可疑原发性房角关闭患眼在明暗环境下眼前节结构和瞳孔舒张特性的差异

Differences in anterior segment structure and pupillary diastolic characteristics of eyes with primary angle closure suspects under light and shade environments

目的探讨可疑原发性房角关闭(PACS)眼在明暗环境下眼前节解剖结构和瞳孔动态变化参数的变化情况及其与发生急性房角关闭(APAC)的相关性。方法横断面研究。收集2019年9月至2021年3月就诊于哈尔滨医科大学附属第二医院眼科门诊的PACS患者37例(66只眼),其中男性12例,女性25例,年龄(61.27±7.35)岁。66只眼中对侧眼无APAC史者58只眼,对侧眼有APAC史者8只眼。双眼均无APAC病史的患者进行暗室俯卧激发试验(DRPPT),然后将患眼分为3组:DRPPT-组44只眼、DRPPT+组14只眼、APAC组8只眼,将DRPPT+组和APAC组合并为APAC+组。对所有患者进行超声活体显微镜检查,测量明、暗环境下各参数的变化值,包括鼻侧和颞侧的前房角度500(ACA_( 500Δ))和1000(ACA_(1000Δ))、房角开放距离500(AOD_(500Δ))和1000(AOD_(1000Δ))、虹膜厚度500(IT 500Δ)和1000(IT_( 1000Δ))。眼前节分析仪采集所有患眼明暗状态下瞳孔变化过程,记录瞳孔直径、最大扩张速度V_(max)、最大收缩速度V_(min)以及平均速度V m。结果DRPPT+组和APAC组两组间各项参数之间比较均差异无统计学意义(P>0.05)。在差异性分析中发现,DRPPT-组V m为(0.17±0.07)mm/s,高于APAC+组的(0.13±0.06)mm/s,差异有统计学意义(P<0.05)。其余参数均差异无统计学意义(P>0.05)。在所有PACS患眼中V_(max)与颞侧ACA_(1000Δ)和颞侧AOD_(1000Δ)呈正相关(r=0.302,0.260;P<0.05),V_(min)与颞侧ACA_(1000Δ)和颞侧AOD_(1000Δ)呈负相关(r=-0.338,-0.330;P<0.05)。结论在PACS患者中,临床前期眼相比于DRPPT阴性眼,虹膜发生了调节、运动能力的改变,平均瞳孔扩张速度减慢;瞳孔扩张过程中的扩张速度与房角结构变化相关,扩张速度越高,房角开放程度越高。

ObjectiveTo investigate the anatomical structure changes of the anterior segment and dynamic pupil changes in eyes with suspected primary angle-closure(PACS)under light and dark conditions,and their correlation with the occurrence of acute primary angle-closure(APAC).MethodsThis cross-sectional study collected data from 37 PACS patients(66 eyes)who visited the ophthalmology clinic of the Second Affiliated Hospital of Harbin Medical University between September 2019 and March 2021.The patients included 12 males and 25 females,with an average age of(61.27±7.35)years.Of the 66 eyes,58 had no history of APAC in the contralateral eye,while 8 had a history of APAC in the contralateral eye.Patients without a history of APAC in both eyes underwent the dark room prone provocative test(DRPPT),and the eyes were divided into three groups:DRPPT-(44 eyes),DRPPT+(14 eyes),and APAC(8 eyes).The DRPPT+and APAC groups were combined into the APAC+group.All patients underwent ultrasound biomicroscopy(UBM)to measure the changes in various parameters under light and dark conditions,including anterior chamber angle 500(ACA_(500Δ))and 1000(ACA_(1000Δ)),angle opening distance 500(AOD_(500Δ))and 1000(AOD_(1000Δ)),and iris thickness 500(IT 500Δ)and 1000(IT 1000Δ).Anterior segment analysis was performed to capture the pupil changes under light and dark conditions,recording pupil diameter,maximum dilation speed(V_(max)),maximum constriction speed(V_(min)),and average speed(V m).ResultsThere was no significant difference in the parameters between DRPPT+group and APAC group(P>0.05).In the difference analysis,it was found that the V m value of DRPPT-group[(0.17±0.07)mm/s]was higher than that of APAC+group[(0.13±0.06)mm/s],and the difference was statistically significant(P<0.05).There was no significant difference in other parameters(P>0.05).V_(max) was positively correlated with temporal ACA_(1000Δ)and temporal AOD_(1000Δ)in all patients with PACS(r=0.302,0.260;P<0.05),V_(min) was negatively correlated with temporal ACA_(1000Δ)and temporal AOD_(1000Δ)(r=-0.338,-0.330;P<0.05).ConclusionsThe dynamic changes in the anterior segment and pupil under different lighting conditions provide insights into the risk factors and potential predictive indicators for the occurrence of APAC in PACS patients.