原发性房角关闭疾病中脉络膜厚度的临床研究

发布时间：2018-06-10 07:22

本文选题：青光眼 + 原发性房角关闭疾病　；参考：《河北医科大学》2017年硕士论文

【摘要】：青光眼(glaucoma)是世界范围内发病数量位居第一的不可逆致盲性眼病。其中,原发性房角关闭疾病(primary angle-closure disease,PACD)是我国最常见的青光眼类型,约占47.5%。其发病与异常的眼球解剖结构有密切的关系,最新研究认为脉络膜膨胀增厚是PACD的发病机制之一。近年来,眼科诊疗设备不断完善,诊疗技术日益提高,尤其是频域相干光断层深度增强成像技术(Enhanced depth imaging spectral—domain optical coherence tomography EDI SD-OCT)的出现,可方便、清晰地获得脉络膜断层影像,并通过测量获得患者脉络膜厚度的具体数值,且能对其动态变化进行观察。本研究分析脉络膜厚度在不同类型PACD中的特点及变化规律,探讨脉络膜在原发性房角关闭疾病发生、发展中的作用。目的:1探究不同分型原发性房角关闭疾病患者脉络膜厚度的差异,分析前房深度、眼轴长度与脉络膜厚度的相关性;2探讨原发性房角关闭疾病患者手术前后脉络膜厚度的变化;3探讨脉络膜厚度在原发性房角关闭疾病的发生、发展中所起的作用。方法:收集2015年12月至2016年12月在河北医科大学第二医院眼科诊断为原发性房角关闭疾病的患者82例(155眼)。其中包括可疑原发性房角关闭患者24例(24眼),急性原发性房角关闭患者28例(35眼),慢性原发性房角关闭患者30例(38眼),原发性闭角型青光眼患者38例(58眼)。另收集于我院行眼部常规检查的健康人72例(72眼)作为正常对照组。所有患者均进行相关病史采集:包括患者年龄、性别、现病史等;并进行眼部相关检查:最佳矫正视力、眼压、裂隙灯显微镜、双目间接眼底镜,应用IOL-Master测量眼轴长及中央前房深度。应用EDI SD-OCT测量患者黄斑中心凹下及距黄斑中心凹1、3mm处上方(S)、下方(I)、颞侧(T)、鼻侧(N)脉络膜厚度,并测量距视乳头1、2mm处上方(S)、下方(I)、颞侧(T)、鼻侧(N)脉络膜厚度,对需要手术治疗的急性原发性房角关闭及原发性闭角型青光眼患者55例(76眼)行青白联合或小梁切除手术。并在术后7天、1个月对术眼行EDI SD-OCT检查,对脉络膜厚度进行观察。结果:1各组在黄斑中心凹下及周围各个位点上平均脉络膜厚度的差异可疑原发性房角关闭(Primary angle-closure suspects,PACS)组、急性原发性房角关闭(Acute primary angle-closure,APAC)组、慢性原发性房角关闭(Chronic primary angle-closure,CPAC)组、原发性闭角型青光眼(Primary angle-closure glaucoma,APCG)组、正常对照组的黄斑中心凹下脉络膜厚度(Subfoveal choroidal thickness,SFCT)分别为296.25±79.36μm、310.23±68.78μm、280.74±64.34μm、280.69±82.72μm、232.19±72.21μm,经统计分析:PACD各组患者在黄斑中心凹下及周围不同位点上平均脉络膜厚度值均比正常对照组厚,且差异具有统计学意义(P0.05)。在PACD各组患者中,APAC组中SFCT及距离黄斑中心凹1、3mm处上方(S)、下方(I)、颞侧(T)、鼻侧(N)最厚,其次PACS组、CPAC组,PACG组最薄,所有PACD患者及正常人中SFCT最厚,且距离黄斑中心凹越远脉络膜越薄。在PACD各组患者中,APAC组中SFCT均较PACD其余各组厚,且差异均有统计学意义(P0.05)。PACS组、CPAC组与PACG组之间SFCT无显著的统计学差异(P0.05)。2各组在视乳头周围各个位点上平均脉络膜厚度的差异原发性房角关闭疾病患者在视乳头周围各个位点上平均脉络膜厚度均比正常人薄,但均无显著的统计学意义(P0.05)。在水平及垂直截面上,原发性房角关闭疾病患者各组及正常对照组平均脉络膜厚度均距离视乳头越远而越厚,且差异有统计学意义(P0.05)。3 AL和ACD与PACD患者黄斑中心凹下脉络膜厚度的相关性分析在原发性房角关闭疾病患者中,AL与黄斑中心凹下脉络膜厚度呈负相关(r=-0.295,P=0.007),然而ACD与SFCT无显著的相关关系(P0.05)。4 PACD患者术前、术后黄斑中心凹下及周围各个位点上平均脉络膜厚度无论术前还是术后,PACD患者黄斑区脉络膜厚度均在黄斑中心凹下最厚,且距离黄斑中心凹越远其脉络膜越薄。PACD患者的术前SFCT值为:281.76±63.51μm,术后7天及1个月分别为:318.41±75.48μm、295.89±66.25μm。术后7天、1个月时其SFCT值较术前均明显升高,且差异有统计学意义(t1=㧟8.894,P10.001;t2=㧟2.032,P2=0.046)。而术后1个月时SFCT值较7天前降低,差异有统计学意义(t=3.384,P=0.001)。5 PACD患者术前、术后视乳头周围各个位点上平均脉络膜厚度无论术前还是术后,视乳头周围各个位点上平均脉络膜厚度均随着与视乳头距离的增加而增加。PACD患者在术后7天时在视乳头周围各个位点上平均脉络膜厚度均明显高于术前,且差异有统计学意义(P0.05)。术后1个月时在距离视乳头上方2mm、鼻侧1、2mm及颞侧2mm上平均脉络膜厚度高于术前,差异均有统计学意义(P0.05)。其中在距离视乳头鼻侧2mm及颞侧2mm上平均脉络膜厚度较术后7天降低,差异均有统计学意义(P0.05)。在距离视乳头上方2mm及鼻侧1mm上平均脉络膜厚度低于术后7天,但差异均无统计学意义(P0.05)。结论:1 PACS组、APAC组、CPAC组、PACG组患者在黄斑中心凹下及周围位点脉络膜厚度均大于正常对照组,差异有统计学意义。在视乳头周围位点脉络膜厚度小于正常对照组,但差异无统计学意义。2 PACD各组中APAC组黄斑中心凹下及周围各位点上脉络膜厚度最厚。3 PACD各组患者及正常对照组中脉络膜厚度在各个位点上分布不均。在黄斑区,SFCT最厚,距离黄斑中心凹越远其脉络膜越薄;在视盘周围,视盘最薄,距离视盘越远其脉络膜越厚。4 PACD患者的眼轴长度与黄斑中心凹下脉络膜厚度呈负相关,而中央前房深度与黄斑中心凹下脉络膜厚度无相关性。5 PACD患者术后黄斑区及视乳头周围平均脉络膜厚度在短期内增加,但术后1个月时有下降趋势。
[Abstract]:Glaucoma (glaucoma) is the world's number one irreversible blinding blindness disease. Primary angle-closure disease (PACD) is the most common type of glaucoma in China, which accounts for a close relationship between the incidence of 47.5%. and the abnormal eyeball anatomy. The latest study suggests that the choroid expansion is expanded. Thickening is one of the pathogenesis of PACD. In recent years, the medical equipment of ophthalmology has been perfected, and the diagnosis and treatment technology is increasing, especially in the frequency domain coherent optical fault depth enhancement imaging (Enhanced depth imaging spectral domain optical coherence tomography EDI SD-OCT), which can easily and clearly obtain the choroidal fault images. The specific values of the choroidal thickness of the patients were measured and the dynamic changes were observed. This study analyzed the characteristics and changes of choroidal thickness in different types of PACD, and discussed the role of choroid in the occurrence and development of the primary angle closure disease. Objective: 1 to explore the patients with different types of primary angle closure disease. The difference of choroidal thickness, the correlation of anterior chamber depth, axial length and choroidal thickness; 2 to explore the changes of choroidal thickness before and after operation in patients with primary angle closure disease; 3 to explore the role of choroidal thickness in the occurrence of primary angle closure disease and the role of the development. Methods: from December 2015 to December 2016 in the river 82 cases (155 eyes) were diagnosed as primary angle closure disease in the second hospital of North Medical University, including 24 cases (24 eyes) with suspected primary angle closure, 28 cases of acute primary angle closure (35 eyes), 30 cases of chronic primary angle closure (38 eyes), 38 cases of primary angle closure glaucoma (58 eyes). 72 healthy people (72 eyes) were used as the normal control group in our hospital. All patients were collected, including age, sex, current history, and eye related examination: best corrected visual acuity, intraocular pressure, slit lamp microscope, binocular indirect ophthalmoscope, and IOL-Master measurement of axial length and central anterior chamber depth. Degree. EDI SD-OCT was used to measure the upper (S), lower (I), temporal (T), and nasal (N) choroidal thickness above the macular central fovea (I), the temporal (T), and the nasal side (N), and to measure the thickness of the lateral (I), temporal (T), and nasal (N) choroid thickness above the 1,2mm of the optic papilla, and the acute angle closure and primary angle closure glaucoma requiring surgical treatment. 55 patients (76 eyes) were treated with white or trabeculectomy. EDI SD-OCT examination was performed at 7 days and 1 months after the operation, and the choroidal thickness was observed. Results: 1 the differences in the average choroidal thickness at the macular fovea and the surrounding loci were suspicious of primary angle closure (Primary angle-closure suspects, PACS). The primary angle closure (Acute primary angle-closure, APAC) group, chronic primary angle closure (Chronic primary angle-closure, CPAC), primary angle closure glaucoma (Primary angle-closure glaucoma, APCG) group, and the normal control group of the macular fovea choroidal thickness were 296.25 79.36 mu m, 310.23 + 68.78 mu m, 280.74 + 64.34 micron m, 280.69 + 82.72 mu m, 232.19 + 72.21 m. The mean choroidal thickness of the patients in the macular center and around the surrounding different sites were all thicker than the normal control group, and the difference was statistically significant (P0.05). In each group of PACD, the APAC group SFCT and the macula range from the macula. The upper (S), the lower (I), the temporal side (T), the nasal side (N) were the thickest, the PACS group, the CPAC group and the PACG group were the thinnest, and the SFCT was the thickest in all the PACD patients and normal people, and the farther from the macular fovea, the thinner the choroid was. In the PACD groups, the APAC groups were all thicker than the other groups, and the difference both had statistical significance. There was no significant difference in SFCT between the group and the PACG group (P0.05) the difference in the average choroidal thickness at the various sites around the optic papillae. The average choroidal thickness at all the sites around the optic papilla was thinner than the normal person, but there was no significant statistical significance (P0.05). The level and vertical section were not significant. On the other hand, the average choroidal thickness of the patients with primary angle closure disease and the normal control group were the farther and thicker from the optic papilla, and the difference was statistically significant (P0.05).3 AL and ACD and the correlation analysis of the macular central choroidal thickness of the patients with PACD in the patients with primary angle closure disease, AL and the choroidal choroid under the macular center. The thickness was negatively correlated (r=-0.295, P=0.007), but there was no significant correlation between ACD and SFCT (P0.05).4 PACD patients before operation. The average choroidal thickness of the macular region in the macular region of PACD patients was the thickest under the macular fovea, and the farther from the macular fovea, before and after the operation. The preoperative SFCT value of.PACD patients was 281.76 + 63.51 mu m, 7 days and 1 months after operation, respectively, 318.41 + 75.48 m, 295.89 + 66.25 M. after 7 days, and 1 months higher than before operation, and the difference was statistically significant (t1=? 8.894, P10.001; t2=? 2.032, P2=0.046). Statistical significance (t=3.384, P=0.001).5 PACD patients, the average choroidal thickness around the peripapillary sites around the optic papilla before and after operation, the average choroidal thickness at the various sites around the papilla increased with the increase in the distance from the optic papilla, which increased the average pulse of the.PACD patients at the 7 day of the optic papilla at the peripapillary sites. The thickness of the collateral membrane was significantly higher than that before the operation, and the difference was statistically significant (P0.05). The average choroidal thickness of 2mm above the optic papilla at 1 months after the operation was higher than that before the operation, and the difference was statistically significant (P0.05). The average choroidal thickness on the nasal side of the optic papilla on the nasal side of the optic papilla and the temporal side of the temporal 2mm was lower than that of the 7 day after the operation. The difference was statistically significant (P0.05). The average choroidal thickness of 2mm and 1mm on the nasal side of the optic papilla was lower than 7 days after the operation, but the difference was not statistically significant (P0.05). Conclusion: the thickness of the choroidal membrane in the 1 PACS group, the APAC group, the CPAC group and the PACG group were all larger than the normal control group, and the difference was statistically significant. The choroidal thickness of the site around the optic papilla was less than that of the normal control group, but the difference was not statistically significant in.2 PACD groups, and the thickness of the choroidal membrane in each group of APAC groups was the thickest of.3 PACD and the choroidal thickness in the normal control group was not evenly distributed. In the macular region, SFCT was the thickest and the macula from the macula area. The thinner the choroid is, the thinner the choroid is, the thinner the optic disc around the disc, the farther from the optic disc, the thicker the choroid of the.4 PACD patient has a negative correlation with the choroidal thickness under the macular fovea, but the central anterior chamber depth is not related to the choroidal thickness of the macular fovea and the average vein in the macular area and the peripapillary veins after the operation of.5 PACD patients. The thickness of the membrane increased in the short term, but decreased at 1 months after operation.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R775

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