超声乳化白内障吸出术对急性原发性闭角型青光眼眼前段的影响

Effects of anterior segment after phacoemulsification in patients with acute primary angle closure glaucoma

目的 使用Pentacam三维前房分析仪和眼前段光学相干断层扫描仪（AS-OCT）观察超声乳化白内障吸出术对急性原发性闭角型青光眼（APACG）患者眼前段的影响.方法 收集2010年7月至12月于中山大学附属中山医院眼科就诊的伴有白内障APACG的病例共39例（39眼）.常规行超声乳化白内障吸出联合人工晶体（IOL）植入术.术前和术后3个月使用Pentacam和AS-OCT测量眼前段参数.结果 术后3个月,APACG患者眼压由术前（33.08±5.21）mm Hg降至（16.36±3.44）mm Hg（1mm Hg=0.133 kPa,t=20.644,P=0.000）,中央前房深度由（1.79±0.20）mm增至（3.41±0.38） mm （t=36.191,P=0.000）,周边前房深度由（0.82±0.12） mm加深至（1.81 ±0.20） mm （t=40.732,P=0.000）,前房容积自（74.10±9.94） mm增加至（149.72± 17.12） mm （t=54.921,P=0.000）,下方前房角自（24.03±3.50）.加宽至（ 43.29±3.92）.（t=55.489,P=0.000）,鼻侧前房角自（23.02±2.96）°加宽至（42.36±4.61）.（t=43.291,P=0.000）,上方前房角自（21.62±3.04）.加宽至（39.66±3.53）.（ t=43.511,P=0.000）,颞侧前房角自（22.88±2.87）.加宽至（41.21±3.81）.（t=44.930,P=0.000）.瞳孔直径由术前（3.06±1.32）mm缩小至术后的（3.00±1.21）mm,但差异无统计学意义（t=1.177,P=0.247）.结论 超声乳化白内障吸出术可改善APACG患者眼前段结构的狭窄.Pentacam和AS-OCT可简便快捷和非接触地观察眼前段,有良好的应用前景.

Objective To investigate the morphological changes of anterior segment in patients with acute primary angle closure glaucoma （APACG） after phacoemulsification using the Pentacam three-dimension anterior chamber analysis system and anterior segment optical coherence tomography （AS-OCT）.Methods Thirty- nine APACG patients （39 eyes） accompanied with cataract were treated with phacoemulsification from July 2010 to December 2010 in Zhongshan Hospital.All the patients were examined by Pentacam and AS-OCT preoperation and 3 months postoperation.Outcomes included intraocular pressure （IOP）,central anterior chamber depth （CACD）,peripheral anterior chamber depth （PACD）,anterior chamber volume （ACV）,pupil diameter （PD）,and anterior chamber angle （ACA） on cross- section photographs.Results Mean IOP decreased from preoperative （33.08 ± 5.21） mm Hg to postoperative （16.36±3.44） mm Hg （1 mm Hg=0.133 kPa,t=20.644,P=0.000） and CACD measurements increased from （1.79±0.20） mm to （3.41±0.38） mm （t=36.191,P=0.000）.PACD deepened from （0.82±0.12） mm to （1.81±0.20） mm （t=40.732,P=0.000）.ACV increased from （74.10±9.94） mm to （149.72±17.12） mm （t=54.921,P=0.000）.Inferior ACA widened from （24.03±3.50）° to （43.29±3.92）° （t=55.489,P=0.000）,and from （23.02±2.96）° to （42.36±4.61）° （t=43.291,P=0.000） in nasal direction.Superior ACA widened from （21.62±3.04）° to （39.66±3.53）° （t=43.511,P=0.000）,and from （22.88±2.87）° to （41.21±3.81）° （t=44.930,P=0.000） in temporal direction.PD before and after phacoemulsification were （3.06± 1.32） mm and （3.00 ± 1.21） mm （t=1.177,P=0.247） respectively,with no statistic difference.Conclusions Phacoemulsification can widen the angle and lessen angle crowding in APACG patients.The Pentacam and AS-OCT allow easy,fast,automatic and noncontact quantification of the anterior chamber parameters with good prospects.