126例可疑原发性房角关闭的5年随访观察

目的探讨可疑原发性房角关闭（PACS）患者接受激光周边虹膜切开术的手术时机。方法 126例（252只眼）PACS被纳入本研究,其中女性77例（154只眼）,男性49例（98只眼）,平均年龄（61±4.53）岁。入选标准：（1）无急性闭角型青光眼的发作史、症状和体征;（2）眼压正常;（3）周边前房深度≤1/4 CK（Vam-Herick法）,中央前房深度≤2.0 mm（光学测量法）;（4）房角宽度≤Ⅱ级（Shaffer分级系统）;（5）经压陷式前房角镜证实无虹膜-小梁网粘连性或接触性关闭;（6）无青光眼性视神经损害和视野缺损。患者每3个月随访一次,平均随访≥5年。结果 35只眼由PACS发展为原发性房角关闭（PAC）,PAC的发病率是13.9%（35/252）。结论并不是所有的PACS都会发展成PAC,有下列情况之一的PACS容易发展为PAC：（1）危险窄房角（≤Ⅰ级）;（1）前房逐渐变浅、房角进行性变窄;（3）暗室试验阳性的危险窄房角,或作暗室房角镜检查证实有房角功能关闭者或超声生物显微镜（UBM）检查发现房角功能关闭者;（4）危险窄房角同时具有明确的家族史者;（5）有间歇性发作史的窄房角,房角镜检查发现小梁网有周边虹膜功能关闭后遗留的损害;（6）危险窄房角因诊治其他疾病需反复散瞳者（如糖尿病视网膜病变全视网膜光凝）;（7）有老年性白内障的远视患者;（8）无随访条件的危险窄房角。

A five year follow up survery of primary angle closure suspect

Objective To investigate the timing of laser peripheral iridotomy（LPI）for the treatment of primary angle closure（PACS）.Methods A total of 126 patients（252 eyes） diagnosed with PACS were enrolled.There were 77 females（154 eyes） and 49 males（98 eyes）.Mean age of the patients was 61±4.53 years（range,47~79 years）.The main criteria for diagnosis of PACS were：1.no history of attack,signs and symptoms of acute PACG;2.normal intraocular pressure;3.the depth of peripheral anterior chamber≤1/4CK;4.narrow angle width（gradeⅡ or less,Shaffer＇S grading system）;5.no iris-trabecular contact demonstrated by compression gonioscopy;6.no glaucomatous optic nerve damage and visual field defect.The patients were re-examined every 3 months.The average follow-up was longer than 5 years.Results 35 of 252 eyes with PACS develop into PAC.prevalence of PAC was 13.9%（35/252）.Conclusion Not all patients with PACS develop PAC.In patients with any of the following features,PACS is easy to develop into PAC,and prophylactic iridotomy may be indicated in these situations：（1）Critically narrow angle（grade Ⅰor less）;（2）The adhesion of angle gradually develops;（3）Narrow angle with positive dark room test;（4）Narrow angle with a well-documented family history of PACG;（5）Narrow angle with history of previous angle-closure attacks;（6）Need for repeated pupillary dilation and extensive retinal treatment（e.g.,panretinal photocoagulation for abetic retinopathy）;（7）Hyperopia with senile cataract;（8）Younger patients,especially those who live in urban area away from medical care.