房角关闭机制指导下可疑原发性房角关闭患者激光干预的疗效评价

发布时间：2018-03-03 01:26

本文选题：可疑原发性房角关闭　切入点：超声生物显微镜　出处：《眼科》2017年03期 　论文类型：期刊论文

【摘要】：目的根据房角关闭的不同机制,对可疑原发性房角关闭(PACS)患者行激光周边虹膜切除(LPI)术或LPI联合激光周边虹膜成形(LPIP)术,通过超声生物显微镜(UBM)评估PACS患者激光早期干预的疗效。设计前瞻性病例系列。研究对象2016年1月-11月在河北省邯郸市眼科医院连续就诊的PACS患者50例(65眼)。方法根据房角关闭的不同机制,通过UBM评估患眼,对所有入选患眼均首先行LPI治疗,术后第3天复查UBM,检查提示仍存在至少一个象限房角呈接触性关闭的患者再进一步联合LPIP治疗。术后3天复查UBM,根据测量的相关参数的前后变化评价治疗效果。主要指标UBM图像中的中央前房深度(ACD),巩膜突前500μm处的房角开放距离(AOD)、小梁虹膜夹角(TIA)、房角隐窝面积(ARA)、小梁睫状体距离(TCPD)、虹膜厚度(IT)。结果 65眼中,47眼(72.3%)行LPI治疗后3天UBM检查未发现存在至少一个象限的房角接触性关闭,术后AOD、TIA、TCPD、ARA较术前均明显增加(P均0.01),IT较术前无明显变化(P=0.465);18眼(27.7%)行LPI术后3天,UBM提示存在至少一个象限的房角接触性关闭,联合LPIP治疗后AOD、TIA、TCPD、ARA较术前均明显增加(P均0.01),IT较LPI术后减少更明显(P0.01)。结论 LPI后UBM可用于判断房角关闭的机制,并据此考虑是否联合LPIP,可进一步改善非单纯性瞳孔阻滞机制的可疑房角关闭患者的疗效。
[Abstract]:Objective according to different mechanisms of angle closure, patients with suspected primary closure of atrial angle were treated with laser peripheral iridectomy (LPI) or LPI combined with laser peripheral iridoplasty (LPI). The effect of early laser intervention on PACS patients was evaluated by ultrasound biomicroscopy. Prospective series of cases were designed. Fifty patients with PACS from January 2016 to November in Handan Ophthalmology Hospital of Hebei Province were enrolled in this study. According to different mechanisms of angle closure, UBM was used to evaluate the affected eyes. All the selected eyes were treated with LPI first. The results showed that there was at least one quadrant angle contact closure and further combined with LPIP therapy on the 3rd day after operation, and the therapeutic effect was evaluated according to the changes of the parameters measured before and after the operation. Main outcome measures: central anterior chamber depth in UBM images, open angle of anterior sclera at 500 渭 m, trabecular iris angle, angle of trabecular iris, area of atrium recess, trabecular ciliary body distance and thickness of iris. Results LPI was performed in 47 eyes of 65 eyes (72.3 eyes). No contact closure of at least one quadrant was found on UBM 3 days later. There was no significant change in IT (P < 0. 465) and 18 eyes (27. 7%) after LPI (3 days after LPI), there was at least one quadrant contact closure of atrium angle. After the treatment of AODTIA combined with LPIP, the TCPDARA of AODTIA was significantly increased than that of preoperation (P < 0.01). Conclusion UBM after LPI can be used to judge the mechanism of atrial angle closure. Considering whether LPIP combined with LPIP can further improve the efficacy of suspected atrial angle closure in patients with non-simple pupillary block mechanism.
【作者单位】：邯郸市眼科医院眼科(邯郸市第三医院);首都医科大学附属北京同仁医院北京同仁眼科中心眼科学与视觉科学北京市重点实验室;温州医科大学附属眼视光医院;
【分类号】：R779.63

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