原发性房角关闭性疾病患者脉络膜厚度的临床研究

Choroidal thickness in primary angle-closure disease

目的:应用频域光学相干断层扫描深度增强成像技术(EDI-OCT)测量并探讨原发性房角关闭性疾病(PACD)患者黄斑区及视盘周围脉络膜厚度的特点及规律,分析脉络膜厚度在PACD发病机制中的作用。方法:前瞻性研究。收集2015-01/2019-12于我院就诊的PACD患者82例155眼,其中可疑原发性房角关闭(PACS)组24例24眼;急性原发性房角关闭(APAC)组28例35眼;慢性原发性房角关闭(CPAC)组30例38眼;原发性闭角型青光眼(PACG)组38例58眼。另收集健康志愿者87例87眼纳入正常对照组。所有研究对象均应用EDI-OCT测量黄斑区及视盘周围脉络膜厚度。结果:PACD各组黄斑区脉络膜厚度均高于正常对照组(P<0.05)。在PACD患者中,除距黄斑中心凹3mm处鼻侧,PACG组黄斑区其余各点位脉络膜厚度均低于PACS组、APAC组、CPAC组(P<0.05)。APAC组黄斑中心凹下脉络膜(357.17±61.49μm)最厚,PACS组(318.04±56.52μm)次之,PACG组最薄(263.55±67.87μm)。除CPAC组,其余各组黄斑中心凹旁1mm处脉络膜厚度均较黄斑中心凹下脉络膜厚度降低(P<0.05)。各组受检者黄斑中心凹旁3mm处脉络膜厚度均低于黄斑中心凹下和黄斑中心凹旁1mm处(P<0.05)。各组受检者视盘周围脉络膜厚度无差异(P>0.05)。结论:PACD患者及正常人黄斑中心凹下脉络膜最厚,离黄斑中心凹越远,脉络膜越薄。黄斑区脉络膜增厚是PACD患者又一特征性解剖结构,可能是诱发青光眼急性发作的重要因素。PACD患者视盘周围脉络膜厚度与正常人相比并无特征性改变。

AIM:To measure the macular and peripapillary choroidal thickness(CT)in primary angle-closure disease(PACD)with enhanced depth imaging optical coherence tomography(EDI-OCT).To explore the characteristics of CT in each subtypes of PACD and to evaluate its role in the pathogenesis of PACD.METHODS:This was a prospective clinical study.A total of 155 PACD eyes(82 patients)were enrolled in the study,including 24 PACS eyes(24 patients),35 APAC eyes(28 patients),38 CPAC eyes(30 patients),58 eyes PACG(38 patients).87 normal eyes(87 patients)were set up as control.The EDI-OCT was used to measure the macular and peripapillary choroidal thickness in all study patients.RESULTS:PACD eyes exhibited thicker choroid than the control eyes at all macular locations(P<0.05).Choroidal thickness of PACG was thinner than other PACD eyes in area except for 3mm nasal from the fovea(P<0.05).Subfoveal choroidal thickness(SFCT)of APAC was thickest(357.17±61.49μm),followed by PACS group(318.04±56.52μm).PACG group presented the thinnest SFCT(263.55±67.87μm).The average macular CT at 1mm centered at the fovea was thinner than SFCT(P<0.05)in all subgroups except for CPAC.The average macular CT at 3mm as well as 1mm centered at the fovea was thinner than SFCT in all subgroups(P<0.05).There was no statistical differences in CT at peripapillary locations between PACD and controls groups(P>0.05).CONCLUSION:In PACD and controls groups,the CT of subfoveal location was the thickest with decreasing thickness when moving eccentrically from the fovea.The thicker CT might be another anatomic characteristic of PACD.Increased CT in macular location might be a contributing factor of acute attacks.There was no characteristic distinction in the peripapillary CT of PACD when compared with normal controls.