周边虹膜切除术对原发性闭角型青光眼眼前段结构的影响

Changes of Anterior Segment after Iridectomy in Eyes with Primary Angle Closure Glaucoma

[目的]利用眼前段光学相干断层扫描仪（AS-OCT）观察原发性急性闭角型青光眼（APACG）和原发性慢性闭角型青光眼（CPACG）手术周边虹膜切除（SPI）前后眼前段结构的改变.[方法]连续性收集周边虹膜粘连＜6个钟点的、性别年龄匹配的APACG发作期患者37例（37眼）及CPACG患者25例（25眼）,于SPI术前及术后1月行AS-OCT检查.比较术前及术后的中央前房深度（ACD）、房角开放距离（AOD）、小梁网虹膜间面积（TISA）、房角隐窝面积（ARA）、前房宽度（ACW）、前房容积（ACV）和晶状体矢高（CLR）的差异.[结果]与术前相比,APACG眼术后较术前AOD（0.096±0.063 vs 0.052±0.065,mm）、TISA（0.054±0.024 vs 0.030±0.029,mm2）、ARA（0.095±0.042 vs 0.059±0.057,mm2）和ACV（90±17 vs 73±17,mm3）增加（P＜ 0.001-0.032）,而ACD、ACW及CLR无明显变化（P=0.102 ～ 0.609）;CPACG眼术后较术前ARA （0.078±0.036 vs 0.065±0.024,mm2）及ACV（91±22 vs 83±22,mm3）明显增加（P=0.042和＜0.001）,而AOD、TISA、ACD、ACW和CLR无明显变化（P=0.102-0.774）.[结论]周边虹膜切除术可使APACG的房角开放和前房容积增加,使CPACG的前房容积增加,但不能改变APACG和CPACG眼的中央前房深度和晶状体的相对位置和CPACG眼的房角参数.

[Objectives] To evaluate the changes in anterior segment configuration after surgical peripheral iridectomy （SPI） in acute primary angle closure glaucoma （APACG） and chronic primary angle closure glaucoma （CPACG） using anterior segment optical coherence tomography （AS-OCT）. [Methods] Thirty-seven eyes of 37 patients with APACG and 25 eyes of 25 age- and gender- matched patients with CPACG were recruited consecutively, and peripheral anterior synechiae （PAS） of these patients were 〈 180~. AS-OCT examination was performed before and 1 month after SPI to measure central anterior chamber depth （ACD）, angle opening distance （AOD）, trabecular iris area （TISA）, angle recess area （ARA）, anterior chamber width （ACW）, anterior chamber volume （ACV） and crystalline lens rise （CLR）. [Results] In APACG group, the AOD （0.096 ± 0.063 mm）, TISA （0.054 ±0.024 ram2）, ARA （0.095 ± 0.042 mm2） and ACV （90.074 ± 16.796 mm3） after SPI were significantly increased than that of before SPI [AOD （0.052 ± 0.065）mm, TISA （0.030 ± 0.029）mm2, ARA （0.059± 0.057）mm2, ACV （73 ± 17） mm3] （P 〈 0.001 ± 0.032）. But there were no significantly changes in ACD, ACW, and CLR （P = 0.102 - 0.609）. In CPACG group, ARA （0.078±0.036） mm2 and ACV （91±22） mm3 after SPI were significantly increased than that of before SPI [ARA （0.065 ± 0.024）mm2, ACV （83 ± 22） mma,p = 0.042 and 〈 0.001 ）, But there were no significantly changes in other AS-OCT parameters （P = 0.102 ± 0.774）. [Conclusions] SPI can lead to an increase of ACV in both APACG and CPACG, SPI can also widen anterior chamber angle in APACG. However, SPI cannot change the ACD, CLR in both APACG and CPACG, and the anterior chamber angle parameters in CPACG.