原发性前房角关闭行LPI后眼前节形态学的UBM观察

The observation of anterior segment morphological changes in eyes with primary angle closure after LPI by using UBM

观察原发性前房角关闭(primary angle closure,PAC)行YAG激光周边虹膜切除术(laser peripheral iridotomy,LPI)后眼前节形态学的变化。方法:选择2012年3月至2013年3月在我院诊断为PAC并行LPI的患者28例(48眼)为研究对象,应用超声生物显微镜(ultrasound biomicroscopy,UBM),观察LPI术前及术后1天、1周、1个月及3个月各时间点颞上、正上、正下、颞侧、鼻侧共5个位点的房角开放距离(angle opening distance,AOD500)、小梁虹膜夹角(trabecular-iris angle,TIA)、小梁睫状体距离(trabecular ciliary process distance,TCPD)、虹膜睫状体距离(iris ciliary process distance,ICPD)、虹膜晶体夹角(iris lens angle,ILA)、虹膜晶体接触距离(iris lens process distance,ILCD)、虹膜厚度1(iris thickness,ITl)、IT2、IT3以及中央前房深度(cental depth distance,ACD)的变化。结果:AOD500、TIA:术后较术前均增大(P<0.05);术后1周大于术后其余时间点(P>0.05)。TCPD:除个别位点较术前增加(P>0.05),其余时间点相应位点较术前增加(P<0.05);术后1周大于术后其余时间点(P>0.05)。ILA:术后较术前均减小(P<0.05);术后1天至术后3个月逐渐增大(P>0.05)。ILCD:术后较术前均增大(P<0.05),术后1天至术后3个月逐渐减小(P>0.05);IT1、IT2、IT3:术后较术前均减小(P<0.05);术后各时间点间比较(P>0.05)。ACD:术后较术前增加(P>0.05)。LPI术前及术后各时间点平均ILA与平均ILCD的相关性显示二者呈高度负相关。结论:PAC患者行LPI术后周边前房明显加深,虹膜膨隆和瞳孔阻力减轻,但术后3个月内眼前节形态并不稳定,个别参考值有不同程度的回退,LPI术后有必要进行长期随访观察。

Objective To evaluate the changes in the anterior segment morphology by using ultrasound biomicroscopy （UBM） after YAG laser peripheral iridotomy （LPI） in eyes with primary angle closure （PAC）. Methods From March 2012 to March 2013, 28 patients （48 eyes） who diagnosed with PAC and underwent LPI in our hospital, are regarded as the research object. By using the UBM, the following issues are observed on the superior temporal, above, below, bitamporal, and nasal side of the eyeball at 1 day, 1 week, 1 month and 3 months with the preoperative and postoperative of LPI： AOD500, TIA, TCPD, ICPD, ILA, ILCD, IT1, IT2, IT3 and ACD were included. Results AOD500, TIA were increased significantly（P 〈 0.05）, compared to before LPI; and the postoperative 1 week was more than the rest of the time after surgery （P 〉 0.05）. TCPD was increased significantly, compared to before LPI（P 〈 0.05）, in addition to individual sites （P 〉 0.05 ） ; and postoperative 1 week were more than the others after sur- gery （P 〉 0.05）. ILA were decreased （P 〈 0.05） in the postoperation compared to the preoperation; and ILA were increased gradual- ly from 1 day to 3 months after the operation（P 〉 0.05）. ILCD were increased after LPI （P 〈 0.05）, converse to ILA, ILCD were decreased gradually from 1 day to 3 months after the operation （P 〉 0.05）. IT1, IT2, IT3 were decreased in the postoperation com- pared to preoperation （P 〈 0.05）. ACD of postoperation was increased compared to before perfoming LPI（P 〉 0.05）. Average ILA and average ILCD correlation shown that the two were highly negative correlation on every time points Conclusion The peripheral anterior chamber of PAC patients after the LPI were obviously deepened, the iris bombe and pupillary block were relieved after LPI. In addition, TCPD was increased, but the anterior segment morphology in the 3 months of postoperation was not stable, indi- vidual reference of which had some degree of retrograde. Therefore, long-term follow-up is necessary after LPI.