色素播散综合征患者散瞳后短期眼压波动的初步观察

Preliminary observation on short-term intraocular pressure fluctuation after mydriasis in patients with pigment dispersion syndrome

目的观察色素播散综合征(PDS)患者瞳孔散大后短期眼压波动曲线及其规律。设计前瞻性病例系列。研究对象2021年8月至2022年1月北京同仁医院门诊PDS患者21例(21眼),其中单纯PDS10眼,PDS继发色素性青光眼(PG)11眼。方法采集患者病史并行基本眼科检查,测量基线眼压。每例患者随机选一眼连续滴用复方托吡卡胺眼液2次,间隔15分钟。第二次滴药后5分钟开始测量眼压,每隔1小时重复测量一次,连续测量8次,至瞳孔恢复至入组时水平。主要指标散瞳前后眼压、眼压波动曲线。结果21只PDS眼的平均基线眼压(18.0±3.1)mmHg,散瞳后第2小时眼压达到峰值(19.4±4.2)mmHg,平均升高(1.4±2.6)mmHg(t=-2.425,P=0.025);散瞳后眼压波动幅度平均为(5.4±2.3)mmHg。单纯PDS的平均基线眼压为(18.0±3.2)mmHg,PG为(18.0+3.1)mmHg,分别在散瞳后第3和第4小时达到眼压峰值(19.4±5.2)mmHg和(19.8±5.6)mmHg,眼压平均升高分别为(1.4±3.3)mmHg和(1.7±4.3)mmHg。21眼PDS中,已行激光周边虹膜切开术(LPI)者13眼,初始眼压(18.6±2.6)mmHg;未行LPI者8眼,初始眼压(17.1±3.8)mmHg,分别在散瞳后第3、第4小时达到峰值(19.7±4.1)mmHg和(19.2±7.3)mmHg,眼压平均升高分别为(1.2±2.6)mmHg和(2.0±5.1)mmHg。21眼PDS中,初始眼压>21mmHg者3眼(14.3%),散瞳后8次眼压有任一次眼压>21mmHg者10眼(47.6%);眼压波动幅度>8mmHg者3眼(14.3%),均为PG患者,最高眼压32mmHg。结论散瞳对中国人PDS患者的眼压波动影响较小,较少引起眼压剧烈波动。

Objective To observe the short-term intraocular pressure(IOP)fluctuation curve and its regularity in Chinese patients with pigment dispersion syndrome(PDS)after mydriasis.Design Prospective cases series.Participants Twenty-one eyes of 21 Chinese patients with PDS presenting for care at the glaucoma specialty clinic in Beijing Tongren Hospital,from August 2021 to January 2022,including 10 eyes with simple PDS and 11 eyes with PDS complicated with pigment glaucoma(PG).Methods Medical history,essential ophthalmological examination,and initial IOP was collected.One eye of each patient was randomly selected as the research object,in which compound tropicamide eye drops were instilled twice with an interval of 15 minutes.The IOP was measured 5 minutes after the second instllation and repeated hourly for eight consecutive measurements until the pupil diameter recovered to the level at enrollment.Main Outcome Measures IOP values pro-and post-mydriasis,IOP fluctuation curve.Results The initial IOP of these PDS eyes(n=21)was(18.0±3.1)mmHg,which rose to the highest level of(19.4±4.2)mmHg at the second post-mydriasis hour,with a mean increase of(1.4±2.6)mmHg(t=-2.425,P=0.025).The magnitude of I0P fluctuation was(5.4±2.8)mmHg among all enrolled eyes after pupil di-lation.The initial IOP of those simple PDS eyes was(18.0+3.2)mmHg,and the average IOP of PG eyes was(18.0±3.1)mmHg.They reached the highest I0P level at the third and fourth hour after the mydriasis,at(19.4±5.2)mmHg and(19.8±5.6)mmHg,with an in-crease of(1.4±3.3)mmHg and(1.7±4.3)mmHg,respectively.Thirteen PDS eyes with laser peripheral iridotomy(LPI)before admission had an average IOP of(18.6±2.6)mmHg,and the remaining 8 PDS eyes without LPI had an initial IOP of(17.1±3.8)mmHg,which peaked at the third and fourth post-mydriasis hour at(19.7±4.1)mmHg and(19.2±7.3)mmHg respectively,with an increase of(1.2±2.6)mmHg and(2.0±5.1)mmHg.On admission,three(14.3%)of these enrolled PDS eyes had initial IOP of above 21 mmHg.Affer pupil dilation,ten of the enrolled eyes(47.6%)had at least one measurement of over 21 mmHg.IOP fluctuation of 8 mmHg or more was discerned in 3 of these PDS eyes,all of which were PG eyes,and the highest IOP was 32 mmHg.Conclusion Mydriasis has a mild effect on IOP fluctuation in Chinese patients with PDS.Pupil dilation is unlikely to causes intensive IOP spike in these patients.