Characteristics and reproducibility of anterior chamber angle assessment by anterior‐segment optical coherence tomography

Purpose: To evaluate the basic characteristics and reproducibility of anterior chamber angle (ACA) measurements determined by anterior‐segment optical coherence tomography (AS‐OCT) in open‐angle and primary angle closure suspect (PACS) patients. Methods: Thirty‐nine open‐angle and 18 PACS patients were imaged for ACA by AS‐OCT. Subjects underwent imaging of the nasal, temporal and inferior ACA under conditions of constant light, and darkness. For analysis, we used three ACA parameters handled by the Visante OCT software: angle opening distance at 500 μm (AOD₅₀₀), trabecular‐iris space area at 500 μm (TISA₅₀₀) and angle recess area at 500 μm (ARA₅₀₀). For determination of inter‐session reproducibility, a single well‐trained operator (D.Y.K.) scanned all patients at two different visits. For determination of inter‐operator variability, a second operator (S.B.P.) acquired another set of images independently. Three sets of images were acquired at least 24 hour apart. Results: All parameters were significantly different when measured both in light and darkness, and in the nasal and temporal quadrants. There were no significant differences between the left and right eyes in the three ACA parameters in all quadrants. The temporal angle was wider than the nasal and inferior angles. All parameters of the nasal, temporal angles had excellent inter‐session and inter‐operator reproducibility [intra‐class correlation coefficient (ICC) 0.796–0.981], but these values were slightly lower for inferior angle measurements (ICC 0.662–0.892) in both open‐angle and PACS groups. Conclusion: AS‐OCT provides quantitative and reproducible assessment of ACA. Reproducibility was lower in the inferior angle compared with the nasal and temporal angles, perhaps because of variable placement of the scleral spur.     

Atrial Fibrillation: The Role of Atrial Defibrillation

Dual defibrillator implantation represents an emerging option to treat patients with drug refractory atrial fibrillation. Atrial antitachycardia pacing and cardioversion have been demonstrated to be highly effective in treating spontaneous tachyarrhythmias and may reduce atrial fibrillation burden by preventing atrial remodeling. Device implantation has been associated to improved quality of life and reduced hospitalization rate. Patient selection and tailored device programming are critical as regard to clinical outcome. Individual psychological profile analysis as well as underlying heart disease and atrial fibrillation clinical patterns represent the main drivers for the right strategy. Controlled studies are needed in order to define the subset of patients who can benefit more from device implantation.     

哈萨克族与汉族大学生正视眼生物学测量的对比分析

目的：：观察哈萨克族与汉族大学生正视眼的角膜中央厚度、前房深度、角膜前后表面曲率的差异性,并分析角膜厚度与角膜前、后曲率的相关性。方法：对新疆医科大学一年级500多名学生进行近视眼筛查,选取正视眼的汉族学生55名和哈萨克族学生51名,应用Sirius角膜地形图对其进行测量。结果：哈萨克族与汉族大学生角膜中央厚度(哈：0.52±0.03mm,汉：0.54±0.03mm )、前房深度(哈：2.97±0.31mm,汉：3.14±0.25mm)有显著性差异(P<0.05)。角膜前、后表面曲率(K1,K2)无显著性差异(P>0.05)。汉族的角膜厚度与角膜前曲率相关分析r<0,与角膜后曲率相关分析r<0.1。哈萨克族的角膜厚度与角膜前曲率相关分析r<0,与角膜后曲率相关分析r<0.1。结论：哈萨克族与汉族大学生正视眼的生物学测量指标中,角膜厚度、前房深度是有差异的。两个民族的角膜厚度与角膜前、后曲率(K1,K2)无相关性。     

飞秒LASIK术后早期前房参数的变化研究

目的：探讨飞秒LASIK术后早期前房参数的变化情况。

方法：收集2014-01/06在我院就诊符合常规手术适应证并接受飞秒LASIK手术的患者共90例90眼,其中男47例47眼,女43例43眼,年龄18～33(平均22.38±3.96)岁。根据屈光度分为三组：A组：轻度近视组,30例30眼,≤3D; B组：中度近视组,30例30眼,>3～6D; C组：高度近视组,30例30眼,>6D。分别于术前、术后1,3mo行Pentacam检查测量前房相关参数,包括前房深度(ACD)、前房容积(ACV)、前房角(ACA)变化值。

结果：所有手术顺利,无并发症。A,B,C组术前与术后1,3mo时ACD和ACV比较,差异均有统计学意义(P<0.05),而A组术后1,3mo时ACD和ACV值比较差异有统计学意义(P<0.05),B组和C组术后1,3mo时ACD和ACV值比较差异无统计学意义(P>0.05); 无论A组和B组还是C组,ACA值差异均无统计学意义(P>0.05)。屈光度与ACD,ACV,ACA变化值无明显相关性。

结论：飞秒LASIK术后早期引起前房参数变化,包括ACD变浅,ACV变小,但对周边前房角无明显影响,对屈光手术后行内眼手术患者有进一步指导作用。     

Pentacam评估高度近视有晶状体眼人工晶状体植入术前后眼前节形态的改变

目的：通过眼前节全景分析仪( Pentacam)量化分析高度近视患者行ICL植入术手术前后眼前节形态的改变,评估手术的安全性、有效性。
　　方法：收集我院2011-09/2013-02高度近视眼行ICL植入手术的患者21例39眼,术后随访6~12mo。通过Pentacam分别测量术前;术后1wk;1,6mo的中央前房深度( ACD)、前房角度(ACA)、前房容积(ACV);记录术后1wk;1,6mo的ICL拱高(ICL-vault);记录术前裸眼视力(pre-UCVA)、最佳矫正视力( BCVA)、术后裸眼视力( post-UCVA)以及眼压值。使用SPSS18.0统计软件分析各项指标,术前、术后的资料均采用配对t检验进行统计学分析。
　　结果：术前;术后1wk;1,6mo 的ACD分别是3.27±0.22,3.02±0.33,2.98±0.31,2.98±0.32mm, ACA分别是(40.39±5.40)°,(26.70±4.47)°,(26.96±4.48)°,(26.95±4.45)°, ACV分别是207.74±25.43,122.87±17.58,128.05±17.84, 128.64±17.50mm 3。术后1wk;1,6mo的拱高分别是0.49±0.13,0.46±0.13,0.46±0.14mm。术前与术后3个不同时段的ACD,ACA,ACV的值相比,其均存在统计学差异( P<0.05);术后1 wk拱高与术后1,6 mo拱高相比,均存在统计学差异( P<0.05)。 BCVA手术前后比较,亦存在统计学差异( P<0.05)。 ICL与透明晶状体没有任何接触,没有引起房角关闭。术后随诊未发现白内障、青光眼、黄斑囊样水肿、视网膜脱离等术后并发症。
　　结论：通过眼前节全景分析仪( Pentacam)分析发现ICL术后前房变浅,房角变窄,前房容积变小,但人工晶状体与透明晶状体之间仍拥有安全的间隙,ICL植入术治疗高度近视眼安全、有效,但远期疗效有待进一步观察。     

飞秒 LASlK 术后早期前房参数的变化研究

目的：探讨飞秒LASIK术后早期前房参数的变化情况。
　　方法：收集2014－01／06在我院就诊符合常规手术适应证并接受飞秒LASIK手术的患者共90例90眼,其中男47例47眼,女43例43眼,年龄18～33（平均22．38±3．96）岁。根据屈光度分为三组：A组：轻度近视组,30例30眼,≤3 D;B组：中度近视组,30例30眼,＞3～6 D;C组：高度近视组,30例30眼,＞6D。分别于术前、术后1,3mo 行Pentacam检查测量前房相关参数,包括前房深度（ ACD）、前房容积（ ACV）、前房角（ ACA）变化值。
　　结果：所有手术顺利,无并发症。 A,B,C组术前与术后1,3 mo时 ACD 和 ACV 比较,差异均有统计学意义（ P＜0．05）,而A组术后1,3 mo时ACD和ACV值比较差异有统计学意义（ P＜0．05）,B组和C组术后1,3 mo时ACD和ACV值比较差异无统计学意义（ P＞0．05）;无论A组和B组还是C组,ACA值差异均无统计学意义（P＞0．05）。屈光度与ACD,ACV,ACA变化值无明显相关性。
　　结论：飞秒LASIK术后早期引起前房参数变化,包括ACD变浅,ACV变小,但对周边前房角无明显影响,对屈光手术后行内眼手术患者有进一步指导作用。     

三种不同方法测量年龄相关性白内障患者前房深度的比较

目的：：比较光学生物学测量仪( IOL Master )、接触式和浸润式A超对前房深度( anterior chamber depth,ACD)的测量结果,分析三种测量方法是否存在差异及其一致性。方法：选取2013-07/10于我院诊断为年龄相关性白内障患者58例98眼术前分别进行IOL Master、接触式A超和浸润式A超的ACD测量,应用方差分析对三种方法的测量结果差异进行比较,应用Blant-Altman分析法比较其一致性。结果：IOL Master 测量 ACD 为2.31~3.90(平均3.03±0.38) mm;接触式 A 超测量 ACD 为1.51~4.06(平均2.88±0.56)mm;浸润式A超测量ACD为1.99~4.17(平均3.17±0.38)mm。 IOL Master和接触式A超的ACD测量值差异有统计学意义( P=0.022<0.05)。 IOL Master和浸润式A超ACD测量值差异有统计学意义( P=0.031<0.05)。接触式A超与浸润式A超ACD测量值差异有统计学意义(P=0.000<0.05)。三种方法相互间一致性均较差。结论：三种方法测量白内障患者ACD时,浸润式A超测得结果最大,IOL Master次之,接触式A超测得结果最小,三者相互间一致性均较差,临床不建议相互替代。     

原发性闭角型青光眼白内障联合房角分离术房角形态变化及疗效分析

目的：研究房角关闭≥180°(动态房角镜检)的原发性闭角型青光眼合并白内障患者行白内障超声乳化联合人工晶状体植入联合房角分离术前后房角形态的变化,并评价此手术的疗效。

方法：前瞻性系列病例研究。观察2013-01/12在我院行白内障手术的房角关闭≥180°(动态房角镜检)的原发性闭角型青光眼合并白内障患者79例79眼术前、术后1、6mo的房角形态、眼压、最佳矫正视力的变化情况。术前与术后各时间点前房角开放距离500(AOD500)、小梁网与虹膜间夹角500(TIA500)比较采用配对t检验,术前与术后各时间点房角粘连度、最佳矫正视力均采用Kruskal-Wallis H检验。

结果：术后1mo 58眼无需用药眼压控制正常,术后6mo 56眼无需用药眼压控制正常。术后1、6mo与术前相比房角粘连情况、AOD500、TIA500、最佳矫正视力差异均有统计学意义(P<0.05)。术后最佳矫正视力除8眼视神经萎缩无改善,其余最佳矫正视力均有提高。

结论：对于单纯性瞳孔阻滞性闭角型青光眼合并白内障患者行白内障超声乳化联合人工晶状体植入联合前房角分离术是安全有效的; 对于病史较长、虹膜附着位置靠前的非瞳孔阻滞性及多种机制共存型闭角型青光眼合并白内障患者,则术后可能需要联合药物治疗。     

Comparison of corneal measurements in keratoconic eyes using rotating Scheimpflug camera and scanning-slit topography

AIM: To compare the anterior segment measurements obtained by rotating Scheimpflug camera (Pentacam) and Scanning-slit topography (Orbscan IIz) in keratoconic eyes. METHODS: A total of 121 patients, 71 males (58.7%) and 50 females (41.3%) (214 eyes) with the diagnosis of keratoconus (KC) were enrolled in this study. Following diagnosis of KC by slit-lamp biomicroscopic examination, central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior chamber depth (ACD), and pupil diameter (PD) were measured by a single examiner using successive instrumentation by Pentacam and Orbscan. RESULTS: There was no significant difference between the two instruments for the measurement of CCT and TCT. In contrast, scanning-slit topography measured ACD (3.46±0.40 mm vs. 3.38±0.33 mm, P=0.019) and PD (4.97±1.26 mm vs 4.08±1.19 mm, P<0.001) significantly larger than rotating Scheimpflug camera. The two devices made similar measurements for CCT (95% CI: -2.94 to 5.06, P=0.602). However, the mean difference for TCT was -6.28 (95% CI: -10.51 to -2.06, P=0.004) showing a thinner measurement by Orbscan than by Pentacam. In terms of the ACD, the mean difference was 0.08 mm (95% CI: 0.04 to 0.12, P<0.001) with Orbscan giving a slightly larger value than Pentacam. Similarly, Orbscan measurement for PD was longer than Pentacam (95% CI: 0.68 to 1.08, P<0.001). CONCLUSION: A good agreement was found between Pentacam and Orbscan concerning CCT measurement while comparing scanning-slit topography and rotating Scheimpflug camera there was an underestimation for TCT and overestimation for ACD and PD.     

三维适形放射治疗挡铅射野质量保证的方法探讨

目的:探讨MatriXX 2D矩阵电离室和X线模拟定位机应用于挡铅射野质量保证的方法及可靠性.方法:用MatriXX 2D矩阵电离室测得挡铅射野的形状和大小,应用Matlab编程绘制出治疗计划系统(treatment plan system,TPS)中相对应的射野的形状和大小;利用X线模拟定位机拍摄出射野挡铅的验证片并通过计算机上的RT PACS获取保存,对尺寸较大的射野,使用Photoshop图像处理软件合成出包含挡铅射野全部信息的验证片;从TPS调出相对应的包含挡铅射野信息的数字重建影像(digital reconstruction radiography,DRR).分别比较2对图片包含的射野信息.结果:对60个所测挡铅射野和计划射野进行比较,发现2种射野的形状总体上相符,3种方式的误差分别为(1.71±0.84)、(2.32±0.31)和(2.89±0.47)mm.结论:利用MatriXX 2D矩阵电离室和X线模拟定位机进行挡铅射野质量保证,简单易行、快速有效,能够满足放疗质控中对射野挡铅的要求.