原发性前房角关闭眼激光周边虹膜切开术后前房角形态学变化

Alteration of anterior chamber and angle structure in eyes with primary angle closure after laser peripheral iridotomy

目的定量检测和评价原发性前房角关闭（PAC）眼行激光周边虹膜切开（LPI）术后前房角形态学变化。方法临床病例系列研究。对入选的31例（54只眼）PAC患者于LPI术前、术后2周、6及12个月，进行眼科常规检查，定量检测超声活体显微镜（UBM）图像中前房角的各项参数。各随访时间点的UBM参数比较采用重复测量的方差分析，巩膜突前750μm与500μm处各参数的比较采用配对t检验。结果LPI术后前房深度较术前加深0．10mm，但差异并无统计学意义（F=3．50，P〉0．05）。LPI术前，巩膜突前750μm处，前房角开放距离（66．2±51．6）μm，小梁网与虹间夹角5．0°±3．5°，前房角隐窝面积（0．025±0．017）mm2，小梁网与睫状突距离（571．0±97．2）μm；LPI术后2周、6及12个月，巩膜突前750μm处，前房角开放距离分别为（165．0±70．3）、（185．8±68．5）及（196．1±77．7）μm，小梁网与虹膜间夹角分别为（11．9±4．9）、（13．3±4．8）及14．0°±5．4°，前房角隐窝面积分别为（0．058±0．024）、（0．065±0．023）及（0．068±0．026）mm2，小梁网与睫状突间距离分别为（647．1±113．0）、（701．8±93．4）及（670．1±95．4）μm，均较LPI术前增加，差异均有统计学意义（前房角开放距离：F=92．60，小梁网与虹膜间夹角：F=92．60，前房角隐窝面积：F=92．60，小梁网与睫状突间距离：F=34．00；P〈0．05）。术后前房角开放距离、小梁网与虹膜间夹角及前房角隐窝面积均较术前增加1倍以上。巩膜突前750μm处检测参数的增加幅度均较巩膜突前500μm处大（前房角开放距离：t=5．90，P〈0．05；小梁网与虹膜间夹角：t=2．70，P〈0．05；前房角隐窝面积：t=2．00；P=0．05）。结论LPI能显著增宽PAC眼的周边前房角，且随访观察1年期间前房角仍开放。巩膜突前750μm处的参数比500μm处参数对评价周边前房角形态变化更为敏感。

Objective To quantitatively evaluate the long-term changes in anterior segment morphology by using ultrasound biomicroscopy （UBM） after laser peripheral iridotomy （LPI） in eyes with primary angle closure （PAC）. Methods This was a clinical case series study. A total of 54 eyes with PAC of 31 consecutive patients were enrolled. Routine ophthalmic and UBM examination were performed at visit one （ before LPI） , 2 weeks, 6, and 12 months after LPI. The parameters of anterior chamber were measured by UBM and calculated. Results of each follow-up time were analyzed using repeated measures analysis of variance. Parameters of UBM measurement at 750 μm anterior to the sclera spur and at 500 μm counterpart were compared using paired student t-test. Results Compared to before LPI, anterior chamber depth （ACD） was deepened by approximate 0. 10 mm after LPI, however, it was not statistically significant（ F = 3.50,P 〉 0. 05 ）. Angle opening distance （AOD）, trabecular-iris angle （TIA）, angle recess area （ARA） and trabecular-ciliary process distance （TCPD） were significantly increased at 2 weeks, 6 and 12 months after LPI compared with respective baseline [ AOD750： （ 165.0 ± 70. 3 ）, （ 185.8 ± 68. 5 ）, （ 196. 1±77.7）txmvs （66.2 ±51.6） μm, F=92.60;TIA750：14.1° ±6.3°, 15.5° ±6.2°,16.4° ±5.9° vs 6. 4° ± 4. 9°, F = 92. 60 ; ARA ： （ 0. 058 ± 0. 024 ）, （ 0. 065 ±0. 023 ）, （ 0. 068 ± 0. 026 ） mm2 vs （ 0. 025 ± 0.017）mm2,F=92.60;TCPD：（647.1 ±113.0）,（701.8 ±93.4）,（670.1 ±95.4） μm vs（571.0 ± 97.2） μm,F = 34.00; P 〈 0.05 ]. The parameters of UMB measurement at 750 μm were significantly increased more than that at 500 μm anterior to the sclera spur（AOD： t =5.90,TIA750：t =2. 70,P 〈0. 05 ; ARA ： t = 2. 00, P = 0. 05 ）. Conclusions LPI can significantly widen the peripheral anterior angle in eyes with PAC lasting for at least 1 year after LPI. Parameters detected by UBM at 750 μm anterior to the sclera spur appear to be more sensitive in evaluating the alternation of peripheral angle structure.