原发性青光眼晶状体厚度与位置的研究

The study of lens thickness and lens position in primary glaucoma

目的利用眼前段相干光断层扫描仪（AS-OCT）和A型超声波定量测量、分析和比较原发性闭角型青光眼（PACG）、原发性开角型青光眼（POAG）和正常人的晶状体生物学参数及眼轴的差异。方法临床病例对照研究。对2015年1-10月的临床病例连续入组收集病例，包括急性PACG （APACG）患者89例89只眼，慢性PACG （CPACG）患者63例63只眼，POAG33例33只眼和正常人90名90只眼，行A型超声波眼轴长度（AL）测量及AS-OCT前房及晶状体断层扫描定量测量中央前房深度（ACD）、晶状体厚度（LT）、晶状体矢高（CLR）和晶状体厚度／眼轴长度系数（LT/AL ratio）；比较PACG、POAG和正常人之间上述参数的差异。结果POAG眼和正常眼晶状体参数的平均值为：LT （4.67±0.54 vs. 4.57±0.42）mm，CLR （0.36±0.28 vs. 0.39±0.33）mm，LT/AL ratio （0.20±0.01 vs. 0.20±0.01），两组间的差异无统计学意义（P=0.429-0.791）；PACG眼的各项晶状体参数平均值LT （5.13±0.37）mm，CLR （1.00±0.25）mm，LT/AL ratio （0.23±0.02）均显著小于POAG眼和正常对照眼，差异有统计学意义（P均〈0.001）；APACG的ACD （1.84±0.24）mm和AL （22.29±0.82）mm比CPACG的小（分别为2.02±0.25和22.76±0.91 mm），但LT （5.19±0.38）mm、CLR （1.15±0.26）mm和LT/AL ratio （0.23±0.02）比CPACG的大（分别为5.05±0.36 mm、0.93±0.21 mm和0.22±0.01），差异均有统计学意义（t=-5.947-4.307，P 〈0.001-0.007）。结论PACG的眼前节结构较正常人和POAG狭窄，APACG较CPACG有更厚的晶状体且晶状体位置更加靠前，POAG与正常人的晶状体厚度及位置无差异。

Objective To quantitatively measure and evaluate the lens biological parameters and axial length among primary angle-closure glaucoma （PACG）, primary open angle glaucoma （POAG） and normal controls using anterior segment optical coherence tomography （AS-OCT） and A mode ul-trasound. Methods Prospective and comparative cases series. Eighty-night subjects （89 eyes） with acute primary angle-closure glaucoma （APACG）, 63 subjects （63 eyes） with chronic primary angle-closure glaucoma （CPACG）, 33 subjects （33 eyes） with primary open angle glaucoma （POAG） and 90 cases （90 eyes） of normal controls were collected and performed AS-OCT and A mode ultrasound ex- amination. The recorded parameters included： anterior chamber depth （ACD） lens thickness （LT）, crys- talline lens rise （CLR）, axial length （AL） and LT/AL ratio, and the difference between PACG , POAG and normal controls were compared. Results The average of lens biological parameters of PO- AG and normal controls were LT （4.67±0.54 vs. 4.57±0.42） mm, CLR （0.36±0.28 vs. 0.39±0.33）mm, LT/AL ratio （0.20±0.01 vs. 0.20±0.01）, and there were no significant difference between the 2 groups （P =0.429-0.791）. All of the lens biological parameters of PACG （LT 5.13±0.37 mm, CLR 1.00±0.25 mm, LT/AL ratio 0.23±0.02） were significantly less than that of POAG and normal con- trois （P all〈0.001）. The parameters of ACD and AL of APACG （1.84±0.24, 22.29±0.82 mm） were smaller than CPACG （2.02±0.25, 22.76±0.91 ram）, while LT, CLR and LT/AL ratio of APACG （5.19±0.38 mm, 1.15±0.26 ram, 0.23±0.02） were larger than CPACG （5.05±0.36 mm, 0.93±0.21 mm, 0.22±0.01） （t =-5.947-4.307, P 〈0.001-0.007）. Conclusions PACG has a more crowding anterior seg- ment configuration than normal controls and POAG. APACG has thicker and more anterior located lens than CPACG. There is no difference between POAG and normal controls in LT and LP.