原发性房角关闭眼激光虹膜切除术后UBM测量参数比较

目的:比较激光虹膜切开术前后原发性房角关闭(primary angle closure,PAC)眼超声生物显微镜(ultrasound biomicroscopy,UBM)参数。方法:对46例74眼PAC患者进行了一项前瞻性临床试验。平均年龄58,04±11.33(24.0-82.0)岁。所有病例行完整的眼科检查,前房角镜A超生物测量和超声生物显微镜检查(Vu-max,SonomedInc.,NY,USA)及24-2标准无色差视野检查(SAP,Humphrey Visual Field Analyzer-II i,Carl Zeiss Meditec Inc.,Dublin,CA,USA)。使用配对t检验评估基准和随访的平均值之间的变化。结果:激光周边虹膜切除术(laser peripheral iridotomy,LPI)术后,平均房角从8.02±4.61(0.10-19.60)度增加到17.66±6.39(0.10-32.70)度(P=0.000),房角开放距离500(angle opening distance 500,AOD500)从0.11±0.06(0.01-0.30)mm增加到0.23±0.07(0.13-0.50)mm(P=0.000),平均虹膜厚度(iris thickness,IT)从0.58±0.11(0.33-0.99)mm下降到0.52±0.10(0.25-0.77)mm(P=0.000)。小梁睫状突距离,虹膜睫状突距离和睫状体厚度均未发现显著统计学差异。结论:LPI术后PAC的白种人眼睛的AOD500,虹膜晶体距离和前房角增加,IT和虹膜晶体高度减少。这说明LPI解除了瞳孔阻滞,加深了前房,扩大了房角,减少了虹膜前凸和增厚。     

原发性闭角型青光眼激光周边虹膜切开术后前房角形态变化的一年观察

目的定量观察原发性闭角型青光眼(PACG)激光周边虹膜切开术(LPI)后前房角形态变化及周边虹膜前粘连(PAS)对LPI术后效果的影响。设计前瞻性病例系列。研究对象河北省邯郸市眼科医院连续的25例(39眼)PACG患者。方法患眼行LPI治疗。术前、术后2周、6个月、12个月时行眼科常规检查及超声生物显微镜(UBM)检查。根据末次随访时眼压情况分为眼压控制不良组(A组)及眼压控制良好组(B组)。各随访时间点的UBM参数进行重复测量的方差分析,组间比较采用配对t检验及Wilcoxon检验。主要指标UBM图像中测量的前房角参数。结果平均随访时间为(386.4±36.7)天。LPI术后2周、6个月及12个月的房角开放距离(AOD)、小梁虹膜夹角(TIA)、虹膜隐窝面积(ARA)较术前增加均有统计学意义(P均<0.001)。小梁睫状突距离(TCPD)术后12个月较术前增加具有统计学意义(P<0.001)。B组AOD500、TIA500、ARA500及TCPD均大于A组(P均<0.05),而PAS钟点范围少于A组(P=0.01)。结论 LPI能显著增宽PACG患者的周边前房角,但PAS的范围对LPI的效果起到明显的制约作用。     

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。     

原发性前房角关闭眼激光周边虹膜切开术后前房角形态学变化

目的 定量检测和评价原发性前房角关闭(PAC)眼行激光周边虹膜切开(LPI)术后前房角形态学变化.方法 临床病例系列研究.对入选的31例(54只眼)PAC患者于LPI术前、术后2周、6及12个月,进行眼科常规检查,定量检测超声活体显微镜(UBM)图像中前房角的各项参数.各随访时间点的UBM参数比较采用重复测量的方差分析,巩膜突前750μm与500 μm处各参数的比较采用配对t检验.结果 LPI术后前房深度较术前加深0.10 mm,但差异并无统计学意义(F=3.50,P＞0.05).LPI术前,巩膜突前750 μm处,前房角开放距离(66.2±51.6) μm,小梁网与虹膜间夹角5.0°±3.5°,前房角隐窝面积(0.025±0.017)mm2,小梁网与睫状突距离(571.0±97.2) μm;LPI术后2周、6及12个月,巩膜突前750 μm处,前房角开放距离分别为(165.0±70.3)、(185.8±68.5)及(196.1±77.7)μm,小梁网与虹膜间夹角分别为(11.9±4.9)、(13.3±4.8)及14.0°±5.4°,前房角隐窝面积分别为(0.058±0.024)、(0.065±0.023)及(0.068±0.026)mm2,小梁网与睫状突间距离分别为(647.1±113.0)、(701.8±93.4)及(670.1±95.4) μm,均较LPI术前增加,差异均有统计学意义(前房角开放距离:F =92.60,小梁网与虹膜间夹角:F=92.60,前房角隐窝面积:F=92.60,小梁网与睫状突间距离:F =34.00;P ＜0.05).术后前房角开放距离、小梁网与虹膜间夹角及前房角隐窝面积均较术前增加1倍以上.巩膜突前750 μm处检测参数的增加幅度均较巩膜突前500 μm处大(前房角开放距离:t=5.90,P＜0.05;小梁网与虹膜间夹角:t=2.70,P＜0.05;前房角隐窝面积:t=2.00;P =0.05).结论 LPI能显著增宽PAC眼的周边前房角,且随访观察1年期间前房角仍开放.巩膜突前750 μm处的参数比500μm处参数对评价周边前房角形态变化更为敏感.     

原发性闭角型青光眼单侧急性发作对侧眼激光虹膜周边切除术后随访研究

背景对于有房角关闭高危因素的眼,激光虹膜周边切除术（LPI）是首选的治疗方法,但可疑原发性房角关闭患者行LPI术后2年内仍有28％发生房角关闭,因此有必要了解影响LPI术后疗效的相关因素。目的观察原发性闭角型青光眼（PACG）急性发作眼的对侧眼行LPI后眼压及房角变化情况,分析与手术疗效相关的影响因素。方法回顾性分析单侧急性发作史的PACG患者（≥40岁）87例87眼,其对侧眼接受LPI,于术后1周,3、6、9、12个月随访眼压,并在裂隙灯下使用压陷式Goldmann单面房角镜观察LPI后颞、鼻、上、下各象限房角开放情况并按Shaffer房角分级标准记录,同时观察周边同位性房角关闭（AAC）范围以及周边房角黏连范围,与术前值进行比较。手术成功标准为：术后眼压在未使用药物情况下保持在6～21mmHg;并未出现青光眼特征性视神经病变及相应的视野缺损;无需任何抗青光眼药物或手术治疗。对影响LPI成功率的因素进行Cox多因素逐步回归分析。结果共完成随访并纳入分析79例79眼,其中男33例（41．8％）,女46例（58．2％）,年龄（61．4±0．4）岁。手术前后6个组眼压差异的总体比较差异有统计学意义（F=4．056,P〈0．01）,LPI术后各时间点的眼压均较术前降低,差异有统计学意义（P〈0．01）。房角除下方之外各象限及平均Shaffer级别有所增加,LPI术后1周、3个月和6个月与术前比较差异均有统计学意义（P〈0．05）;术后1周和3个月AAC范围较术前缩小,差异均有统计学意义（P〈0．05）,而术后6、9、12个月的AAC范围与术前比较差异无统计学意义（P〉0．05）。术后1年LPI成功者61例（77．2％）,术前眼压、房角各象限及平均Shaffer级别、AAC范围在LPI手术成功与失败病例之间差异有统计学意义（P〈0．01）。Cox逐步回归分析发现,AAC范围与LPI生存率之间具有相关性（Wald=48．150,RR=1．963,P〈0．01）,而术前眼压、房角各象限及平均Shaffer级别、年龄、性别与LPI生存率无明显相关性（P〉0．05）。结论PACG急性发作眼的对侧眼行LPI后可使房角增宽、眼压降低,术后成功率与术前AAC的范围有关,提示在考虑术前ACC范围条件下,LPI可以更有效地预防房角关闭的发生。     

Argon laser iridotomy in angle closure glaucoma

Argon laser iridotomy was successfully performed in 30 eyes of glaucoma patients. A modified two stage procedure has been described to achieve a successful iridotomy in pigmented eyes. At the chosen site of laser iridotomy, partial thickness burns were applied in the first stage followed by a penetrating burns in the second stage. This minimised the complications associated with laser iridotomy and decreased the incidence of subsequent closure. At the end of 6 months follow up the success rate was 93.3 percent.     

Ultrasound biomicroscopic quantification of the change in anterior chamber angle following laser peripheral iridotomy in early chronic primary angle closure glaucoma

AIMS: To prospectively evaluate by ultrasound biomicroscopy (UBM) and gonioscopy the anterior chamber angle widening following laser peripheral iridotomy (LPI) in eyes with early chronic primary angle closure glaucoma (CACG). METHODS: A total of 55 eyes of 55 patients with CACG presenting with less than 180 degrees peripheral anterior synechiae (PAS) were enrolled in the study. Angles were assessed by gonioscopy (Shaffer's grading) and UBM, before and 4 weeks after LPI. The angle opening distance at 250 and 500 microm from the scleral spur (AOD 250 and AOD 500) was computed. Results were analysed using the Wilcoxon signed-rank test. RESULTS: In the quadrant with LPI, the mean gonioscopy grade increased significantly from 0.45 to 1.45 (P<0.001) and the mean AOD 250 and AOD 500 increased from 38.5+/-25.9 to 83.5+/-48.4 microm (P<0.001) and 110.2+/-80.9 to 170.6+/-83.4 microm (P<0.001), respectively. The angles widened significantly in the opposite quadrant on UBM (AOD 250: 48.8+/-31.5-82.7+/-43.9 microm, P<0.001; AOD 500:117.2+/-65.5-172.2+/-81.7 microm; P<0.001), but the median gonioscopy grade remained unchanged. CONCLUSIONS: LPI significantly widened the anterior chamber angle in the quadrant with LPI and the quadrant furthest away in patients of CACG with established glaucomatous damage. This change was much better appreciated by the UBM than gonioscopy.     

Outcome of laser peripheral iridotomy in chronic primary angle closure glaucoma

BACKGROUND AND OBJECTIVES: To report the effect of laser peripheral iridotomy on the angles of eyes with chronic angle closure glaucoma. PATIENTS AND METHODS: The hospital records of 171 consecutive patients with chronic primary angle closure glaucoma (CPACG) seen between October 1994 and March 1997 were analyzed to study the gonioscopic outcome of laser peripheral iridotomy (LPI). Success was defined as open angles (with or without medications for intraocular pressure (IOP) control) following LPI at the 1 month follow-up. RESULTS: Forty-seven eyes of 34 patients had chronic appositional angle closure glaucoma (CAACG), and 186 eyes of 124 patients had chronic synechial angle closure glaucoma (CSACG). Seventy eyes of 57 patients that underwent primary trabeculectomy for advanced disease were excluded from the study. Two hundred thirty-three eyes of 158 patients underwent LPI; the angles could be opened in 171 eyes (73.4%; confidence interval 67.7% to 79.1%) of 117 patients. Medications to control the IOP were required in 25 eyes (10.7%) of 19 patients. Fifty-four eyes of 34 patients that did not respond to LPI underwent argon laser gonioplasty. Gonioplasty was successful in opening at least 180 degrees of the angle in all eyes. There was no significant difference in success between CAACG (74.5%) and CSACG (73.1%). Age, IOP, and field loss were not predictors of outcome. There was perfect concordance of results between the 2 eyes of patients who had bilateral LPI. CONCLUSIONS: In this series, laser iridotomy was successful in opening the angle in 73.4% of eyes. Gonioplasty opened the angle in all eyes that underwent this procedure. The effect of iridotomy on one eye was predictive of the effect on the fellow eye.     

原发性闭角型青光眼患者与可疑原发性房角关闭患者虹膜睫状体构型特征的比较分析

目的 比较原发性闭角型青光眼（PACG）患者与可疑原发性房角关闭（PACS）患者的房角生物学特征。设计 回顾性比较性病例系列。研究对象 2019年10月至2021年3月同济医院58例PACG及PACS患者。方法 回顾患者病例资料及超声生物显微镜（UBM）图像,测量其房角生物学参数,进行定量及定性分析。主要指标 中央前房深度（ACD）、500 μm房角开放距离（AOD500）、500 μm小梁虹膜夹角（TIA500）、500 μm小梁睫状突距离（TCPD500）、500 μm小梁睫状体夹角（TCA500）、虹膜根部厚度（IT500）、睫状突长度（CPL）、睫状体厚度（CBT）。结果 与PACS组（n=25）相比,PACG组（n=33）患者最佳矫正视力（BCVA）更低（0.4±0.35、0.2±0.17）,基线眼压更高（21.17±6.09、15.57±3.57 mmHg）,眼轴更短（22.17±1.22、22.74±0.88 mm）,ACD更浅（1.77±0.27、1.94±0.25 mm）,AOD500、TIA500、TCPD500、TCA500更小（0.04±0.04、0.10±0.05 mm;3.90±4.58、11.07±4.77°;0.51±0.10、0.58±0.10 mm;60.55±13.26、71.54±12.58°）,CPL更长（1.43±0.26、1.28±0.15 mm）。虹膜插入点位于睫状体基底部的比例（54.5%、20.0%）及睫状体前旋的比例（68.0%、39.4%）PACG组较PACS组更大（P均<0.05）。而IT500、CBT、虹膜成角和虹膜凸度在两组间未见差异。结论 PACG眼较PACS眼具有更短的眼轴和更浅的前房,长而前旋的睫状体构型更明显,虹膜插入点位于基底部的比例更高。（眼科,2022,31： 20-26）     

YAG激光虹膜周边切开术联合非穿透性小梁切除治疗闭角型青光眼

目的 观察YAG激光虹膜周边切开术联合非穿透性小梁切除术(NPDS)治疗单纯瞳孔阻滞型闭角型青光眼的疗效.方法 对2002年1月至2004年10月收治的21例(35只眼)单纯瞳孔阻滞型闭角型青光眼进行YAG激光虹膜周边切开术联合非穿透性小梁切除术,分析手术前后眼压的差异及术后各个随访期的手术成功率.随访期10～36月,平均(18.77±10.47)月.结果 术前平均眼压(25.57±4.92)mmHg,术后3月、6月、12月、24月和36月的眼压分别为(13.34±4.18)mmHg、(14.49±2.83)mmHg、(14.92±4.57)mmHg、(16.77±3.45)mmHg、(17.32±4.17)mmHg.术后3月、6月、12月、24月和36月的完全成功率分别为81.2%、78.1%、73.3%、69.0%、66.1%;部分成功率分别为82.4%、80.9%、74.7%、72.7%、70.1%.并发症有:微穿透6例,前房出血4例,低眼压3例,脉络膜脱离2例.结论 YAG激光虹膜周边切开术联合NPDS可作为治疗部分类犁的闭角型青光眼是安全有效地手术方式.     

YAG laser iridotomy treatment for primary angle closure in east Asian eyes

AIM: To assess the efficacy of Nd:YAG laser iridotomy as initial treatment for primary angle closure in a community setting in rural Mongolia. METHODS: Subjects with occludable drainage angles in two glaucoma prevalence surveys in Mongolia (carried out in 1995 and 1997) were treated with YAG laser iridotomy at the time of diagnosis. These patients were re-examined in 1998. Patency of iridotomy, intraocular pressure (IOP), visual acuity, and gonioscopic findings were recorded. Iridotomy was classified unsuccessful in eyes where further surgical intervention was required or in which there was a loss of visual acuity to <3/60 from glaucomatous optic neuropathy. RESULTS: 164 eyes of 98 subjects were examined. Patent peripheral iridotomies were found in 98.1% (157/160) of eyes that had not undergone surgery. Median angle width increased by two Shaffer grades following iridotomy. Iridotomy alone failed in 3% eyes with narrow drainage angles and either peripheral anterior synechiae or raised IOP, but normal optic discs and visual fields. However, in eyes with established glaucomatous optic neuropathy at diagnosis iridotomy failed in 47%. None of the eyes with occludable angles that were normal in all other respects, and underwent iridotomy, developed glaucomatous optic neuropathy or symptomatic angle closure within the follow up period. CONCLUSIONS: Nd: YAG laser iridotomy is effective in widening the drainage angle and reducing elevated IOP in east Asian people with primary angle closure. This suggests that pupil block is a significant mechanism causing closure of the angle in this population. Once glaucomatous optic neuropathy associated with synechial angle closure has occurred, iridotomy alone is less effective at controlling IOP.     

急性闭角型青光眼对侧眼与可疑原发房角关闭眼的前节参数比较

目的：探讨原发闭角型青光眼单侧急性发作( acute angle closure glaucoma,AACG)的对侧眼、可疑原发房角关闭眼(primary angle closure suspects,PACS)和正常眼的前节生物学参数差异。
　　方法：采用光学相干断层扫描( optical coherence tomography,OCT)和 Pentacam 三维眼前节分析诊断系统(pentacam scheimpflug system,Pentacam)完成26例26眼AACG对侧眼及与之年龄、性别匹配的28例28眼PACS和34例34眼正常眼的前节扫描。采用Pentacam获得以下参数：中央角膜厚度( CCT)、角膜容积( CV)、瞳孔直径( PD)、中央前房深度( CACD)、周边前房深度( PACD)、前房容积( CV )和房角度数( ACA )。应用图像处理软件和OCT测量虹膜厚度(IT750,IT2000),面积(IS)、体积(IV)和房角开放距离500( AOD500)进行。
　　结果：角膜参数(CCT,CV),PD、虹膜参数(IT750,IT2000, IS,IV)无统计学差异( P>0.05)。与 AACG 对侧眼和PACS比较,正常人CACD和PACD更深, ACV更大, ACA和AOD500更宽敞( P<0.05)。 AACG对侧眼和PACS相比,各项前节解剖参数均无统计学差异(P>0.05)。以AACG对侧眼作为房角关闭好发的诊断标准,上述前房参数的受试者工作特征曲线下面积均小于0.7。
　　结论：AACG对侧眼和PACS的前节生物学参数无显著差异,以此作为房角关闭好发的诊断精准度较低。     

Anterior segment morphology after laser iridotomy in primary angle closure suspects

Purpose

To evaluate and compare the changes in anterior segment parameters in primary angle closure suspects before and after laser peripheral iridotomy and intrasession repeatability of measurements before laser iridotomy as assessed by Scheimpflug‐Placido disc topographer.

Methods

Before laser iridotomy, 56 eyes of 56 primary angle closure suspect patients underwent anterior segment analysis with the Sirius Scheimpflug‐Placido disc topographer system using glaucoma analysis mode, which was repeated a week after iridotomy. Anterior segment parameters such as central anterior chamber depth, central corneal thickness, anterior chamber volume and iridocorneal angle were analysed before and after laser iridotomy and compared with paired t‐test. Three consecutive scans were obtained to assess the intrasession repeatability of measurements before iridotomy by a single examiner and intraclass correlation co‐efficient was calculated. Multivariate regression analysis was performed to evaluate the predictors associated with iridocorneal angle narrowing.

Results

Intraclass correlation co‐efficient values ranged from 0.982 for anterior chamber volume to 0.998 for the iridocorneal angle. After laser iridotomy, mean central anterior chamber depth increased from 2.14 ± 0.29 mm to 2.21 ± 0.28 mm (p = 0.04), mean anterior chamber volume increased from 96.2 ± 16.98 mm³ to 98.14 ± 15.87 mm³ (p < 0.0001) and mean iridocorneal angle widened from 33.38 ± 3.96° to 34.82 ± 4.27° (p = 0.01), compared with pre‐iridotomy status. There was no change in central corneal thickness, intraocular pressure or pupil diameter. Multivariate regression analysis model showed that at one week after iridotomy, iridocorneal angle opening was positively correlated with age (β = 0.773, p = 0.005) and anterior chamber volume (β = 1.308, p < 0.0001).

Conclusions

Laser peripheral iridotomy induces significant changes in the 3‐D anterior segment morphology in primary angle closure suspect patients. The Scheimpflug‐Placido disc topographer provides reproducible measurements of the iridocorneal angle and other parameters measured and hence, may become clinically useful for non‐invasive detection of potentially occludable angles. Predictors of iridocorneal angle widening after iridotomy were older age and anterior chamber volume.

     

Ultrasound biomicroscopic changes after laser iridotomy or trabeculectomy in angle-closure glaucoma

This study was performed to demonstrate the ultrasound, biomicroscopic and dimensional changes of angle structure after laser iridotomy (LI) and primary trabeculectomy (PT) in primary angle-closure glaucoma (PACG). Angle-opening distance at a point 500 m from the scleral spur (AOD500), trabecular-iris angle (theta1), trabecular ciliary process distance (TCPD), ciliary process-iris angle (CPI), iris thickness (ID1, ID3), length of iris-lens contact distance (ILCD) and anterior chamber depth (ACD) were assessed before and after each procedure. Thirteen patients with LI and 16 with PT were prospectively enrolled. There were statistically significant increases in AOD500, theta1, and ILCD in both groups. CPI was decreased in both groups. ACD, TCPD, and iris thickness were not changed significantly. The changes in angle configuration after LI or PT may result more from alterations in aqueous pressure gradients across the iris and the changes of configuration were greater in the iris roots without rotation of ciliary body. However, we didn't find any significant differences in the changes of parameters between the two procedures.     

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。