超声生物显微镜观察急性闭角型青光眼与慢性闭角型青光眼眼前节结构差异的对比研究

Ultrasound biomicroscopic differences between fellow eyes of acute angle-closure glaucoma and chronic angle-closure glaucoma

目的比较急性闭角型青光眼(AACG)急性发作眼的对侧眼与慢性闭角型青光眼(CACG)青光眼性损伤较轻眼的眼前节结构差异。方法病例对照研究。收集2016年9月至2018年10月就诊于北京大学人民医院青光眼门诊确诊为单眼急性发作的AACG患者的对侧眼(41只眼,F-AACG组)和不对称CACG患者损伤较轻眼(46只眼,F-CACG组)的临床资料。在超声生物显微镜(UBM)图像上测量晶状体拱高(LV)、前房深度、虹膜厚度、房角开放距离、小梁虹膜夹角,分析两组眼前节结构特征和差异。统计学方法采用独立样本t检验及logistic回归分析。结果F-AACG组患者年龄为(65±10)岁,F-CACG组患者年龄为(67±12)岁,差异无统计学意义(P>0.05)。F-AACG组的前房深度为(1.79±0.25)mm,距巩膜突750μm处的虹膜厚度为(0.39±0.07)mm,距巩膜突500μm处房角开放距离为(0.12±0.06)mm,距巩膜突500、750μm处的小梁虹膜夹角分别为10.91°±5.23°、9.33°±5.02°,均低于F-CACG组[(1.99±0.34)mm、(0.43±0.05)mm、(0.15±0.07)mm、13.93°±6.33°、13.93°±6.82°],差异均有统计学意义(均P<0.05);F-AACG组的LV为(0.99±0.44)mm,高于F-CACG组[(0.72±0.30)mm],差异有统计学意义(P<0.01)。多因素logistic回归分析显示,距巩膜突750μm处的小梁虹膜夹角每减少1°(比值比为0.872,95%置信区间:0.794~0.958,P<0.01),LV每增加1 mm(比值比为14.138,95%置信区间:2.348~85.130,P<0.01),AACG的发生显著增加。结论与CACG损伤较轻眼相比,AACG急性发作眼的对侧眼周边虹膜厚度较薄,房角较窄,前房深度较浅,LV较大。LV和距巩膜突750μm处的小梁虹膜夹角可能是AACG区别于CACG的重要结构参数。(中华眼科杂志,2021,57:672-678)

Objective To compare the structural differences of the anterior segment between fellow eyes of acute angle-closure glaucoma(AACG)and the eyes of chronic angle-closure glaucoma(CACG)with milder glaucomatous damage.Methods In this case-control study,patients with AACG(41 eyes)and CACG(46 eyes)without prior treatment in the glaucoma clinic of Peking University People′s Hospital from September 2016 to October 2018 were enrolled.Ultrasound biomicroscopy was performed under dark condition.Parameters were measured on images including lens vault(LV),anterior chamber depth(ACD),iris thickness(IT750 and IT2000),angle-opening distance(AOD500 and AOD750),and trabecular iris angle(TIA500 and TIA750).The independent t-test was used to compare the continuous variables of the fellow eyes of AACG patients and the eyes of CACG patients with milder glaucomatous damage.After adjusting for age and gender,univariate and multivariate logistic regression analyses were performed to explore the most important parameters that may distinguish AACG from CACG.Results The mean age of AACG patients was(65±10)years old and the age of CACG patients was(67±12)years old(P>0.05).The ACD[(1.79±0.25)mm vs.(1.99±0.34)mm],IT750[(0.39±0.07)mm vs.(0.43±0.05)mm],AOD500[(0.12±0.06)mm vs.(0.15±0.07)mm],TIA500(10.91°±5.23°vs.13.93°±6.33°),and TIA750(9.33°±5.02°vs.13.93°±6.82°)were less and the LV[(0.99±0.44)mm vs.(0.72±0.30)mm]was greater in the fellow eyes of AACG as compared to the eyes of CACG with milder glaucomatous damage(all P<0.05).In the forward multivariate logistic regression analysis,every 1-degree decrease in TIA750(odds ratio=0.872,95%CI:0.794 to 0.958,P<0.01)and every 1-mm increase in LV(odds ratio=14.138,95%CI:2.348 to 85.130,P<0.01)were significantly associated with AACG.Conclusions Compared with the eyes of CACG with milder glaucomatous damage,fellow eyes of AACG have thinner peripheral iris thickness,narrower angle width,shallower ACD,and greater LV.LV and TIA750 may play important roles in distinguishing eyes predisposed to AACG or CACG.(Chin J Ophthalmol,2021,57:672-678)