周边前房深度扫描分析仪对可关闭房角的筛查效能研究——邯郸眼病研究

Screening efficiency of scanning peripheral anterior chamber depth analyzer for occludable angle——Handan Eye Study

背景 原发性闭角型青光眼（PACG）是中国人群青光眼患者中常见的类型,对存在房角关闭风险者进行筛查对于PACG的防治具有重要意义. 目的 探讨周边前房深度扫描分析仪（SPAC）在中国成人可关闭房角筛查中的效能,寻找最佳参数及其临界值.方法 采用横断面研究,于201 3年2-4月在邯郸眼病研究的5年随访调查中纳入年龄≥40岁、无影响房角观察的角膜或结膜病变、无眼部手术或外伤史的受试者180人,在接受视力、验光、裂隙灯显微镜等基本检查后,在暗室下对每位受试者随机选取一眼行SPAC测量和房角镜检查.以静态房角镜检查≥180°时看不到后部小梁网作为定义可关闭房角的标准,用SPAC测得的中央前房深度（ACD）指标和数字分级≤5或定性分级为S/P指标（联合指标）分别进行可关闭房角的筛查判断,建立受试者工作特征曲线（ROC）,比较曲线下面积（AUC）,对上述2种指标的筛查效能进行评价和比较.结果 共检出可关闭房角者62人,房角开放者118人.与房角开放者相比较,可关闭房角者年龄更大（P＜0.001）,女性更多（P＜0.05）,视力更差（P＜0.001）,等效球镜度数更大（P＜0.05）,ACD值较低（P＜0.001）,眼轴长度较短（P＜0.001）.用ACD作为筛查指标时可关闭房角的AUC为0.832,ACD临界值为2.7 mm时,其敏感性和特异性分别为85.48％和68.64％,ACD临界值为2.8 mm时,其敏感性和特异性分别为90.32％和61.02％.联合指标筛查可关闭房角的AUC为0.768,敏感性和特异性分别为62.90％和90.68％. 结论 SPAC在中国成人可关闭房角的筛查中ACD≤2.8mm的敏感性最高.

Background Primary angle-closure glaucoma （PACG） is the most common type of glaucoma in China.A screening to identify the possible angle closure is important in the prevention and treatment of PACG.Objective This study was to determine the characteristics and the optimal parameters measured by the scanning peripheral anterior chamber depth analyzer （SPAC） in the screening of occludable angle of a sample of adult Chinese population.Methods A cross-sectional study was performed in Handan from February to April in 2013.One hundred and eighty Chinese adults were enrolled with the age of 40 years and older and acceptable criteria during 5-year following-up duration of the Handan Eye Study.Routine eye examinations were carried out in all subjects under the informed consent,including visual acuity,optometry,anterior ocular segment examination under the slit lamp microscope,and then SPAC measurement and gonioscopy were performed in a dark room.Occludable angle was defined as posterior trabecular meshwork being invisible in ≥ 180° range under the static gonioscope.Occludable angle by SPAC was estimated using available central chamber depth （ACD） and a combined indicator,numerical grade was 5 or fewer and/or the categorical grade was S or P,separately.Receiver operating characteristic （ROC） curve was calculated to assess the performance of these parameters in detecting eyes with occludable angle for the population-based sample,and area under curve （AUC） was drown to compare the screening efficiencies between available ACD and combined indicator.Results In 180 subjects,occludable angles were found in 62 and open angles were in 118.Compared to the subjects with open angle,the subjects with occludable angle showed the older age （P＜0.001）,more females （P＜0.05）,lower visual acuity （P＜0.001）,greater hyperopic diopter （P＜0.05）,smaller ACD value （P＜0.001） and shorter axial length（P＜0.001）.In eyes with occludable angle by using SPAC,the ACD showed an AUC of 0.832.Using a cutoff of 2.7 mm for ACD,the sensitivity and specificity were 85.48％ and 68.64％,and under the cutoff of 2.8 mm,the sensitivity and specificity was 90.32％ and 61.02％,respectively.For the combined parameters,the sensitivity and specificity was 62.90％ and 90.68％,respectively and the AUC was 0.768.Conclusions When gonioscopy is used as a reference,a cutoff of 2.8 mm ACD by SPAC shows the highest sensitivity for the screening of occludable angle in Chinese population.