaucoma with cataract.Phacoemulsification with intraocular lens implantation can prevent and control high IOP.