原发性前房角关闭激光治疗前后前房角的UBM改变
发布时间：2018-09-07 16:26
【摘要】：目的利用超声生物显微镜(UBM)筛查原发性前房角关闭(PAC),进行预防性激光周边虹膜切除术(LPI)或联合激光周边虹膜成形术,比较前房角形态变化情况,探索房角关闭机制及阻止PAC向原发性闭角型青光眼(PACG)进展的方法,以减少PACG的发生率。 方法1、应用前瞻性干预性病例研究。30例(51眼)就诊于遵义医学院眼科门诊的解剖窄房角(ANA)患者,进行明、暗光线下UBM检查,每眼检查8个位点,检查位点中明、暗光线任一情况下有1个位点以上虹膜小梁网暂时性接触者,判断为PAC,记录PAC的眼数。UBM观察前房角及睫状体图像,测量指标包括房角开放距离(AOD500)、小梁虹膜夹角(TIA)、周边虹膜厚度(IT1)、虹膜睫状体距离(ICPD)、小梁睫状体距离(TCPD)、虹膜晶体夹角(ILA)、虹膜晶体接触距离(ILCD)以及每眼的中央前房深度(ACD),对筛出的PAC进行LPI治疗,术后2周复查UBM,复查后对仍然存在虹膜小梁网暂时性接触者进行激光周边虹膜成形术,术后2周再次复查UBM,每次UBM检查的照明条件及测量参数均同术前。2、应用自身对照配对设计：(1)ANA眼明、暗光线下的PAC发生率采用自身配对,检验；(2)行LPI的PAC眼术前与术后PAC发生率采用Fisher精确概率法检验,其他UBM计量指标采用自身配对t检验；(3)LPI后仍为PAC者联合应用激光周边虹膜成形术,术前与术后UBM检查参数的变化,采用自身配对t检验。所有比较均以P0.05表示有统计学意义。 结果1、PAC的筛选：ANA患者经UBM检查,暗光线下PAC发生率为78.43%(40/51),明光线下PAC发生率为50.98%(26/51),暗光线下PAC发生率较高,差异有统计学意义(P=0.000,χ2值=23.588)。2、PAC眼LPI治疗前后的UBM改变(28眼)：暗光线下LPI前PAC发生率为96.43%(27/28),LPI后PAC发生率为32.14%(9/28),LPI后PAC发生率降低,差异有统计学意义(P=0.000)；明光线下LPI前PAC发生率为67.86%(19/28),LPI后PAC发生率为7.143%(2/28),LPI术后PAC发生率降低,差异有统计学意义(P=0.000)。UBM参数变化情况：明、暗光线下AOD5o0、TIA术后较术前均增大(P0.05),LPI后房角宽度增加；明、暗光线下ILCD术后较术前增大、ILA术后较术前减小(P0.05),LPI后瞳孔阻滞力降低；明、暗光线下ACD、ICPD、TCPD术后无明显变化(P0.05),LPI对中央前房深度及睫状体位置无明显影响；暗光线下比较IT1术后以上方点位变薄明显,明光线下比较则以下方点位变薄明显(P0.05),LPI后激光孔附近点位虹膜变薄。3、激光周边虹膜成形术前后PAC变化情况(10眼)：术后在明、暗光线下房角均完全开放,房角关闭率为0；部分点位AOD500、TIA术后较术前增大(P0.05),激光周边虹膜成形术能使LPI后的PAC房角增宽,而对其他UBM检查指标无明显影响(P0.05)。4、初步探索房角关闭机制：根据PAC患者LPI前后的UBM图像特征进行初步分类：单纯瞳孔阻滞占64.28%(18/28),单纯非瞳孔阻滞型占7.14%(2/28),混合机制型占28.57%(8/28)。 结论暗光线下UBM筛查ANA眼能较早发现PAC；PAC房角关闭的机制以瞳孔阻滞、混合机制为主,周边虹膜肥厚或/和睫状体前移是PAC眼LPI后仍然存在房角关闭的主要因素；联合激光周边虹膜成形术能使LPI后的PAC房角宽度增加,使得房角完全开放。
[Abstract]:Objective To screen primary angle closure (PAC) by ultrasound biomicroscopy (UBM) and perform preventive laser peripheral iridectomy (LPI) or combined with laser peripheral iridoplasty (LPI) to compare the morphological changes of the anterior chamber angle, to explore the mechanism of angle closure and to prevent the progression of PAC to primary angle closure glaucoma (PACG), so as to reduce the incidence of PACG. Rate of birth.
Methods 1. Prospective intervention case study. 30 patients (51 eyes) with anatomical narrow angle (ANA) were examined by UBM under light and dark light. Each eye was examined for 8 sites. Those who had temporary contact with more than one site of trabecular meshwork in light or dark light were judged to be PAC. Angle of anterior chamber and ciliary body were measured by UBM. Measurements included angle opening distance (AOD 500), trabecular iris angle (TIA), peripheral iris thickness (IT1), iris ciliary body distance (ICPD), trabecular ciliary body distance (TCPD), iris lens angle (ILA), iris lens contact distance (ILCD) and central anterior chamber depth (ACD) of each eye, and P to sieve out. Patients who had temporary contact with the trabecular meshwork underwent laser peripheral iridoplasty. UBM was reexamined 2 weeks after operation. The illumination conditions and measurement parameters of each UBM examination were the same as those of preoperative. 2. A self-matched design was used: (1) PAC incidence in light and dark light was used. The incidence of PAC before and after LPI was examined by Fisher's exact probability method, and other UBM measurements were examined by self-matched t-test. (3) Patients who were still PAC after LPI were combined with laser peripheral iridoplasty, and the changes of UBM parameters before and after LPI were examined by self-matched t-test. It has statistical significance.
Results 1. PAC screening: The incidence of PAC was 78.43% (40/51) in dark light, 50.98% (26/51) in bright light, and higher in dark light (P = 0.000, _2 = 23.588). The difference was statistically significant (P = 0.000, 2 = 23.588). The incidence of PAC after PI was 32.14%(9/28) and that after LPI was significantly lower (P = 0.000). The incidence of PAC before and after LPI was 67.86%(19/28) under bright light, 7.143%(2/28) after LPI and 7.143%(2/28) after LPI. The incidence of PAC after LPI was significantly lower (P = 0.000). The width of anterior chamber angle increased after LPI (P 0.05), the width of anterior chamber angle increased after LPI; the width of anterior chamber angle increased after ILCD under bright and dark light, decreased after ILA (P 0.05), and the pupil block force decreased after LPI; there was no significant change after ACD, ICPD and TCPD under light and dark light (P 0.05), but LPI had no significant effect on the depth of anterior chamber and ciliary body position after IT1 under dark light. After LPI, the iris near the laser hole became thinner. 3. The PAC changes before and after laser peripheral iridoplasty (10 eyes): The angle of the chamber was completely opened under light and dark light, the closure rate of the angle was 0; AOD500 was at some points, and it increased after TIA (P 0.05). Laser peripheral iridoplasty can widen the angle of PAC after LPI, but has no significant effect on other UBM parameters (P 0.05). 4. To explore the mechanism of angle closure: According to the characteristics of UBM images before and after LPI in PAC patients, we classified them as follows: simple pupil block (64.28%), simple non-pupil block (7.14%) and mixed mechanism type (2/28). Accounting for 28.57% (8/28).
Conclusion PAC can be detected early in the eyes with ANA screened by UBM under dark light. The mechanism of angle closure of PAC is mainly pupil block and mixed mechanism. Peripheral iris hypertrophy or/and ciliary body anterior displacement are the main factors of angle closure after LPI in PAC eyes. To open up.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63
本文编号：2228792
[Abstract]:Objective To screen primary angle closure (PAC) by ultrasound biomicroscopy (UBM) and perform preventive laser peripheral iridectomy (LPI) or combined with laser peripheral iridoplasty (LPI) to compare the morphological changes of the anterior chamber angle, to explore the mechanism of angle closure and to prevent the progression of PAC to primary angle closure glaucoma (PACG), so as to reduce the incidence of PACG. Rate of birth.
Methods 1. Prospective intervention case study. 30 patients (51 eyes) with anatomical narrow angle (ANA) were examined by UBM under light and dark light. Each eye was examined for 8 sites. Those who had temporary contact with more than one site of trabecular meshwork in light or dark light were judged to be PAC. Angle of anterior chamber and ciliary body were measured by UBM. Measurements included angle opening distance (AOD 500), trabecular iris angle (TIA), peripheral iris thickness (IT1), iris ciliary body distance (ICPD), trabecular ciliary body distance (TCPD), iris lens angle (ILA), iris lens contact distance (ILCD) and central anterior chamber depth (ACD) of each eye, and P to sieve out. Patients who had temporary contact with the trabecular meshwork underwent laser peripheral iridoplasty. UBM was reexamined 2 weeks after operation. The illumination conditions and measurement parameters of each UBM examination were the same as those of preoperative. 2. A self-matched design was used: (1) PAC incidence in light and dark light was used. The incidence of PAC before and after LPI was examined by Fisher's exact probability method, and other UBM measurements were examined by self-matched t-test. (3) Patients who were still PAC after LPI were combined with laser peripheral iridoplasty, and the changes of UBM parameters before and after LPI were examined by self-matched t-test. It has statistical significance.
Results 1. PAC screening: The incidence of PAC was 78.43% (40/51) in dark light, 50.98% (26/51) in bright light, and higher in dark light (P = 0.000, _2 = 23.588). The difference was statistically significant (P = 0.000, 2 = 23.588). The incidence of PAC after PI was 32.14%(9/28) and that after LPI was significantly lower (P = 0.000). The incidence of PAC before and after LPI was 67.86%(19/28) under bright light, 7.143%(2/28) after LPI and 7.143%(2/28) after LPI. The incidence of PAC after LPI was significantly lower (P = 0.000). The width of anterior chamber angle increased after LPI (P 0.05), the width of anterior chamber angle increased after LPI; the width of anterior chamber angle increased after ILCD under bright and dark light, decreased after ILA (P 0.05), and the pupil block force decreased after LPI; there was no significant change after ACD, ICPD and TCPD under light and dark light (P 0.05), but LPI had no significant effect on the depth of anterior chamber and ciliary body position after IT1 under dark light. After LPI, the iris near the laser hole became thinner. 3. The PAC changes before and after laser peripheral iridoplasty (10 eyes): The angle of the chamber was completely opened under light and dark light, the closure rate of the angle was 0; AOD500 was at some points, and it increased after TIA (P 0.05). Laser peripheral iridoplasty can widen the angle of PAC after LPI, but has no significant effect on other UBM parameters (P 0.05). 4. To explore the mechanism of angle closure: According to the characteristics of UBM images before and after LPI in PAC patients, we classified them as follows: simple pupil block (64.28%), simple non-pupil block (7.14%) and mixed mechanism type (2/28). Accounting for 28.57% (8/28).
Conclusion PAC can be detected early in the eyes with ANA screened by UBM under dark light. The mechanism of angle closure of PAC is mainly pupil block and mixed mechanism. Peripheral iris hypertrophy or/and ciliary body anterior displacement are the main factors of angle closure after LPI in PAC eyes. To open up.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R779.63
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