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

发布时间：2018-10-19 19:29

【摘要】：目的采用超声生物显微镜(ultrasound biomicroscope,UBM)和眼前节光学相干断层扫描仪(optical coherence tomography,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(best corrected visual acuity,BVCA)及眼压,于术前、术后3个月分别用UBM及Visante OCT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(1 kPa=7.5 mmHg)、(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Visante OCT术后检测中央前房深度(anterior chamber depth,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Visante OCT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Visante OCT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Visante OCT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Visante OCT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。
[Abstract]:Objective to observe the anatomical changes of anterior segment of primary acute angle closure glaucoma (ACG) patients before and after phacoemulsification with ultrasonic biomicroscopy (ultrasound biomicroscope,UBM) and anterior segment optical coherence tomography (optical coherence tomography,OCT). To evaluate the application value of these two methods. Methods 35 cases (35 eyes) of primary acute angle closure glaucoma complicated with cataract were treated with phacoemulsification cataract extraction combined with intraocular lens implantation. The best corrected visual acuity (best corrected visual acuity,BVCA) and intraocular pressure (IOP) were monitored before and after operation. The anterior segment was measured by UBM and Visante OCT 3 months after operation. The changes of anterior segment parameters before and after operation were analyzed and the differences between the two methods were compared. Results the IOP of all patients was (13.85 卤5.06) mmHg (1 kPa=7.5 mmHg), (13.29 卤4.55) mmHg, (13.47 卤4.11) mmHg, significantly lower than that of preoperative mmHg (17.07 卤4.02) mmHg 1 week, 1 month and 3 months after operation. The BCVA was 0.51 卤0.100.65 卤0.21 卤0.63 卤0.19 at 1 week, 1 month and 3 months postoperatively, which was significantly higher than that before operation (0.20 卤0.10). There were significant differences in intraocular pressure (IOP) and BCVA before operation (F9.33P0.000F106.27PU 0.000). UBM and (anterior chamber depth,ACD after Visante OCT) were (3.41 卤0.44) mm, (3.45 卤0.39) mm, and (1.93 卤0.28) mm, (1.95 卤0.32) mm, respectively. There was significant difference between the two methods (t _ (12. 142) mm, (~ (12.087), P ~ (0.000), and there was no significant difference between the two methods (t _ (0.143) ~ (0.90) ~ (-1) ~ (-0.197) ~ 0. 824). UBM and (0.37 卤0.16) mm, (~ (0.29 卤0.11) mm, respectively, compared with (0.18 卤0.10) mm, (0.15 卤0. 05) mm before operation, and (0. 18 卤0. 10) mm, (, 0. 15 卤0. 05) mm, respectively. The difference was statistically significant (tn 14.561 ~ 13.233, P = 0.000), and the difference between the two methods was statistically significant (t = 1.825). The iris angle of trabeculae was (36.55 卤5.93) 掳, (29.83 卤4.87) 掳after Visante OCT, and (17.81 卤5.17) 掳, (12.44 卤4.25) 掳after Visante OCT, which was significantly higher than that of pre-operation (17.81 卤5.17) 掳, (12.44 卤4.25) 掳). The difference was statistically significant (tn 13.328 mm2, 11.751, both P0. 000), and the difference between the two methods was statistically significant (tt2. 012 + Pu 0. 029 ~ 3. 381P0. 000). UBM and Visante OCT after operation were (0. 19 卤0. 15) mm2, (0. 12 卤0. 10) mm2, and (0. 06 卤0. 04) mm2, (0. 05 卤0. 06) mm2, respectively), and there was no significant difference between the two methods in detecting the area of cornea recess (0. 19 卤0. 15) mm2, (0. 12 卤0. 10) mm2, and (0. 06 卤0. 04) mm2, (0. 05 卤0. 06) mm2, respectively. The difference was statistically significant (t _ (10. 122) ~ 9.081, P ~ (0.000), and the difference between the two methods was statistically significant (t _ (3.427) P ~ (+) ~ (0.001) ~ (2.914) (P ~ (0.003). Conclusion phacoemulsification is performed in patients with primary acute angle-closure glaucoma complicated with cataract. The anterior chamber depth is obviously increased and the angle structure is improved after phacoemulsification. Intraocular pressure was effectively controlled. UBM and Visante OCT could objectively measure the anatomical parameters of anterior segment in patients with primary acute angle-closure glaucoma complicated with cataract, but the clinical application value was different.
【作者单位】：广西医科大学第四附属医院柳州市工人医院眼科;暨南大学第一附属医院保健科;
【分类号】：R779.6

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