原发性急性闭角型青光眼大发作缓解后视盘参数变化

Changes in optic disc parameters after remission from a major attack of acute angle-closure glaucoma

目的研究原发性急性闭角型青光眼(acute primary angle-closure glaucoma,APACG)患者大发作缓解1 a后的视盘形态学变化。方法收集2016年1月至2017年1月在我科就诊的APACG单眼首次大发作患者30例,男12例,女18例,应用频域光学相干断层扫描深层成像技术获取大发作缓解1 a后发作眼和对侧眼的视盘参数,并进行眼压测量,应用SPSS 20.0进行统计学分析。结果大发作时发作眼平均眼压57.2(30~84)mmHg(1 kPa=7.5 mmHg),急性大发作持续时间3~130 h(平均50.5 h)。30眼中,19眼行虹膜周边切除术,11眼行外路小梁切除术。与对侧眼相比,APACG大发作缓解1 a后的发作眼视杯宽度增加,筛板前组织厚度与筛板厚度均变薄,差异均有统计学意义(均为P<0.05),房角开放小于180°的发作眼变化更明显。多元线性回归分析表明,大发作时眼压升高的时间、程度均与筛板厚度、鼻侧最小盘沿宽度和颞侧最小盘沿宽度负相关,眼压升高的程度与筛板前组织厚度亦呈负相关。结论 APACG大发作时眼压升高的时间、程度与大发作缓解后视盘的远期形态学变化相关。

Objective To study the morphological changes of the optic disc of the patients with acute primary angle closure glaucoma(APACG)after 1 year of remission from a major attack.Methods Thirty patients with APACG were collected,who were hospitalized in our hospital from January 2016 to January 2017,12 males and18 females.Spectral-domain optical coherence tomography(SD-OCT) deep imaging technology was used to obtain the parameters of optic disc of the eyes and the contralateral eyes 1 year after the remission and intraocular pressure(IOP) was measured,and SPSS20.0 was used for statistical analysis.Results During the mager attack,the mean IOP of the affected eyes was 57.2(30-84)mmHg(1 kPa=7.5 mmHg),and the duration of the acute great attack was 3-130(average 50.5)h.Among the 30 eyes,19 eyes underwent periiridotomy and 11 eyes underwent external trabeculectomy.Compared with the contralateral eye,the optic cup of the ictal eye becomes wider,and the thickness of the lamina cribiosa and prelaminar tissue become thinner.The difference is statistically significant(all P<0.05).The changes were more obvious when the angle of anterior chamber was less than 180 degrees.Multiple linear regression analysis showed that the duration and degree of IOP increase during major attack were negatively related to the thickness of the lamina cribiosa,the width of the minimum rim of the nose and the width of the minimum rim of the temporal,and the degree of IOP elevation was also negatively correlated with the thickness of the prelaminar tissue.Conclusion The duration and IOP increase during APACG major attack is negatively related to the long-term morphological changes of optic disc in APACG patients after remission of the major attack.