急性原发性房角关闭眼的睫状体参数改变

Quantitative evaluation of the ciliary body parameters in eyes with acute primary angle-closure

目的研究急性原发性房角关闭(APAC)眼睫状体参数的变化。方法采用病例对照研究方法,收集2016年1—10月在宁夏眼科医院就诊的APAC单眼发作的患者55例55眼作为APAC发作眼组,对侧眼作为APAC对侧眼组,并收集同期年龄、性别与病例组相匹配的正常人55人55眼作为正常对照组,采用A型超声及超声生物显微镜(UBM)测量并比较各组眼部生物学参数及睫状体参数,其中生物学参数包括眼轴长度(AL)、晶状体厚度(LT)、中央前房深度(ACD)、瞳孔直径(PD)、前房宽度(ACW)和晶状体拱高(LV);睫状体参数包括最大睫状体厚度(CBTmax)、巩膜突睫状体厚度(CBT 0)、距巩膜突1000μm处睫状体厚度(CBT 1000)、前端睫状体厚度(APCB)、小梁-睫状体角度(TCA),并分析入组研究对象睫状体参数与生物学参数的相关性。结果与APAC对侧眼组相比,APAC发作眼组ACD较浅,PD较大,LT较厚,差异均有统计学意义(t=-6.805、3.490、2.624,均P<0.05)。与正常对照组相比,APAC对侧眼组AL较短,ACD较浅,差异均有统计学意义(t=-4.828、-6.947,均P<0.001)。APAC发作眼组、APAC对侧眼组、正常对照组CBTmax均值分别为(0.907±0.106)、(0.960±0.098)和(1.020±0.108)mm;TCA均值分别为(48.99±11.48)°、(51.32±10.87)°和(81.94±12.45)°。与APAC对侧眼组相比,APAC发作眼组平均CBTmax、CBT 0、CBT 1000和TCA均较小,差异均有统计学意义(t=-5.354、-3.517、-3.407、-0.753,均P<0.05)。与正常对照组相比,APAC对侧眼组平均CBTmax、CBT 0、CBT 1000、TCA均较小,APCB较大,差异均有统计学意义(t=-6.040、-3.132、-6.005、-13.509、16.795,均P<0.05)。入组研究对象生物测量参数与睫状体测量参数的相关性分析结果显示,AL与CBT 1000、TCA均呈正相关(r=0.335,P=0.012;r=0.380,P=0.004),眼压与CBTmax呈负相关(r=-0.289,P=0.032)。结论与正常眼相比,APAC发作眼及其对侧眼睫状体较薄且向前旋转,并且这种解剖上的改变与短眼轴及高眼压相关。

Objective To investigate the measurements of the ciliary body in patients with acute primary angle-closure(APAC).Methods This was a case-control study.Subjects were admitted to Ningxia Eye Hospital from January to October 2016.Fifty-five consecutive patients diagnosed with APAC in one eye were presented as case groups,and their fellow eyes were presented as fellow groups.Fifty-five eyes from 55 age-matched normal controls were also recruited as control groups.A-scan ultrasonography and ultrasound biomicroscopy(UBM)were conducted to determine biometric measurements and ciliary body parameters.Biometric measurements included axial length(AL),lens thickness(LT),anterior chamber depth(ACD),pupil diameter(PD),anterior chamber width(ACW)and lens vault(LV).Ciliary body parameters included maximum ciliary body thickness(CBTmax),ciliary body thickness at the point of the scleral spur(CBT 0)and 1000μm from the scleral spur(CBT 1000),anterior placement of the ciliary body(APCB),and trabecular-ciliary process angle(TCA),respectively.Pearson correlation analysis was used to examine the correlation between the biometric measurements and the ciliary body parameters.Written informed consent was obtained from each subject before any medical examination.The study protocol was approved by the Ethics Committee of People's Hospital of Ningxia Hui Autonomous Region.Results The ACD was smaller,while the PD and lens thickness were larger in eyes with APAC compared with their fellow eyes.The differences were statistically significant(t=-6.805,3.490,2.624;all at P<0.05).Smaller AL and ACD measurements were found in the fellow eyes of APAC patients compared with normal eyes,and these differences were statistically significant(t=-4.828,-6.947;both at P<0.001).For eyes with APAC,their fellow eyes and normal eyes,the average CBT max were(0.907±0.106),(0.960±0.098)and(1.020±0.108)mm;average TCA were(48.99±11.48)°,(51.32±10.87)°and(81.94±12.45)°,respectively.CBT max,CBT 0,CBT 1000,and TCA measukements were smaller,and APCB were larger in eyes with APAC compared with their fellow eyes,and these differences were statistically significant(t=-5.354,-3.517,-3.407,-0.753;all at P<0.05).In addition,CBT max,CBT 0,CBT 1000,and TCA measurements were smaller,and APCB were larger in the fellow eyes compared with the normal eyes,these differences were also statistically significant(t=-6.040,-3.132,-6.005,-13.509,16.795;all at P<0.05).Positive correlations were found between AL and CBT 1000,and between AL and TCA(r=0.335,P=0.012;r=0.380,P=0.004),while a negative correlation was found between intraocular pressure and CBTmax(r=-0.289,P=0.032).Conclusions In eyes with APAC,as well as their fellow eyes,ciliary bodies are thinner and anteriorly rotated,and this anatomical change is associated with shorter AL and high intraocular pressure.