首次发生急性原发性房角关闭患者发作眼与对侧眼前节生物学参数的对比分析

目的　采用光学相干断层扫描比较首次发生急性原发性房角关闭（ａｃｕｔｅｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅ，ＡＰＡＣ）患者的发作眼与对侧可疑原发性房角关闭（ｐｒｉｍａｒｙａｎｇｌｅｃｌｏｓｕｒｅｓｕｓｐｅｃｔ，ＰＡＣＳ）眼的眼前节生物学参数差异并分析发病相关危险因素。方法　收集２０１３年８月至２０１４年８月于北京协和医院眼科就诊的首次单眼发生ＡＰＡＣ且对侧眼为ＰＡＣＳ的患者共计３０例（发作眼３０眼，对侧眼３０眼），采用光学相干断层扫描仪测量双眼的中央角膜厚度、瞳孔直径、中央前房深度、晶状体拱高、前房宽度、距离巩膜突５００μｍ和７５０μｍ处的房角开放距离（ａｎｇｌｅｏｐｅｎｄｉｓｔａｎｃｅ，ＡＯＤ５００、ＡＯＤ７５０）及小梁网虹膜间面积（ｔｒａｂｅｃｕｌａｒｉｒｉｓａｒｅａ， ＴＩＳＡ５００、ＴＩＳＡ７５０）、巩膜突角度。采用配对ｔ检验比较双眼各参数之间的差异，条件Ｌｏｇｉｓｔｉｃ回归分析发病相关因素。结果　对侧眼组与发作眼组的中央角膜厚度分别为（５２２．７±３１．３）ｍｍ和（５５７．３±４２．７）ｍｍ，瞳孔直径分别为（２．９０±１．１９）ｍｍ和（３．７８±１．２９）ｍｍ，晶状体拱高分别为（１．０８±０．３６）ｍｍ和（１．２４±０．４２）ｍｍ，发作眼组均较大（均为Ｐ＜０．０１）；中央前房深度分别为（１．８１±０．４５）ｍｍ和（１．６４±０．４４）ｍｍ，ＡＯＤ５００分别为（０．０９７±０．０６５）ｍｍ和（０．０５９±０．０３９）ｍｍ，ＡＯＤ７５０分别为（０．１５７±０．１００）ｍｍ和（０．１２０±０．０６８）ｍｍ，ＴＩＳＡ５００分别为（０．０３６±０．０２１）ｍｍ２和（０．０２０±０．０１６）ｍｍ２，ＴＩＳＡ７５０中位数分别为０．０６５ｍｍ２和０．０４１ｍｍ２，巩膜突角度分别为１１．１３°±６．９２°和６．６８°±４．４３°，发作眼组均较小（均为Ｐ＜０．０５）。条件Ｌｏｇｉｓｔｉｃ回归分析结果显示晶状体拱高的增加与急性房角关闭具有强相关性（ＯＲ＝４０．２５９［１．０２１，１７７９．１９３］，Ｐ＝０．０１４）。结论　晶状体拱高的增加是ＡＰＡＣ发作眼与对侧ＰＡＣＳ眼相比最突出的危险因素，可能在ＰＡＣＳ发展成为ＡＰＡＣ的过程中起关键作用。

Evaluation of anterior segment parameters of firsttime acute primary angle closure eye and fellow eye

Objective To evaluate the anterior segment parameters of first-time acute primary angle closure ( APAC) eye and the fellow eye( primary angle closure suspect , PAC S ) with anterior segment optical coherence tomography ( AS-OCT) . Methods Thirty patients with first-time urulateral APAC ( APAC 30eyes , PACS 30eyes) were collected from August 2013 to August 2014 in the Ophthalmology Department of Peking Union Medical College Hospital. Central cornea thickness ( CCT) , pupil diameter ( PD ) . anterior chamber depth ( ACD ) , lens vault ( LV ) . anterior chamber width ( ACW) , angle open distance at 500 ym and 750 ym from the sclera spur( AODsoo , AOD750 ) , trabecular iris area at 500 ym and 750 Vm from the sclera spur( TISAsoo ,TISA750 ) ,sclera spur angle (SSA) of both eyes were measured by AS-OCT. Paired t-test was applied to find the differences . and conditional logistic regression analysis was performed to analyze the associated factors with the prediction of APAC. Results Compared with the fellow PACS eyes ,APAC eyes showed si~ificant larger CCT ( 522. 7 + 31. 3 ) mm and ( 557. 3 + 42. 7 ) mm , respectively ] , PD ( 2. 90 + 1. 19 ) mm and ( 3. 78 + 1. 29 ) mm , respectively ] and LV ( 1. 08 + 0. 36 ) mm and ( 1. 24 +0. 42) mm ,respectively ] (P < 0. 01 ) , smaller ACD ( 1. 81 + 0. 45 ) mm and( 1. 64 +0. 44) mm , respectively ] , AODscx, ( 0. 097 + 0. 065 ) mm and ( 0. 059 + 0. 039) mm , respectively ] , AOD750 ( 0. 157 + 0. 10 ) mm and ( 0. 120 + 0. 068 ) mm , respectively) ,TISAscx, (0. 036 + 0. 021 ) mmz and ( 0. 020 + 0. 016 ) mm2 , respectively ) , TISA750 ( 0. 065 mmz and 0. 041 mmz ,respectively) and SSA ( 11. 13 +6. 92 ) o and( 6. 68 +4. 43 ) o ,respectively ] (P < 0. 05 ) . The results of conditional logistic regression analysis showed greater LV( OR = 40. 259 1. 021 , 1779. 193 ] ,P = 0. 014) had the strongest correlation with the prediction of APAC. Conclusion Greater LV is the most si~pificant factor associated with the prediction of APAC compared with the fellow PACS eye , and may play a critical role in the progression of PACS to APAC.