首次发生急性原发性房角关闭患者发作眼与对侧眼前节生物学参数的对比分析

Evaluation of anterior segment parameters of firsttime acute primary angle closure eye and fellow eye

目的采用光学相干断层扫描比较首次发生急性原发性房角关闭(acute primary angle closure,APAC)患者的发作眼与对侧可疑原发性房角关闭(primary angle closure suspect,PACS)眼的眼前节生物学参数差异并分析发病相关危险因素。方法收集2013年8月至2014年8月于北京协和医院眼科就诊的首次单眼发生APAC且对侧眼为PACS的患者共计30例(发作眼30眼,对侧眼30眼),采用光学相干断层扫描仪测量双眼的中央角膜厚度、瞳孔直径、中央前房深度、晶状体拱高、前房宽度、距离巩膜突500μm和750μm处的房角开放距离(angle open distance,AOD500、AOD750)及小梁网虹膜间面积(trabecular iris area,TISA500、TISA750)、巩膜突角度。采用配对t检验比较双眼各参数之间的差异,条件Logistic回归分析发病相关因素。结果对侧眼组与发作眼组的中央角膜厚度分别为(522.7±31.3)mm和(557.3±42.7)mm,瞳孔直径分别为(2.90±1.19)mm和(3.78±1.29)mm,晶状体拱高分别为(1.08±0.36)mm和(1.24±0.42)mm,发作眼组均较大(均为P<0.01);中央前房深度分别为(1.81±0.45)mm和(1.64±0.44)mm,AOD500分别为(0.097±0.065)mm和(0.059±0.039)mm,AOD750分别为(0.157±0.100)mm和(0.120±0.068)mm,TISA500分别为(0.036±0.021)mm2和(0.020±0.016)mm2,TISA750中位数分别为0.065 mm2和0.041mm2,巩膜突角度分别为11.13°±6.92°和6.68°±4.43°,发作眼组均较小(均为P<0.05)。条件Logistic回归分析结果显示晶状体拱高的增加与急性房角关闭具有强相关性(OR=40.259[1.021,1779.193],P=0.014)。结论晶状体拱高的增加是APAC发作眼与对侧PACS眼相比最突出的危险因素,可能在PACS发展成为APAC的过程中起关键作用。

Objectlve To evaluate the anterior segment parameters of first-time acute primary angle closure （APAC） eye and the fellow eye （primary angle closure sus- pect, PACS） with anterior segment optical coherence tomography（AS-OCT）. Methods Thirty patients with first-time unilateral APAC （APAC 30eyes, PACS 30eyes） were col- lected from August 2013 to August 2014 in the Ophthalmology Department of Peking U- nion Medical College Hospital. Central cornea thickness （CCT）, pupil diameter（ PD）, an- terior chamber depth （ ACD ）, lens vault （ LV）, anterior chamber width （ ACW ）, angle open distance at 500 μm and 750 μm from the sclera spur （AOD500, AOD750 ）, trabecular iris area at 500 μm and 750 μm from the sclera spur（ TISA500, TISA750 ）, sclera spur angle （SSA） of both eyes were measured by AS-OCT. Paired t-test was applied to find the differences, and conditional logistic regression analysis was performed to analyze the as- sociated factors with the prediction of APAC. Results Compared with the fellow PACS eyes,APAC eyes showed significant larger CCT [（522. 7 ± 31.3 ）mm and （557.3 ±42. 7 ） mm,respectively ], PD [ （ 2. 90 ± 1.19 ） nun and （ 3.78 ± 1.29 ） ram, respectively ] and LV [ （ 1.08 ±0.35）mm and （ 1.24 ±0.42） ram,respectively] （P 〈0.01 ） ,smaller ACD[ （ 1.81 ± 0.45）mm and（1.54 ±0.44）ram,respectively] ,AOD500 [ （0.097 ±0. 055） mm and（0. 059 ± 0. 039 ） mm, respectively ], AOD750 [ （ 0. 157 ± 0. 10 ） mm and （ 0. 120 ± 0. 058 ） ram, respective- ly） ,TISA500 [ （0.035 ±0. 021 ）mm2 and（ 0. 020 ±0. 015） mm2, respectively）, TISA750 （ 0. 055mm2 and 0. 041 mm2, respectively ） and SSA[ （ 11.13 ± 6.92 ） ] and （6.68 ± 4.43 ） °, respectively （P 〈 0.05 ）. The results of condi- tional logistic regression analysis showed greater LV（ OR =40. 259[ 1. 021,1779. 193 ] ,P =0. 014 ） had the strongest correlation with the prediction of APAC. Conclusion Greater LV is the most significant factor associated with the prediction of APAC compared with the fellow PACS eye,and may play a critical role in the progression of PACS to APAC.