原发性急性闭角型青光眼合并白内障患者超声乳化术后眼前节的变化

目的　采用超声生物显微镜（ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｅ，ＵＢＭ）和眼前节光学相干断层扫描仪（ｏｐｔｉｃａｌｃｏｈｅｒｅｎｃｅｔｏｍｏ-ｇｒａｐｈｙ，ＯＣＴ）２种检测方法观察原发性急性闭角型青光眼合并白内障患者行超声乳化手术前后的眼前节解剖结构变化，评估这２种检查方法的应用价值。方法　对３５例３５眼原发性急性闭角型青光眼合并白内障患者行超声乳化白内障摘出联合人工晶状体植入术，监测术前及术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，ＢＶＣＡ）及眼压，于术前、术后３个月分别用ＵＢＭ及ＶｉｓａｎｔｅＯＣＴ对眼前节进行生物学测量，分析术前术后眼前节参数的变化，并比较２种检测方法的差异。结果　所有患者术后１周、１个月、３个月眼压分别为（１３．８５±５．０６）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ）、（１３．２９±４．５５）ｍｍＨｇ、（１３．４７±４．１１）ｍｍＨｇ，与术前（（１７．０７±４０２）ｍｍＨｇ相比均显著降低并保持平稳，术后１周、１个月、３个月ＢＣＶＡ分别为０．５１±０．１０、０．６５±０．２１、０．６３±０１９，与术前（０．２０±０．１０）相比均显著提高。眼压和ＢＣＶＡ术前、术后的差异均有统计学意义（Ｆ＝９．３３，Ｐ＝０．０００；Ｆ＝１０６２７，Ｐ＝０．０００）。ＵＢＭ和ＶｉｓａｎｔｅＯＣＴ术后检测中央前房深度（ａｎｔｅｒｉｏｒｃｈａｍｂｅｒｄｅｐｔｈ，ＡＣＤ）分别为（３．４１±０．４４）ｍｍ、（３．４５±０．３９）ｍｍ，与术前分别为（１．９３±０．２８）ｍｍ、（１．９５±０．３２）ｍｍ相比明显加深，差异具有统计学意义（ｔ＝－１２．１４２，ｔ＝－１２．０８７，均为Ｐ＝０．０００），２种检测方法之间相比差异无统计学意义（ｔ＝０．１４３，Ｐ＝０．８９０；ｔ＝－０．１９７，Ｐ＝０．８２４）。ＵＢＭ和ＶｉｓａｎｔｅＯＣＴ检测术后房角开放距离ＡＯＤ５００分别为（０．３７±０．１６）ｍｍ、（０．２９±０．１１）ｍｍ，与术前分别为（０．１８±０．１０）ｍｍ、（０．１５±０．０５）ｍｍ相比显著增加，差异具有统计学意义（ｔ＝－１４．５６１，ｔ＝－１３．２３３，均为Ｐ＝０．０００），２种检测方法之间相比差异具有统计学意义（ｔ＝１．８２５，Ｐ＝０．０４６；ｔ＝－４．０５４，Ｐ＝０．０００）。ＵＢＭ和ＶｉｓａｎｔｅＯＣＴ术后检测小梁虹膜夹角分别为（３６．５５±５．９３）°、（２９．８３±４．８７）°，与术前分别为（１７．８１±５．１７）°、（１２．４４±４．２５）°相比显著增加，差异具有统计学意义（ｔ＝－１３．３２８，ｔ＝－１１．７５１，均为Ｐ＝０．０００），２种检测方法之间相比差异具有统计学意义（ｔ＝２．０１２，Ｐ＝０．０２９；ｔ＝－３．３８１，Ｐ＝０．０００）。ＵＢＭ和ＶｉｓａｎｔｅＯＣＴ术后检测房角隐窝面积分别为（０．１９±０．１５）ｍｍ２、（０．１２±０．１０）ｍｍ２，与术前分别为（０．０６±０．０４）ｍｍ２、（０．０５±０．０６）ｍｍ２相比明显增加，差异具有统计学意义（ｔ＝－１０．１２２，ｔ＝－９．０８１，均为Ｐ＝０．０００），２种检测方法之间相比差异具有统计学意义（ｔ＝３４２７，Ｐ＝０．００１；ｔ＝２．９１４，Ｐ＝０．００３）。结论　合并白内障的原发性急性闭角型青光眼患者行超声乳化手术，术后前房深度明显增加，房角结构得到改善，眼压得到有效控制。ＵＢＭ和ＶｉｓａｎｔｅＯＣＴ均可以客观测量原发性急性闭角型青光眼合并白内障患者的眼前节解剖参数，但临床应用价值不尽相同。

Evaluation of biological measurement of ocular anterior segment after phacoemulsification in acute primary angle-closure glaucoma with cataract

Objective To observe the changes in the anatonucal structure of the ocular anterior segment in patients with acute primary angle-closure glaucoma combined with cataract before and after phacoemulsification using ultrasound biomicroscope( UBM) and anterior segment optical coherence tomography ( OCT) , and evaluate the clinical application value of these two measuring systems. Methods Thirty-five eyes of 35 patients with APACG combined with cataract received phacoemulsification with intraocular lens implantation. Best corrected visual acuity ( BVCA) and intraocular pressure were recorded pre-and post-operatively. The changes of ocular anterior segment parameters before and three months after surgery were analyzed using UBM and Visante OCT. The difference was compared between these two measuring systems. Results The intraocular pressure of all patients were ( 13. 85 +5. 06) mmHg( 1 kPa = 7. 5 mmHg) , (13. 29 +4. 55 ) mmHg, ( 13. 47 + 4. 11) mmHg at I week, I month.3 months postoperatively,which was significantly decreased to a stable low level compared with that preoperatively ( 17. 07 +4. 02 ) mmHg. BCVA were 0. 51 +0. I .0. 65 +0. 21 and 0. 63 + 0. 19 at I week , I month .3 months postoperatively , respectively , which were significantly improved than preoperatively 0. 20 + 0. 10. The difference of intraocular pressure and BCVA between before and after surgery were statistically sigruficant ( F = 9. 33.P = 0. 000 ; F = 106. 27 ,P = 0. 000 ) . The central anterior chamber depth postoperatively detected by UBM and Visante OCT were ( 3. 41 + 0. 44 ) mm and ( 3. 45 + 0. 39 ) mm , respectiveIy , which were significantly increased compared with that preoperatively ( 1. 93 + 0. 28 ) mm and ( 1. 95 + 0. 32 ) mm , the difference was statistically significant ( t = - 12. 142 , - 12. 087 , all P = 0. 000 ) , and statistical difference was not detected between the two measurrng systems ( t = 0. 143 .P = 0. 890 ; t = - 0. 197 .P = 0. 824 ) . The angle opening distance postoperatively detected by UBM and Visante OCT were ( 0. 37 + 0. 16 ) mm and ( 0. 29 + 0. 11 ) mm , respectiveIy , which were significantly increased compared with that preoperatively ( 0. 18 + 0. 10 ) mm and ( 0. 15 + 0. 05 ) mm , the difference was statistically significant between preoperatively and postoperatively ( t = - 14. 561 . - 13. 233 . all P = 0. 000 ) , there was significant difference between the two measuring systems ( t = 1. 825 .P = 0. 046 ; t = - 4. 054 .P = 0. 000 ) . The trabecular iris angle postoperatively detected by UBM and Visante OCT were ( 36. 55 + 5. 93 ) o and ( 29. 83 + 4. 87 ) o , respectively , which were significantly increased compared with that preoperatively( 17. 81 + 5 . 17 ) o and ( 12. 44 + 4. 25 ) o . the difference was statistically significant( t = - 13. 328 , - 11. 751 , all P = 0. 000) , and there was significant difference between the two measuring systems ( t = 2. 012 ,P = 0. 029 ; t = - 3. 381 .P = 0. 000 ) . The angle recess area postoperatively detected by UBM and Visante OCT were(0. 19 +0. 15 ) mm2 and (0. 12 + 0. 10) mm2 , respectively , which were significantly increased compared with that preoperatively(0. 06 +0. 04) mm2 and ( 0. 05 + 0. 06 ) mm2 , and statistical difference was significant between preoperatively and postoperatively using the two measuring system( t = - 10. 122 . - 9. 081 . all P = 0. 000 ) , with significant difference between the two measuring systems ( t = 3. 427 .P = 0. 001 ; t = 2. 914 , P = 0. 003 ) . Conclusion Phacoemulsification for patients with acute primary angle-closure glaucoma combined with cataract can deepen the anterior chamber,improve the configuration of the anterior chamber angle and effectively control the intraocular pressure. UBM and Visante OCT can objectively measure the anatomical parameters of the ocular anterior segment of patients with acute primary angle-closure glaucoma combined with cataract.while their clinical application value is different.