原发性青光眼患者葡萄膜渗漏发生率及相关因素分析

The morbidity and relevant factors of uveal effusion observed in primary glaucoma patients

目的分析葡萄膜渗漏在原发性青光眼患者的发生率,并对其相关因素进行分析。方法采用病例对照研究方法,收集2016年7月至2017年7月于河北医科大学第二医院就诊的原发性青光眼患者692例,其中原发性急性闭角型青光眼(APACG)患者256例,原发性慢性闭角型青光眼(CPACG)患者368例,原发性开角型青光眼(POAG)患者68例。根据超声生物显微镜(UBM)图像判断有无葡萄膜渗漏,并对渗漏程度进行分级。对葡萄膜渗漏的发生率及渗漏程度的影响因素进行分析。结果APACG缓解期组、APACG临床前期组和CPACG进展期组葡萄膜渗漏的发生率为20.45%(54/264)、3.76%(8/213)和1.45%(8/548),3个组患者葡萄膜渗漏发生率比较差异有统计学意义(χ^2=105.02,P<0.05),其中APACG临床前期组和CPACG进展期组葡萄膜渗漏发生率明显低于APACG缓解期组,差异均有统计学意义(χ^2=29.07、91.15,均P<0.01)。APACG缓解期组葡萄膜渗漏阳性患者初始眼压及眼压波动较葡萄膜渗漏阴性患者高,差异均有统计学意义(Z=-3.626、-4.022,均P<0.05)。APACG缓解期组患者共50例54眼出现葡萄膜渗漏,其中3级渗漏16眼,2级渗漏12眼,1级渗漏26眼。APACG临床前期患者中,共8例8眼出现葡萄膜渗漏,均为1级渗漏。CPACG进展期患者中,共8例8眼出现葡萄膜渗漏,均为1级渗漏。APACG缓解期组患者初始眼压及眼压波动与葡萄膜渗漏程度均呈正相关(rs=0.912、0.923,均P<0.01),治疗后眼压与葡萄膜渗漏程度呈负相关(rs=-0.269,P<0.05)。结论葡萄膜渗漏可发生在经药物治疗后的APACG缓解期、APACG临床前期及CPACG进展期患者,其中APACG缓解期患者葡萄膜渗漏发生率较高,且渗漏程度较重,渗漏程度与初始眼压及眼压下降程度均呈正相关,与治疗后眼压呈负相关。

Objective To analyze the incidence of uveal effusion observed in primary glaucoma and explore the relevant factors.Methods In this case control study,692 primary glaucoma patients in the Second Hospital of Hebei Medical University from July 2016 to July 2017 were recruited,including 256 acute primary angle-closure glaucoma(APACG)patients,368 chronic primary angle-closure glaucoma(CPACG)patients,and 68 primary open angle glaucoma(POAG)patients.Ultrasound biomicroscopy(UBM)was performed to determine the presence of uveal effusion,and to grade the effusion.The incidence of uveal effusion and the degree of effusion were analyzed statistically.The study protocol was approved by the Ethics Committee of the Second Hospital of Hebei Medical University.Results The incidence levels of uveal effusion in the remission stage of APACG,the pre-clinical stage of APACG,and the progress stage of CPACG were 20.45%(54/264),3.76%(8/213)and 1.45%(8/548),respectively;the incidence of uveal effusion among the three groups was statistically significant(χ^2=105.02,P<0.05).The incidence levels of uveal effusion in the pre-clinical stage of APACG and the progress stage of CPACG were obviously lower than that in the remission stage of APACG(χ2=29.07,χ^2=91.15;both at P<0.01).In the remission stage of APACG,the initial intraocular pressure was higher,and intraocular pressure fluctuation was larger in the patients with uveal effusion than that in the patients without uveal effusion,and these differences were statistically significant(Z=-3.626,Z=-4.022;both at P<0.05).Uveal effusion was detected in 54 eyes of the 50 APACG patients in the remission stage,including Grade 3 in 16 eyes,Grade 2 in 12 eyes,and Grade 1 in 26 eyes.Uveal effusion was demostrated in eight eyes of eight patients in the preclinical stage of APACG,and all at Grade 1.In the progress stage of CPACG,uveal effusion was also revealed in eight eyes of eight patients,all at Grade 1.In the remission stage of APACG,the degree of effusion was positively correlated with the initial intraocular pressure and the fluctuation of intraocular pressure(rs=0.912,rs=0.923;both at P<0.01).However,the degree of effusion was inversely associated with intraocular pressure after treatment(r s=-0.269,P<0.05).Conclusions Uveal effusion can be observed in the remission and preclinical stages of APACG,and in the progress stage of CPACG.The remission stage of APACG shows both the highest rate and the severest degree of this complication.The degree of effusion is positively correlated with the initial intraocular pressure and the decrease in intraocular pressure,but it is inversely associated with intraocular pressure after treatment.