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。

Appositional angle closure in fellow eyes of acute primary angle closure after laser peripheral iridotomy

Objective To investigate the frequency and anatomical characteristics of appositional angle closure after laser peripheral iridotomy in the fellow eyes of acute primary angle closure. Methods Prospective study. Fifty-four fellow eyes of acute primary angle closure without peripheral anterior synechia after laser peripheral iridotomy were studied. Mean age of （67.1±7.2）years （range 54-83 years）. Uhrasounic biomicroscopy （UBM） were performed in darkness. Qualitative analysis of appositional angle closure and quantitative measurements of the angles from UBM images were taken. It was compared between the eyes of positive and negative appositional angle closure groups in intraocular pressure, gonioscopy and UBM parameters, including angle opening distance500 （AOD500）, angle recess area750 （ARA750）, trabecular-iris angle （T-I angle）, trabecular-ciliary process distance （TCPD）, peripheral iris thickness （IT1）, iris-zonule distance （IZD）, the position of iris insertion and central anterior chamber depth （ACD）. All analyses were performed using a two-tailed Student＇s t test and two independent samples rank sum tests of SPSS 12.0 statistical software. Results Twenty patients （37%） were found to have appositional angle closure in at least one quadrant from UBM images in darkness after laser peripheral iridotomy. The indexes showing angle open degree （AOD~, ARA75o, T-I angle） and the index showing ciliary body position （TCPD） in appositional angle closure positive group were less than those in negative group （t=11.741, 11.089, 12.175 and 4.349 respectively, P〈0.01）. The index showing iris configuration and position IT1 in appositional angle closure positive group was more than that in negative group （t=-3.300, P=0.002）. There were no significant differences in IZD, position of iris insertion and center anterior chamber depth between the two groups （t=-1.880,P=0.066; Z=-1.423, P=0.155; and t=0.072, P=0.942 respectively）. Conclusion The fellow eyes of a（＇ute pfimm＇y angle （;losure still appear at）positional angle closure in darkness propoltionally afler laser peripheral iridotomy. The narrower angle, the more anterior position of the ciliary body, and the thicker peripheral iris. are the anatonlical characteristics associated with appositional angle closure after laser peripheral iridotomy. It suggests the possibility of chronic angle closure development in the eyes having these anatomical characteristics in acute primary angle closure after laser peripheral iridotomy.