急性与慢性闭角型青光眼临床前期眼房角及相关结构构型的差异

Comparison of the anterior chamber angle and related structures in fellow eyes of acute and chronic primary angle-closure glaucoma

目的比较急性闭角型青光眼(ACG)与慢性闭角型青光眼(CACG)临床前期眼房角及相关结构的差异,了解闭角型青光眼不同发病方式与解剖结构的关系。设计病例对照研究。研究对象急性闭角型青光眼临床前期眼(FEACG)40眼与慢性闭角型青光眼临床前期眼(FECACG)42眼。方法利用超声生物显微镜对FEACG和FECACG的前房、瞳孔、虹膜、睫状体、房角等相关结构的形态进行观察和测量,并对两组数据进行比较分析。主要指标前房深度(ACD)、瞳孔直径(PD)、虹膜厚度(IT1、IT2、ITM)、虹膜根部附着点(SIT)、虹膜膨隆高度(IH)、睫状体位置(A角、B角、TCPD)。结果 FEACG的前房深度小于FECACG,但无统计学意义(P=0.067)。FEACG的瞳孔直径(3.094±0.782mm)小于FECACG(3.613±0.925mm)(P=0.008)。FEACG眼的虹膜厚度(IT1、IT2、ITM)比FECACG薄(P=0.005,0.000,0.001);FECACG虹膜根部附着位置较FEACG更靠近巩膜突(P=0.016);FEACG虹膜膨隆高度比FECACG高(P=0.000)。FEACG的睫状体位置与FECACG相比较为靠后,FEACG的A角、B角大于FECACG(P=0.004,0.017)。FEACG与FECACG房角开放程度无显著性差异。结论 FEACG与FECACG的房角及相关结构存在差异。除前房浅、房角狭窄等共有解剖学特征外,与FECACG相比FEACG的瞳孔直径小、虹膜厚度薄、根部附着位置靠后、膨隆程度更高、睫状体位置靠后。这些差异与两者的房角急性关闭和缓慢进行性关闭的差异表现有关。(眼科,2014,23:26-30)

Objective To evaluate the anterior segment parameters in the fellow eyes of acute primary angle-closure glaucoma （PACG） and chronic primary angle-closure glaucoma using ultrasound biomicroscope. Design Case-controlled study. Participents Two groups, 40 fellow eyes of acute PACG, 42 fellow eyes of chronic PACG, were included in the present study. Methods The related structure parameters of iris, pupil, ciliary body and anterior chamber angle were observed and analyzed with ultrasound biomicroscope. Main Outcome Measures Anterior chamber depth（ACD）, pupil diameter（PD）, iris thickness （IT）1, IT2, maximal iris thickness（ITM）, scleral spur iris distance（SIT）, iris-bombe height（IH）, angle A, angle B, trabecular-ciliary process distance（TCPD）, trabecular-iris angle （TIA） and angle opening distence （AOD） were measured. Results On ultrasound biomicroscopy the ACD of the fellow eye in acute PACG （FEACG） was shallower than the fellow eye of chronic PACG （FECACG）, but was no significant difference （P=0.067）. The PD of FEACG 3.094±0.782 mm was less than FECACG 3.613±0.925 mm （P=0.008）. IT1, IT2, ITM of FEACG were thinner than FECACG （P=0.005, 0.000, 0.001）. There was a positive correlation between IT2, ITM and PD （P=0.000） which were using covariance analysis. SIT of FEACG was bigger than FECACG （P=0.016）. IH of FEACG was higher than FECACG （P=0.000）. Angle A, and angle B of FEACG was wider than FECACG （P=0.004, 0.017）. TIA and AOD of FEACG was wider than FECACG but there were no significant differences between two groups （P=0.417, 0.278）. Conclusion There is a difference between the fellow eyes of acute PACG and chronic PACG. Compared with chronic PACG, beside the common features such as shallow anterior chamber depth, narrow anterior chamber angle, ACG has a smaller pupil, thinner iris, higher iris bombe, and a more posterior positioned iris insert and wider ciliary-trabecu-lar-angle. The differences between the anterior segments of acute PACG and chronic PACG may result in the different disease courses of these two types of PACG.