Pentacam分析仪比较正常和高度近视眼前房深度和前房角的研究

目的：使用Pentacam三维眼前段分析仪比较高度近视眼与正常人（正视眼）中央前房深度（central anterior chamberdepth,CACD）和前房角（anterior chamber angle,ACA）两项前房参数差异,进一步了解高度近视眼的解剖学特点。方法：收集2010-10/2011-06在我院门诊就诊的正视眼82例,收集同期我院门诊与准分子激光中心就诊的高度近视眼68例,采用Pentacam三维眼前段分析仪测量CACD和ACA。对高度近视组与正视眼组的前房参数值进行两样本t检验,比较两组间参数有无差异。结果：Pentacam三维眼前段分析仪测得正常人CACD平均值为3.02±0.47mm,ACA平均值为33.26°±6.20°。高度近视眼的CACD平均值为3.24±0.38mm,ACA的平均值为39.55°±6.68°。高度近视眼与正视眼的两项前房参数值均存在显著性差异（均P〈0.05）。结论：Pentacam三维眼前段分析仪测量前房参数,高度近视眼与正视眼相比中央前房深度深、前房角宽。     

眼前节分析系统检查中国人正常房角宽度和前房深度

目的 :使用眼前节分析系统 (AnteriorEyeSegmentAnalysisSystem)对中国人正常房角宽度和前方深度进行调查研究 ,初步报告其正常值范围 ,并对该系统的临床应用价值进行评价。方法 :使用眼前节分析系统对 0～ 19岁、 2 0～ 2 9岁、 3 0～ 3 9岁、 40～ 49岁、 5 0～ 5 9岁、 60岁以上共 6组 44例 (85只眼 )正常眼上方、下方、鼻侧、颞侧的房角宽度和前方深度进行测量 ,利用SPSS10 0统计分析软件对 4个方向不同年龄段的房角宽度、各年龄段中 4个方向的房角宽度 ,以及各年龄段前房深度之间进行统计学分析。并做年龄与前房深度的相关回归分析。结果 :正常眼上方、下方、鼻侧、颞侧的房角宽度平均分别为 2 9 3 3± 4 44、 2 9 49± 4 48、 2 9 68± 4 93、 3 0 0 3± 4 2 8度。中央前房深度平均为 2 90± 0 3 8mm。 4个方向不同年龄段之间的房角宽度以及各年龄段之间前房深度存在差异 (Least significantdifferenceLSDP <0 0 5 ) ,而 4个不同方向房角宽度之间差异无统计学意义 (One WayANOVAP =0 813 )。前房深度与年龄之间的关系服从直线回归 :前房深度 =3 3 0 9-0 0 0 11×年龄 ,相关系数 =-0 5 49。结论 :3 0岁以后房角宽度逐渐变窄 ,前房深度逐渐变浅 ,60岁以后这种变化更加明显。不同方向的房角     

有晶状体眼前房硅油的原因分析和处理

目的:探讨有晶状体眼在玻璃体切割术后硅油进入前房的原因及处理方法.方法:对19例视网膜脱离的患者行常规玻璃体切割联合硅油填充手术,对术后发生的硅油进入有晶状体眼前房的原因进行回顾性分析,并根据不同原因及发生程度采取不同处理.结果:有2例(2眼)硅油进入前房发生于二次环扎术中,17例(19眼)发生于术后2～11 d之内(其中1例取出前房硅油3d后硅油再度进入前房并形成瞳孔阻滞继发青光眼,二次取出前房硅油并行虹膜6点位周边切除后再未发生硅油进入前房).所有病例均在硅油进入前房1wk内取出前房硅油,并对其中13例出现继发性青光眼患者行6点位虹膜周边切除;全部病例眼压控制于20mmHg以下,视力均恢复至硅油进入前房之前的矫正视力,取出前房硅油后未出现严重角膜并发症,无1例出现视网膜脱离.结论:有晶状体眼在玻璃体切割术后硅油进入前房原因主要为眼外伤、高度近视、术中医源性损伤等造成悬韧带损伤.对于玻璃体切割术后有晶状体眼前房进入硅油应注意体位及观察角膜、眼压,尽早取出前房硅油,有瞳孔阻滞继发性青光眼的患者必要时行虹膜6点位周边切除.可保护角膜、视网膜及有效的视力.     

Evaluation of blotchy pigments in the anterior chamber angle as a sign of angle closure

Background:

Blotchy pigments in the anterior chamber (AC) angle are considered diagnostic of primary angle closure (PAC). But there are no reports either on the prevalence of blotchy pigments in AC angles or the validity of this sign.

Aims:

To determine the prevalence of blotchy pigments in AC angles and to evaluate their relationship with glaucomatous optic neuropathy (GON) in eyes with occludable angles.

Setting and Design:

Cross-sectional, comparative study.

Materials and Methods:

Gonioscopy was performed in 1001 eyes of 526 subjects (245 eyes of 148 consecutive, occludable angle subjects and 756 eyes of 378 non-consecutive, open angle subjects), above 35 years of age. Quadrant-wise location of blotchy pigments was documented.

Statistical Analysis:

Odds of blotchy pigments in occludable angles against that in open angles were evaluated. Relationship of GON with blotchy pigments in occludable angle eyes was evaluated using a multivariate model.

Results:

Prevalence of blotchy pigments in occludable angles was 28.6% (95% CI, 22.9-34.3) and in open angles was 4.7% (95% CI, 3.2-6.3). Blotchy pigments were more frequently seen in inferior (16%) and superior quadrants (15%) of occludable angles, and inferior quadrant of open angles (4%). Odds of superior quadrant blotchy pigments in occludable angles were 33 times that in open angles. GON was seen in 107 occludable angle eyes. Blotchy pigments were not significantly associated with GON (odds ratio = 0.5; P = 0.1).

Conclusions:

Blotchy pigments were seen in 28.6% of occludable angle eyes and 4.7% of open angles eyes. Presence of blotchy pigments in the superior quadrant is more common in occludable angles. Presence of GON in occludable angle eyes was not associated with blotchy pigments.     

前房型人工晶状体植入术后对房角结构的影响

目的了解新型弹性开袢式前房型人工晶状体(AC-IOL)植入术后对房角的影响。方法采用Goldmann房角镜仔细观察50只眼植入AC-IOL术前、术后360°房角的变化。结果房角粘连30只眼,其中房角粘连范围超过1/2周的3只眼,术后继发青光眼。垂直轴向固定的人工晶状体眼易发生房角粘连。结论尽可能使人工晶状体袢水平位固定于房角的巩膜突,减少房角粘连,建议行AC-IOL植入术的病例术前、术后均应作房角镜检查。     

硅油进入前房对兔眼房角组织的影响

目的 探讨硅油进入前房后对房角组织的影响。方法 将30只健康新西兰白兔随机分成实验组和对照组，分别于前房注射硅油和平衡盐溶液，注射后据眼压情况再次分组，并于注射后第30天将眼压增高眼中的硅油取出。分别于注射后第5，15，30，60，90天采集标本行透射电镜观察。结果 21／50的兔眼注射硅油后出现眼压增高。电镜下可见小梁间隙增宽；胶原及弹性纤维增生，内皮网内不定形物堆集并随高眼压持续时间延长而更趋明显。硅油取出术后眼压和房角组织逐渐恢复正常。眼压正常眼初期可见小梁网轻度扩张，房水丛管腔壁内皮细胞吞噬囊泡增多，后逐渐消退。结论 硅油进入前房后可引起持续性眼压增高并由此引起房角组织发生病理改变，硅油取出后可恢复正常。硅油自身对房角组织无毒性和破坏性。     

Periods of development of the normal human chamber angle

Stages of fetal and postnatal development of the normal human chamber angle are reevaluated. Major growth phases can be detected: trabecular anlage formation (around the 15th week), differentiation into definitive structures (around the 24th week), specialisation of the definitive structures (around the 28th week), achievement of final components (birth) and final moulding of the chamber angle and the maturation of its cellular and extracellular constituents (1–8 years). A cleavage or gradual atrophy of chamber angle tissues could not be detected during any of the above phases, nor was a membrane found, which covered the chamber angle recess at any stage of development. In the light of the described periods, potential disturbances of development are discussed, which might be a cause of congenital glaucoma.     

Alteration of anterior chamber in 81 glaucomatous eyes using Pentacam Scheimpflug system

AIM: To study the effects of gender, eye side and age on anterior chamber measurements; To compare the anterior chamber parameters between glaucoma and normal subjects. METHODS: A total of 169 patients (299 eyes), of which 122 normal subjects (218 eyes), 24 cases (39 eyes) with primary angle-closure glaucoma (PACG) and 22 cases (42 eyes) with primary open-angle glaucoma (POAG) visiting our hospital from Apr. 2008 to Oct. 2008 were enrolled. The parameters measured by Pentacam between different sexes, eye sides, ages and different groups were compared. RESULTS: The mean central anterior chamber depth (CACD), anterior chamber volume (ACV) and anterior chamber angle (ACA) measurements of normal eyes were 2.82±0.43mm, 159.74±43.64mm3 and 35.47±7.92°. There were no significant differences between different eye sides. There was a negative correlation between age and anterior chamber parameters (all P <0.001); The mean CACD, ACV and ACA were 1.87±0.29mm, 82.00±24.17mm3 and 21.94±7.11° in PACG group, and 2.67±0.34mm, 147.24±43.40mm3 and 31.19±6.34° in POAG group. The differences between PACG and age-matched normal subjects were significant (all P <0.05), but there was no significant difference between POAG and age-matched normal subjects (P >0.05). CONCLUSION: CACD, ACV and ACA decrease mildly with age. Anterior chamber parameters of PACG are smaller than that of normal eyes, but there is no difference between POAG and normal eyes.     

有晶状体眼虹膜固定型人工晶状体植入术后房角宽度的改变

目的 使用光学相干断层扫描(optical coherence tomography,OCT)评估有晶状体眼虹膜固定型人工晶状体(intraocular lens,IOL)近视患者植入术后患者房角宽度的变化.方法 28眼(14例)近视患者植入虹膜固定型IOL矫正高度近视.观察术前、术后患者的等效球镜、角膜内皮细胞计数、眼压以及2点、3点、4点、8点、9点、10点钟位的房角宽度.结果 术前、术后等效球镜分别为(-12.95±0.77)D、(-0.35±0.08)D,差异有显著统计学意义(P＜O.001).术前、术后角膜内皮细胞计数分别为(2859.38±62.27) mm-2、(2783.92±62.67) mm-2,差异有统计学意义(P =0.012).术前、术后眼压分别为(11.87±0.40)mmHg(1 kPa=7.5 mmHg)、(11.80±0.40) mmHg,差异无统计学意义(P=0.800).术后3个月,3点、9点钟位房角较术前变窄,差异均有统计学意义(均为P＜0.05),其他方位房角宽度术前、术后差异均无统计学意义(均为P＞0.05).结论 植入虹膜固定型IOL后高度近视患者部分房角变窄,术后应对患者前房变化情况进行随访观察.     

The role of gonio-photocoagulation in neovascularization of the anterior chamber angle

Gonio-photocoagulation is a name applied to direct laser therapy to neovascular vessels in the anterior chamber angle in progressive anterior segment neovascularization. The technique is useful not in altering the stimulus to anterior segment neovascularization, but in immediately altering the product of the stimulus, the new vessels in the angle. The goal is to halt immediately progression toward angle closure and severe neovascular glaucoma. A recommended protocol is presented for incorporation of this technique into a prophylactic regimen for neovascular glaucoma in conjunction with retinal therapy to alter the stimulus.     

不同内径前房维持器在兔眼连续环形撕前囊中所创前房深度的研究

目的：研究不同内径的前房维持器（anterior chamber maintainer,ACM)在兔眼实验性连续环形撕前囊（continuous curvilinear anterior capsulorhexis,CCC)中所创前房深度（anterior chamber depth,ACD)及眼压（intraocular pressure,IOP)的变化, 探讨ACM内径大小及灌注瓶高度（bottle height,BH)对ACD及IOP的影响。方法：将20只兔40眼随机分为4组,每组10眼,均在ACM维持前房下接受CCC。4个实验组所用ACM内径分别是0．4,0．5,0．6,0．7mm,BH由20cm阶梯式升至100cm,每10cm为一个提升高度,对术前及每个BH,应用A超测定ACD,应用Schiotz眼压计测定IOP,结果：内径为0．7,0．6,0．5mm的ACM在BH分别为50,60,70cm时使ACD较术前显著性加深,所提供IOP较术前较高,结论：内径较大的ACM形成前房及提高IOP迅速,所需BH相对较低,对于兔眼的CCC,内径为0．7,0．6,0．5mm的ACM均可提供理想的ACD及IOP,适宜的BH分别是50,60,70cm.     

鹰视眼前段分析仪对前房的测量分析

目的应用鹰视眼前段分析仪（Oculyser）对前房角宽度（ACAW）和前房深度（ACD）进行定量测量,探讨Oculyser在前房测量的应用价值以及多种仪器眼前房生物学参数的关系。方法应用Oculyser对闭角型青光眼和老年性白内障ACAW和ACD进行定量测量,并对各组参数进行统计分析。结果与老年性白内障组相比,闭角青光眼急性发作组和临床前期组ACAW、ACD差异均具有统计学意义。而闭角青光眼急性发作组和临床前期组间比较,ACAW、ACD差异无统计学意义。男女性别间ACAW、ACD差异无统计学意义。结论Oculyser具有客观、准确、非接触和避免人为干扰等优点,可应用于前房角的测量。     

频域眼前段光学相干断层扫描对周边虹膜切除术前后前房角的研究

目的应用频域眼前段光学相干断层扫描（OCT）分析周边虹膜切除术前后前房角的变化。方法原发性前房角关闭者32例（40只眼）行周边虹膜切除术,术前、术后2d、2个月使用频域眼前段OCT进行前房角测量,比较500μm／750μm前房角角度（ACA500／ACA750）和500μm／750μm前房角开放距离（AOD500／AOD750）等指标。结果各指标在术前、术后差异有统计学意义,术后2d、2个月相应指标差异无统计学意义。结论原发性前房角关闭行周边虹膜切除术后前房角增宽,可缓解瞳孔阻滞,预防前房角进一步关闭,频域眼前段OCT可进行术前术后的非接触检查,实现前房的生物统计学测量。     

Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT

AIM: To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS: This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION: Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.     

前房注气治疗闭角青光眼小梁切除术后浅前房

目的探讨应用前房注气术治疗原发性闭角型青光眼小梁切除术后浅前房的效果。方法原发性闭角型青光眼小梁切除术后Ⅱa级及Ⅱb级浅前房101例（118眼）分为2组：保守治疗组50例（60眼）,前房注气组51例（58眼）,进行回顾性研究,比较两组治疗后视力、眼压、远期滤过泡形态、治疗持续时间、治疗有效率及一次治疗成功率。结果原发性闭角型青光眼小梁切除术后浅前房经保守治疗和前房注气治疗两组治疗后视力、眼压、治疗有效率、远期滤过泡形态比较差异无统计学意义（P〉0．05）,一次治疗成功率和治疗持续时间差异有统计学意义（P〈0．05）。前房注气术一次治疗成功率93．1％,治疗时间短。结论前房注气术是治疗原发性闭角型青光眼小梁切除术后浅前房的简单有效的方法。     

新型中央孔型有晶状体眼后房型人工晶状体植入术后前房角的变化

目的：观察新型中央孔型有晶状体眼后房型人工晶状体(ICL)V4c植入术矫正高度近视术后前房角的变化。

方法：前瞻性临床研究。选择高度近视患者150例300眼,均行ICL V4c植入术,记录术前及术后1d,1、3、6mo,1a的视力、眼压、拱高及前房角的变化。采用重复测量方差分析及LSD-t检验对数据进行分析。

结果：术后1d,1、3、6mo,1a,裸眼视力(UCVA)恢复情况较术前显著提高(F=98.2,P<0.01); 术前与术后各时间点鼻侧AOD500、AOD750、TISA500、TISA750、SSA比较均有差异(F=108.256、112.342、164.856、316.549、115.338,均P<0.01); 术前与术后各时间点颞侧AOD500、AOD750、TISA500、TISA750、SSA比较均有差异(F=102.68、548.47、93.37、316.549、117.698,均P<0.01); 两侧术后1d,1、3mo各房角参数逐渐降低,两两比较均有差异(P<0.05),术后3、6mo,1a各房角参数两两相比均无差异(P>0.05)。

结论：ICL V4c植入术后1d,1、3、6mo,1a水平方向各房角参数较术前变小,3mo后基本趋于稳定状态。     

超声乳化联合人工晶状体植入术对前房深度及房角宽度的影响

目的:探讨超声乳化联合人工晶状体植入术对患者前房深度、房角宽度的影响.方法:选取2015-06/2016-05在我院行白内障超声乳化吸除联合人工晶状体植入术的患者74例89眼,于术前及术后3 mo测量患者眼压、中央前房深度(ACD)、房角开放距离(AOD500)和房角角度(ACA500).结果:术后3mo,眼压为11.34±2.38mmHg,较术前(12.60±2.5 1mmHg)有所降低,差异有统计学意义(P＜0.05);ACD为4.01 ±0.30rmm,较术前(2.30±0.42mm)明显增厚,差异有统计学意义(P＜0.05);AOD500和ACA500分别为0.915±0.223mm和41.71 °±6.55°,明显高于术前0.514±0.201mm和24.01°±8.43°,差异有统计学意义(P＜0.05);眼压值与ACD、AOD500和ACA500呈负相关(r=-0.239、-0.211、-0.252,P＜0.05).结论:超声乳化联合人工晶状体植人术可降低患者眼压,增加患者前房深度和房角宽度,从而对眼内房水循环起到积极作用.     

改良氩激光周边虹膜成形术后前房角的改变

目的 探讨采用改良氩激光周边虹膜成形术后中晚期闭角型青光眼前房角的改变及疗效。方法 对20例34眼前房角关闭270°～360°,虹膜膨隆型及高褶虹膜型的中晚期闭角型青光眼,采用大光斑、低能量的曲线形、斜照、略模糊光斑光凝的改良氩激光周边虹膜成形术式。 结果 术后随访6～24个月,平均10.8 个月,其中1年以上者14例26眼。15例26眼眼压控制≤21 mmHg(76.47％);28眼周边前房加深,房角粘连范闱减轻或重新开放(82.35%) 全部治疗眼的周边虹膜皱缩,堆积现象缓解,并发症少,有效地保护了患者仅存的视功能。结论 改良氩激光周边虹膜成形术是治疗中、晚期闭角型青光眼的有效方法之一     

白内障超声乳化吸除术治疗闭角型青光眼术后房角改变

目的比较观察单纯白内障超声乳化手术治疗不同房角关闭状态的闭角型青光眼,手术前后房角改变。方法本组临床研究对象为采用白内障超声乳化联合人工晶体植入术治疗合并有白内障的闭角型青光眼病例中,非随机选取不同房角关闭状态及药后眼压低于或高于21mmHg 29例47眼,其中A组19眼,房角关闭粘连<180°,药后眼压低于21mmHg,B组28眼,房角关闭粘连>180°,药后眼压大于21mmHg。术前及术后常规行视力、裂隙灯、Goldmann前房角镜检查,前房深度,眼压检查。统计学分析处理。结果两组47眼术后视力均有不同程度提高,前房深度增加。两组术后眼压均明显降低,统计学处理组内手术前后差异有显著性,两组间术后眼压比较无统计学差异。房角镜检查术后前房角均有增宽,房角关闭及周边虹膜前粘连范围减小,部分患者关闭的房角重新开放,其中房角全部开放25眼,仍存1/4~1/2圆周前房角粘连7眼(A组3眼B组4眼),小于1/4圆周前房角粘连15眼(A组6眼B组9眼),随访3~18月未见前房角关闭及粘连范围扩大以及眼压再次升高。结论单纯白内障超声乳化吸除术治疗合并有白内障的原发性闭角型青光眼,其房角关闭粘连的范围广泛超过1/2圆周甚至达到3/4圆周以上,仍可达到增加视力,加深前房,开放房角,降低眼压的治疗目的。