裂隙灯VanHerick比值在判断前房角关闭状态上的临床局限性分析

The Analysis of the Van Herick Ratio Limitations on the Angle-Closure Degree of the Anterior Chamber Angle

目的 通过对一组病例进行回顾性分析,以前房角镜检查为金标准,探讨临床常规裂隙灯检查中,周边前房深度与周边角膜厚度比值（VanHerick比值,下同）在判断前房角关闭状态上的局限性.方法 对已确诊为原发性闭角型青光眼且VanHerick比值≤1/6角膜厚度（CT）的18例（35只眼）患者,进行裂隙灯VanHerick比值和前房角镜结果的对比,分析两种检查方法在前房角检查中的差别,以及在判断前房角关闭状态上的一致性.结果 VanHerick比值推测为关闭的35只眼中,有12只眼在前房角镜下为开放状态.以前房角镜检查为金标准,VanHerick比值检查房角关闭状态的阳性预测值为65.7%.结论 在评价房角宽度时,Van Herick比值在判断前房角关闭状态上有一定的局限性.在此研究中,在依据VanHerick比值≤1/6CT推断为房角关闭的患者中有近34%的房角实际上为开放状态,提醒在临床上即使VanHerick比值已经≤1/6CT,仍不能仅以VanHerick比值来推断房角关闭.

Objective To retrospectively analyze the clinical limitations of peripheral anterior chamber depth and peripheral cornea thickness ratio （ Van Herick ratio） in evaluation of the width of the anterior chamber angle. The gonioscopy is gold standard. Methods Van Herick ratio and gonioscopy examination were used in the 18 patients （35 eyes）who were diagnosed primary angle-closure glaucoma and Van Herick ratio ≤ 1/6CT, analyze the difference and the concordance of the two methods in the anterior chamber angle examination .Results 12 eyes were closed by gonioscopy in the 35 angle-closure eyes by Van Herick ratio. Gonioscopy as the gold standard, the positive predictive value of Van Herick ratio is 65.7%.Conclusion Van Herick ratio was limited to judge the width of the anterior chamber angle, in this study,there are 34% patient with an open angle among the angle-closure patients determined by the Van Herick ratio. Van Herick ratio is not a precise method to judge the width of the angle chamer even Van Herick ratio≤ 1/6CT.