频域眼前节光学相干断层扫描仪(AS-OCT)对激光周边虹膜切开术后患者前房角结构定量检测

目的 利用频域眼前节光学相干断层扫描仪(anterior segment optical coherence tomography,AS-OCT)检测原发性闭角型青光眼及原发性房角关闭眼激光周边虹膜切开术后的房角参数,并探讨测量参数的选择及在青光眼患者筛查与随访中的临床意义.方法 选取原发性闭角型青光眼及原发性房角关闭患者共40例(55眼),其中原发性急性闭角型青光眼缓解期8例11眼,原发性急性闭角型青光眼临床前期20例(20眼),原发性房角关闭12例(24眼).应用频域AS-OCT量化评价激光周边虹膜切开术后房角结构,测量上方、下方、鼻侧、颞侧前房角(anterior chamber angle,ACA)、小梁虹膜夹角(trabecular-iris angle,TIA)、房角开放距离(angle open distance,AOD)、小梁虹膜空间面积(trabecular iris space area,TISA),对检查结果进行分析.结果 选取角膜内侧距巩膜突500 μm和750μm的点,分别测量上方、下方、鼻侧、颞侧四个方位的AOD、TIA、ACA、TISA,归为500系列和750系列.500系列及750系列TIA、ACA、AOD测量值均值均为颞侧最大,鼻侧最小;TISA测量均值下方最大、上方最小.Pearson相关性分析显示TIA500和ACA500(r=0.799、P=0.00)、TIA750和ACA750(r=0.799、P=0.00)、TIA500和TI-SA500(r=0.919、P=0.00)、TIA750和TISA750(r=0.920、P=0.00)均具有正相关关系.以TIA500为自变量x,TISA500为因变量y,得回归方程y=-0.300 +0.005x(F=1195,P=0.00),即TISA500与TIA500呈线性正相关关系.以TIA750为自变量x,TISA750为因变量y,得回归方程y=-0.440 +0.009x(F=854,P=0.00),即TISA750与TIA750呈线性正相关关系.750系列参数的变异系数在四个方位均小于500系列.结论 频域AS-OCT可用于原发性闭角型青光眼及原发性房角关闭患者术后的疗效评价与随访.在房角狭窄时,750系列参数变异系数更小,更具有临床应用价值.

Quantitative evaluation of anterior chamber angle after laser peripheral iridotomy by spectral-domain anterior segment optical coherence tomography (AS-OCT)

Objective To quantitatively assess anterior chamber angle of primary angle-closure glaucoma (PACG) and primary angle-closure (PAC) patients after laser pheripheral iridotomy (LPI) by spectral-domain anterior segment optical coherence tomography (SD-AS-OCT),and investigate which parameters should be used in these patients and the clinical significance of these parameters in screening and follow-ups of glaucoma.Methods Fifty-five eyes of 40 patients diagnosed with PACG remission (11 eyes,8 patients),PAC (20 eyes,20 patients) or PAC suspect (24 eyes,12 patients) were examined.Each eye was examined by SD-AS-OCT at upper,lower,nasal,and temporal sides.Anterior chamber angle (ACA),trabecular iris angle (TIA),and trabecular iris space area (TISA500/750) were measured or calculated.All results were analyzed.Results The points from the inside to the corneal scleral spur 500 μm and 750 pm were selected,AOD,TIA,ACA,TISA at upper,lower,nasal,and temporal sides were measured,which were included into 500 series and 750 series.The mean values of TIA,ACA and AOD in the 500 series and 750 series were the largest in the temporal side and the lowest in the nasal side.The mean values of TISA measurement was the largest in the lower side and the smallest at the upper side.Pearson correlation analysis showed that TIA500 and ACA500 (r =0.799,P =0.00),TIA750 and ACA750 (r =0.799,P =0.00),TIA500 and TISA500 (r=0.919,P =0.00),TIA750 and TISA750 (r =0.920,P =0.00) had positive correlation.With TIA500 as independent variable x and TISA500 as dependent variable y,the regression equation was obtained:y =-0.300 + 0.005x (F =1195,P =0.00),which showed TISA500 and TIA500 were linearly positive correlated.With TIA750 as independent variable x,and TISA750 as dependent variable y,the regression equation was obtained:y =-0.440 + 0.009x (F =854,P =0.00),which showed TISA750 and TIA750 were linearly positive correlated.The coefficient of variation of the 750 series parameters were less than the 500 Series in the four directions.Conclusion SD-AS-OCT is an efficient tool for efficiency evaluation and follow-up during the course of PACG and PAC after LPI.For narrow angles,as the parameters of 750 series parameters have less variability,so 750 series are more recommended in clinical application.