急性原发性房角关闭对侧眼激光周边虹膜切除术后接触性房角关闭的研究

目的了解急性原发性房角关闭（APAC）对侧眼激光周边虹膜切除术（LPI）后接触性房角关闭的发生率和眼部解剖特征。方法前瞻性研究。选择54例APAC对侧眼没有虹膜前黏连（PAS）的患者作为研究对象,平均年龄（67．1±7．2）岁（54—83岁）。采用超声生物显微镜（UBM）在暗环境下观察LPI后是否发生接触性房角关闭．并比较发生接触性房角关闭与不发生接触性房角关闭患眼的眼压、房角及各项UBM参数,包括房角开放距离。（AOD跏）、房角隐窝面积,。（ARA750）、小梁虹膜夹角（T—I角）、小梁睫状体距离（TCPD）、周边虹膜厚度（IT1）、虹膜悬韧带距离（IZD）、虹膜根部附着位置、中央前房深度（ACD）。对两组数据采用独立样本t检验及两样本秩和检验进行分析。结果LPI后暗环境下UBM检查至少一个象限发生接触性房角关闭的有20例,占37％。反映房角开放程度的指标（AOD500、ARA750、T-I角）和反映睫状体位置的指标（TCPD）：接触性房角关闭（＋）组小于（-）组（t=11．741、11．089、12．175、4．349,P均〈0．01）;反映虹膜形态和位置的指标IT1：接触性房角关闭（＋）组大于（-）组（t=-3．300,P=0．002）;IZD、虹膜根部附着位置及ACD比较,两组差异无统计学意义（t=-1．880,P=0．066;Z=-1．423,P=0．155;t=0．072,P=0．942）。结论APAC对侧眼LPI后在暗环境下仍有一定比例发生接触性房角关闭,房角窄、睫状体前位、周边虹膜厚是LPI后发生接触性房角关闭的解剖学特点,提示LPI后具有这些解剖特点的APAC患者有可能进展为慢性房角关闭。     

白内障超声乳化吸除联合房角分离术治疗闭角型青光眼的临床观察

目的观察超声乳化白内障吸除联合房角分离术治疗闭角型青光眼合并白内障患者的临床疗效。方法收集2008年7月至2011年12月闭角型青光眼合并白内障34例（35只眼）,患者均接受采用颞侧隧道式角膜透明切口,超声乳化白内障吸除联合房角分离术,术后随访6个月。结果术后最佳矫正视力,较术前显著提高（t=3．951,P〈0．01）;患者术后6个月眼压平均为（14．2±2．8）m／nHg,较术前用药前后眼压相比均显著下降（t=3．228,P〈0．01）;术后患者房角均较术前增宽,房角粘连关闭象限不同程度开放;术前前房深度为（3．65±0．23）mm,术后增加到（4．60±0．35）mm,差异有显著性（t=2．349,P〈0．05）;未发生恶性青光眼、后囊膜破裂等并发症;所有术眼人工晶状体均在位,未出现偏位、夹持。结论白内障超声乳化吸除联合房角分离术可有效降低眼压,提高视力,为闭角型青光眼同时合并白内障患者安全有效的治疗途径。     

超声乳化联合房角分离术治疗闭角型青光眼术后合并白内障

目的观察超声乳化白内障吸出后房型人工晶状体植入术联合房角分离术治疗原发性闭角型青光眼患者小梁切除术后合并白内障患者的临床疗效。方法前瞻性研究方法。纳入符合条件的手术患者35例（38只眼）,行透明角膜切口白内障超声乳化吸除联合后房型人工晶状体植入术并房角分离术,随访6个月至1年,比较观察手术前后视力、眼压情况、中央前房变化情况和房角开放情况。结果所有患者术后视力均有提高。患者术前平均眼压（16．91±3．44）mmHg,术后平均（11．82±2．52）mmHg,差异有统计学意义（P〈0．05）;术前中央前房深度平均（2．10±0．19）mm,术后平均（3．31±0．28）mm,差异有统计学意义（P〈0．05）。术前周边前房深度〈1／2 CT者29只眼,术后28只眼周边前房深度≥1CT。术后房角关闭所在象限均有不同程度的开放,周边虹膜粘连范围明显缩小。2只眼前房出血,3只眼前房渗出,1只眼发生后囊膜破裂,无恶性青光眼、角膜失代偿等并发症。结论超声乳化自内障吸出人工晶状体植入术联合房角分离术治疗青光眼合并白内障患者可有效的降低眼压。     

超声乳化联合房角分离术治疗闭角型青光眼合并白内障

目的探讨超声乳化吸出联合房角分离术治疗闭角型青光眼合并白内障的临床疗效。方法闭角型青光眼合并白内障20例（22眼）。男12例（14眼）,女8例（8眼）。年龄64～85岁,平均（76．80±3．12）岁。其中急性闭角型青光眼18例,慢性闭角型青光眼4例,所有手术由同一医师完成,均采取超声乳化人工晶状体植入联合房角分离术,观察手术前、后眼压,视力,周边前房深度及房角的变化情况,随访3～12个月。结果患眼术前眼压范围7．8～30．013]mHg,平均（18．91±5．48）mmHg,术后平均（11．81±2．90）mmHg,t值4．77（P〈0．05）,差异有统计学意义,术后眼压较术前显著性降低。术前BCVA≤0．1者7眼,占31．80％,术后BCVA≤0．5者12眼,占54．5％,术后视力明显提高。术前周边前房深度〈1／2CT者18眼,术后22眼周边前房深度≥1CT,虹膜平坦,周边膨隆消失。术后房角关闭所在象限可见不同程度的开放,周边虹膜粘连范围缩小。2眼出现前房渗出．虹膜部分后粘连,1眼发生后囊破裂,未发生角膜失代偿等并发症。结论采用超声乳化吸出联合房角分离术治疗闭角型青光眼合并白内障是安全、有效的。     

激光周边虹膜切开术对原发性闭角型青光眼高危者的二年干预效果

目的 观察激光周边虹膜切开术（laser peripheral iridotomy,LPI）对原发性闭角型青光眼（primary angle clouse glaucoma,PACG）高危者的2年干预效果。设计 队列研究。研究对象 PACG高危者52例（104眼）。方法 PACG高危者随机分成干预组和观察组两组,每组26例（52眼）,干预组行LPI, 观察组仅随访观察。于LPI术前、术后2周、6及12个月、2年进行眼科常规检查及超声生物显微镜（UBM）检查。主要指标 眼压、UBM图像中前房角参数。结果 干预组LPI术前眼压为（16.89±3.01） mm Hg,最后随访眼压为 （15.20±2.39） mm Hg;LPI术后中央前房深度、房角开放距离、小梁虹膜夹角、房角开放象限数均较术前增加,差异均有显著性（P均<0.01）。观察组随访1年时眼压变化无显著差异,但房角开放距离、小梁虹膜夹角、房角开放象限数均较前减少,差异均有显著性（P均<0.05）;随诊2年时眼压（17.31±2.27）mm Hg,  较前增高（P<0.05）。干预组无一例发展为PACG,观察组2例（2眼）PACG急性发作。 结论 LPI能有效改善前房角结构,并可有效防止PACG高危者发展为PACG。     

超声乳化吸除联合IOL植入术治疗不同房角关闭范围的闭角型青光眼的效果

目的：探讨不同房角关闭范围的闭角型青光眼采用超声乳化吸除联合后房型人工晶状体植入进行治疗的疗效,为闭角型青光眼的治疗提供依据。方法：闭角型青光眼患者47例54眼进行研究,所有患者均进行超声乳化吸除联合后房型人工晶状体植入术治疗。按照房角关闭粘连程度分为3组,房角关闭粘连≤1／2周者为A组（13眼）;1／2＜房角关闭粘连≤3／4者为B组（18眼）;房角关闭粘连＞3／4者为C组（23眼）,观察三组患者术后2 wk的房角和眼压情况,并观察术后3 mo内的并发症情况。结果：三组患者治疗后2wk的眼压均较治疗前相比显著降低,且B、C两组眼压降低幅度显著优于A组,差异有统计学意义（P＜0．05）;三组患者术后周边虹膜前粘连范围明显减少,其中 A 组患者房角重新开放13眼,开放率达100％,B组房角开放14眼,开放率达78％,C组房角开放16眼,开放率为70％,三组间相比差异有统计学意义（ P＜0．05）;治疗后仅有C组3眼再次发生青光眼,发生率为13％,与其他两组相比差异有统计学意义（ P＜0．05）;A组患者术后无并发症发生;B组有3眼角膜水肿、2眼房角关闭粘连＞3／4;C组5眼房角关闭粘连＞3／4,1眼有前房消失,3眼角膜水肿,1眼脉络膜上腔出血,三组患者术后并发症发生率组间相比差异具有统计学意义（P＜0．05）,且B、C两组再次出现房角关闭粘连率显著高于A组,差异有统计学意义（P＜0．05）。结论：对于轻中度房角关闭粘连的闭角型青光眼患者采用超声乳化吸除联合后房型人工晶状体植入术治疗效果显著,术后房角达到开放,但对于重度房角粘连患者其术后并发症较多,尤其是可能出现青光眼的复发。     

激光周边虹膜切除术后的原发性房角关闭进展为青光眼的相关因素

目的：研究原发性房角关闭(PAC)患者激光周边虹膜切除术(LPI)后进展成青光眼(PACG)的相关因素。

方法：采用前瞻性研究，收集2017-01/12我院就诊的符合纳入标准PAC患者86例86眼，其中随访2a以上、有5次以上的可靠视野的LPI后PAC患者65例65眼，平均随访时间为2.65±0.27a，根据是否出现视野缺损和相应的青光眼性视神经损害分为进展组与未进展组，记录进展为PACG的情况，并对其相关因素进行分析

结果：LPI后PAC患者65眼中9眼(14%)进展成青光眼。进展组年龄(68.67±7.03岁)、随访眼压波动(10.11±4.17mmHg)与未进展组(61.95±8.03岁，5.54±2.73mmHg)有差异(均P<0.05)，进展组的垂直杯盘比(VCDR)≥0.6、粘连性房角关闭(PAS)≥1个象限、PAS范围合并贴附性房角关闭>2个象限进展率显著高于未进展组(均P<0.05)。PAC患者LPI后进展成PACG与患者的年龄、随访眼压波动、VCDR≥0.6、PAS≥1个象限、PAS范围合并贴附性房角关闭>2个象限呈显著正相关(r_s=0.304、0.396、0.495、0.268、0.309)。

结论：PAS≥1个象限和PAS范围合并贴附性房角关闭>2个象限、VCDR≥0.6、高龄、随访眼压波动大与LPI后PAC患者进展成PACG相关。     

小切口非超声乳化联合房角分离术在原发性急性前房角关闭合并白内障术中的应用

目的评价小切口非超声乳化后房型人工晶体植入联合房角分离术治疗原发性急性前房角关闭合并白内障的疗效。方法回顾分析2012年6月至2015年1月收住我院的原发性急性前房角关闭合并白内障38例40眼。均行小切口非超声乳化后房型人工晶体植入联合房角分离术。术后随访6月至12月,平均8.3月。对其手术前后的视力、眼压、视野、中央前房深度、房角形态进行对照观察。结果术后3月38例40眼最佳矫正视力均有明显提高。术前眼压（28.4±3.2）mm Hg,术后3月眼压（12.6±2.9）mm Hg,两者之间差异有统计学意义（P〈0.05）。术前前房深度（1.85±0.32）mm,术后前房深度（3.10±0.25）mm,两者之间差异有统计学意义（P〈0.05）。术后3月房角镜检查30例32眼房角开放,6例6眼粘连范围〈90°,2例2眼粘连范围为90°~180°,术后随访期间无再次粘连及关闭者。术后有28例30眼视野较术前好转,10例10眼视野无明显变化。结论合并白内障的原发性急性闭角型青光眼行小切口非超声乳化后房型人工晶体植入联合房角分离术,有降低眼压,提高视力和开放房角等作用,是安全有效的手术方法,适合在基层医院推广应用。     

闭角型青光眼伴白内障两种手术方式的选择

目的探讨闭角型青光眼伴发白内障的手术方式选择。方法观察闭角型青光眼伴发白内障116例（124眼）,根据眼压控制和前房角粘连情况分为两组,A组：单用缩瞳剂使眼压控制在≤30mmHg（1mmHg=0．133kPa）,前房角粘连≤180°者70例（76眼）,行白内障超声乳化人工晶状体植入联合前房角分离术。B组：眼压〉30mmHg,前房角粘连〉180°者46例（48眼）,行白内障超声乳化人工晶状体植入联合小梁切除术。术后随访6个月,观察视力、眼压、前房深度。结果A、B两组术后平均矫正视力均较术前有显著性提高（A组：Z=-6．584,P〈0．01,B组：Z=-4．516,P〈0．01）。术后平均眼压显著下降（A组：t=4．504,P〈0．01,B组t=10．802,P〈0．01）。术后平均前房深度显著增加（A组：t=-16．3693,P〈0．01,B组：t=-14．2475,P〈0．01）。结论闭角型青光眼伴发白内障单用缩瞳剂眼压控制在≤30mmHg,前房角粘连≤180。者行白内障超声乳化人工晶状体植入联合前房角分离术是安全有效的;眼压〉30mmHg,前房角粘连〉180。者联合小梁切除术则较好。     

超声乳化人工晶状体植入联合前房角分离术治疗慢性闭角型青光眼合并白内障

目的观察超声乳化人工晶体植入联合前房角粘连分离术治疗慢性闭角型青光眼合并白内障的效果。方法超声乳化术联合前房角粘连分离术联合人工晶状体植入三联术治疗闭角型青光眼合并白内障26例（33眼）。对其手术前后的视力、眼压、视野、中央前房深度、房角形态进行对照观察。结果术后随访3～36个月,视力均较术前明显提高（P〈0．05）。术后中央前房深度均加深（P〈0．05）。33眼术后眼压明显降低（P〈0．05）,术后1个月前房角镜检查房角均较术前开放角度增加。25例（31眼）术后6个月复查视野无明显进展。1例（2眼）眼压正常范围,视野损害加重,用苏为坦滴眼液进一步控制眼压。结论超声乳化前房角分离术可有效治疗合并白内障的慢性闭角型青光眼。     

激光周边虹膜切除术治疗原发性闭角型青光眼的远期疗效观察

目的 探讨激光周边虹膜切除术(LPI)治疗原发性闭角型青光眼(PACG)的远期疗效及安全性.方法 回顾性系列病例研究.收集1992年4月至2002年10月实施LPI治疗且术后随诊时间达5年以上的PACG患者临床资料,根据患者LPI治疗前眼压、视乳头、视野、前房角等情况,将患眼重新分为3组:疑似原发性前房角关闭(PACS)组、原发性前房角关闭(PAC)组、原发性闭角型青光眼(PACG)组,分析LPI治疗后各组患者远期眼压控制、视力及并发症等情况.不同类型的原发性闭角型青光眼之间LPI治疗后眼压控制情况比较采用x~2检验.结果 共收集到符合条件的患者131例(251只眼),其中PACS组18只眼(7.2%),PAC组98只眼(39.0%),PACG组129只眼(51.4%),无法分类的6只眼(2.4%).PACS组、PAC组、PACG组患者LPI治疗后眼压控制满意率分别为88.9%(16/18)、38.8%(38/98)及10.9%(14/129),眼压控制不满意率分别为5.6%(1/18)、48.0%(47/98)及75.2%(97/129),眼压控制失败率分别为5.6%(1/18)、13.3%(13/98)及14.0%(18/129).3组患者LPI治疗后眼压控制情况的差异有统计学意义(x~2=59.08,P=0.000).251只眼中8只眼(3.2%)在LPI治疗后1周至16年发生青光眼急性发作.全部患者在随诊期间未发生大泡性角膜病变.结论 LPI治疗后PACG的眼压控制不如预期的那样好.在大多数青光眼中,LPI可以有效防止闭角型青光眼的急性发作.LPI治疗后PACG、PAC、PACS组患者均存在不同程度的眼压升高危险,需密切随诊,及时处理.     

Acute primary angle closure: configuration of the drainage angle in the first year after laser peripheral iridotomy

PURPOSE: To evaluate the changes in the configuration of the drainage angle in the first year after acute primary angle closure (APAC). DESIGN: Prospective observational case series. PARTICIPANTS: Forty-four Asian subjects with APAC. METHODS: Acute primary angle closure cases were treated with medical therapy followed by laser peripheral iridotomy (LPI). Static and dynamic gonioscopies were performed in APAC-affected and fellow eyes before LPI (baseline) and then at 2 weeks, 4 months, and 12 months after presentation. The angles were graded in each quadrant according to the Shaffer scheme, and the number of clock hours of peripheral anterior synechiae (PAS) was recorded. Patients who underwent intraocular surgery at any point during follow-up were excluded from the study. Intraocular pressure (IOP) and medical treatment were documented at each visit, and gonioscopic changes were correlated with the development of elevation in IOP requiring medical treatment. MAIN OUTCOME MEASURES: Average Shaffer grade and the number of clock hours of PAS. RESULTS: The majority of subjects were Chinese (84%) and female (64%), and the mean age was 60.2+/-10.7 years. At presentation, 73% of both affected and fellow eyes had very narrow angles (average Shaffer grade < or = 1), with affected eyes having more extensive PAS (P<0.001), a third of whom had > or =8 clock hours of PAS. In APAC eyes, there was a significant increase in angle width from baseline to 2 weeks after LPI (P = 0.045), but no change in angle width subsequently. Fellow eyes showed a widening of the angle between baseline and week 2 (P = 0.01) and from week 2 to month 4 (P = 0.001). There was no significant change in PAS in either affected or fellow eyes over the 12 months of follow-up. Of the 44 subjects, 19 (41.3%) subsequently developed IOP elevation during follow-up that required treatment. However, there was no difference in angle width or amount of PAS between eyes with and without a subsequent rise in IOP, and the angle configuration did not change significantly in either group over 1 year. CONCLUSION: In Asian eyes with APAC, the angle widened in the first 2 weeks after LPI, but did not change thereafter over 1 year, and the amount of PAS remained stable throughout. The results indicate the effectiveness of LPI in preventing progressive closure of the angle in the first year after APAC.     

The damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma

 Purpose: To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT). Methods: Twenty four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after remission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled less than 21 mm Hg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 month after IOP controlled. Repeated measures ANOVA was used to examine the time course of changes after IOP controlled in RNFL thickness in both acute attack and unaffected fellow eyes of APACG and eyes with CPACG. Results: The mean RNFL thickness (μm) for the APACG-attacked eyes increased significantly within 3 days (121.49±23.84) after acute strike and then became thinner along with time (107.22±24.72 at 2 week, 93.58±18.37 at 1 month, 84.10±19.89 at 3 month and 78.98±19.17 at 6 month). In APACG-attacked eyes, there were significant differences of average RNFL thickness among 5 different times after IOP was controlled (P ＜ 0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness among 5 different times (F = 0.450, P = 0.104 in APACG unaffected fellow eyes and F = 1.558, P = 0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F = 1.912,P = 0.003). Conclusion:  RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.     

Laser peripheral iridotomy across the spectrum of primary angle closure

BACKGROUND: To study the effectiveness of Nd:YAG laser peripheral iridotomy (LPI) for primary angle closure in Asian Indian patients. METHODS: Retrospective analyses of patients who underwent LPI and completed a minimum follow-up of 2 years. Eyes were classified as primary angle-closure suspects (PACS), primary angle closure (PAC), and primary angle-closure glaucoma (PACG).The indications for LPI, requirement of medication, and subsequent clinical course were studied in each group. RESULTS: 103 eyes of 55 patients were analyzed.The mean (SD) follow-up was 45.6 (2) months. The mean age in women was less than in men (55.7 [8.3] vs. 62.1 [7.8] years).Twenty-seven eyes were classified as PACS, 43 eyes as PAC, and 33 eyes as PACG. After LPI, no eye with PACS progressed to PAC or PACG. Four of 43 eyes (9.3%) with PAC progressed to PACG.Twenty-five of the 33 eyes (75.8%) with PACG did not progress after LPI during the study period. Patients with 2 quadrants of angle closure (risk ratio 12.9). INTERPRETATION: After LPI, the rate of progression from PAC to PACG was less than expected from the reported natural course of the disease, and the majority of eyes with PACG remained stable. LPI appears to alter the natural course of PACS, PAC, and PACG favourably.     

Quantitative evaluation of changes in anterior segment biometry by peripheral laser iridotomy using newly developed scanning peripheral anterior chamber depth analyser

AIM: Using the newly developed scanning peripheral anterior chamber depth analyser (SPAC), the effects of peripheral laser iridotomy (PLI) on peripheral anterior chamber depth (PACD) were determined quantitatively as was the association between PACD and chronic elevation of intraocular pressure (IOP) after PLI. METHODS: 16 eyes of 15 patients with acute primary angle closure glaucoma (PACG) attack, 14 eyes of 14 patients with narrow angle and PACG attack in their fellow eyes, and 13 eyes of seven patients with chronic angle closure glaucoma (CACG) were enrolled. The SPAC scanned the anterior ocular segment from the optical axis to the limbus and took 21 consecutive slit lamp images at 0.4 mm intervals. A computer installed program automatically evaluated the PACD and the averaged values of three measurements were employed for analysis. RESULTS: PLI significantly increased PACD and changed the iris contour from convex to flat or concave in all the enrolled eyes. The extent of the PLI induced PACD increase was enhanced with increasing distance from the optical axis. Comparing PACDs after PLI, eyes that received prophylactic PLI showed the greatest extent of PLI induced PACD increase, followed by eyes with CACG and eyes with PACG attack. The PACD of eyes with PACG attack was almost the same as that of the fellow eyes of PACG attack before prophylactic PLI. Eyes with PACG attack showed poorer IOP control after PLI than eyes with narrow angle and CACG with PLI. CONCLUSIONS: PLI significantly increases PACD and the small PLI induced opening of PACD may contribute to chronic IOP elevation after PLI.     

Outcomes following acute primary angle closure in an Asian population

Background:  Data regarding development of primary angle closure glaucoma (PACG) following acute primary angle closure (APAC) is conflicting. This study looks at outcomes after an APAC episode with a secondary aim to identify any risk factors that could predict progression to PACG.
Methods:  This is a retrospective review of the charts of consecutive patients who were diagnosed with APAC from December 2003 to June 2006. All were treated in a standard manner with initial intensive medical therapy or laser iridoplasty followed by early laser peripheral iridotomy within 24 h of presentation.
Results:  Forty-two eyes of 41 patients were analysed. The mean follow-up period was 27.3 ± 16.2 months. Nine eyes (21.4%) developed an increase in intraocular pressure (IOP) within a mean of 11.9 months (median 5 months) after resolution of APAC. Eight eyes went on to have trabeculectomy or glaucoma drainage device. At final follow up, the mean IOP of attack eye was 13.3 ± 2.92 mmHg. None of the eyes, including those that underwent surgery, required topical medication to control IOP. Thirty-eight eyes (90.5%) have BCVA of 6/6 to 6/12. The duration of symptoms before presentation ( P  = 0.00) and duration taken to abort the acute attack ( P  = 0.01) were found to be significantly associated with development of PACG.
Conclusion:  The results of this study suggest that outcomes following successful treatment of APAC may not be as poor as described previously. Early aggressive management of the acute episode may have a role to play in preventing development of PACG after APAC.     

复合式小梁切除术治疗原发性闭角型青光眼的临床观察

目的 了解复合式小梁切除术治疗原发性闭角型青光眼(PACG)的眼压控制情况及并发症.方法 回顺性系列病例研究.将PACG分为原发性急性闭角型青光眼(APACG)急性发作期、慢性期及原发性慢性闭角型青光眼(CPACG)慢性期和晚期,分别对复合式小梁切除术患者手术前后眼压、最佳矫正视力、手术并发症等指标进行观察,分析复合式小梁切除术治疗APACG与CPACG的眼压控制情况.采用SPSS 12.0统计学软件进行数据处理.手术后患者视力变化及转归情况的等级资料分析采用秩和检验,组间年龄、眼压等定量资料比较采用独立样本的t检验,手术前后不同时期眼压值的比较采用单因素重复测量资料的方差分析.结果 接受复合式小梁切除术的PACG患者共82例(96只眼).其中APACG患者37例(40只眼),CPACG患者45例(56只眼);术后随访时间(中位数)分别是24个月和25个月,APACG与CPACG患者术后随访时间差异无统计学意义(Z=-0.146,P=0.886).APACG患者术前眼压(53.6±17.9)mm Hg(1 mm Hg=0.133 kPa),术后出院时眼压(10.5±4.9)mm Hg,最终随访时眼压降至(14.0±10.3)mm Hg.CPACG患者的术前眼压(36.8±13.8)mm Hg,术后出院时眼压(11.7±4.2)mm Hg,最终随访时眼压(13.8±4.5)mm Hg.APACG患者(F=100.783)和CPACG患者(F=54.383)手术前与手术后眼压差异均有统计学意义(P<0.01).APACG患者中,有38只眼(95.0%)手术后无需使用降眼压药物,眼压即可控制在21 mm Hg以下;其中急性发作期33只眼,慢性期5只眼.CPACG患者中有50只眼(89.3%)手术后无需使用降眼压药物,眼压即可控制在21 mm Hg以下;其中进展期45只眼,晚期6只眼.所有PACG患者在小梁切除术后均以视力下降比例为高,手术后最常见的并发症为浅前房.结论 复合式小梁切除术后,APACG急性发作期和慢性期及CPACG进展期和晚期的眼压控制均较好,表明小梁切除术是治疗PACG和控制眼压的有效方式之一.但是复合式小梁切除术后视力降低比例较高是不可忽视的重要问题.     

Role of lens vault in subtypes of angle closure in Iranian subjects

Purpose

The purpose of this study is to quantify anterior chamber (AC) parameters and to determine the proportion of eyes with exaggerated lens vault (LV) in different subtypes of angle closure disease using anterior segment optical coherence tomography (AS-OCT).

Patients and methods

In this prospective study, 115 eyes of 115 Iranian patients with angle closure disease were included and categorized into three groups: (1) fellow eyes of acute angle closure (AAC; 40 eyes); (2) primary angle closure glaucoma (PACG; 39 eyes); and (3) primary angle closure suspect (PACS; 36 eyes). Complete ophthalmic examination including gonioscopy, A-scan biometry, and AS-OCT were performed. Angle parameters, LV, and iris thickness (IT) were measured using AS-OCT. An exaggerated LV was defined as LV more than one-third the distance between the corneal endothelium and a line drawn to connect the nasal and temporal scleral spurs.

Results

Fellow eyes of AAC had the shallower AC (P=0.01), greater iris curvature (I-curve; P=0.01), and higher LV (P=0.02) as compared with PACS and PACG eyes. There was no statistically significant difference in the mean IT at 750 μm from scleral spur among the three groups (P=0.45). Exaggerated LV was found in 67.5, 35.9, and 40% of fellow eyes of AAC, PACG, and PACS, respectively, (P=0.008) with an odds ratio of 1.92 (P=0.005) for fellow vs PACG and 1.68 (P=0.01) for fellow vs PACS.

Conclusions

Exaggerated LV is highly prevalent in fellow eyes of AAC. These eyes have shallower AC depth, greater I-curve, and higher LV when compared with PACG and PACS.     

Iridotomía periférica láser frente a facoemulsificación en el cierre angular primario: estudio comparativo prospectivo

PurposeA study was designed to determine and describe the changes induced in the anterior segment of the eye and the intraocular pressure (IOP) after laser peripheral iridotomy (LPI) versus phacoemulsification in primary angle closure suspects (PACS) and primary angle closure (PAC).MethodsForty-seven eyes (47 patients) with Shaffer gonioscopy 0-II were included and split into 2 groups: cataract surgery (n = 29) or LPI (n = 18), depending on the lens sclerosis and visual acuity. Tonometry, gonioscopy, funduscopy, and automated measurements of the anterior chamber by Pentacam were performed before the intervention, and one and 3 months after the technique.ResultsPhacoemulsification reduces IOP after one and 3 months (P<.01). LPI reduces IOP after 3 months (P<.04), and after one month (P<.38). IOP was 16.2 mmHg (SD: 3.59) in the phacoemulsification group vs. 16.83 mmHg (SD: 2.36) in the LPI group after one month (P=.4), and 15.52 (SD: 2.95) vs. 16.05 (SD: 2.46) in the third month (P=.5). There were no significant differences in the antiglaucoma drugs.Shaffer gonioscopy grading was greater in the phacoemulsification group vs. in the LPI group one and 3 months after the intervention (P=.01). The highest difference between both techniques was found in the superior quadrant. The anterior chamber depth, angle and volume by Pentacam were wider in the phacoemulsification group after one and 3 months (P<.01).ConclusionsAlthough phacoemulsification and LPI could both be effective techniques in the prevention of pupillary block in PAC, faster and greater amplitude of the angle and the anterior chamber can be obtained after phacoemulsification than after LPI.