CAJ | 학술논문

目的了解急性原发性房角关闭(APAC)对侧眼激光周边虹膜切除术(LPI)后接触性房角关闭的发生率和眼部解剖特征.方法前瞻性研究.选择54例APAC对侧眼没有虹膜前黏连(PAS)的患者作为研究对象,平均年龄(67.1±7.2)岁(54～83岁).采用超声生物显微镜(UBM)在暗环境下观察LPI后是否发生接触性房角关闭,并比较发生接触性房角关闭与不发生接触性房角关闭患眼的眼压、房角及各项UBM参数,包括房角开放距离500(AOD500)、房角隐窝面积750(ARA750)、小梁虹膜夹角(T-I角)、小梁睫状体距离(TCPD)、周边虹膜厚度(IT1)、虹膜悬韧带距离(IZD)、虹膜根部附着位置、中央前房深度(ACD).对两组数据采用独立样本t检验及两样本秩和检验进行分析.结果 LPI后暗环境下UBM检查至少一个象限发生接触性房角关闭的有20例,占37％.反映房角开放程度的指标(AOD500、ARA750、T-I角)和反映睫状体位置的指标(TCPD):接触性房角关闭(+)组小于(-)组(t=1 1.741、11.089、12.175、4.349,P均＜0.01)；反映虹膜形态和位置的指标IT1:接触性房角关闭(+)组大于(-)组(t=-3.300,P=0.002)；IZD、虹膜根部附着位置及ACD比较,两组差异无统计学意义(t=-1.880,P=0.066；Z=-1.423,P=0.155; t=0.072,P=0.942).结论 APAC对侧眼LP1后在暗环境下仍有一定比例发生接触性房角关闭,房角窄、睫状体前位、周边虹膜厚是LPI后发生接触性房角关闭的解剖学特点,提示LPI后具有这些解剖特点的APAC患者有可能进展为慢性房角关闭.
목적 료해급성원발성방각관폐(APAC)대측안격광주변홍막절제술(LPI)후접촉성방각관폐적발생솔화안부해부특정.방법 전첨성연구.선택54례APAC대측안몰유홍막전점련(PAS)적환자작위연구대상,평균년령(67.1±7.2)세(54～83세).채용초성생물현미경(UBM)재암배경하관찰LPI후시부발생접촉성방각관폐,병비교발생접촉성방각관폐여불발생접촉성방각관폐환안적안압、방각급각항UBM삼수,포괄방각개방거리500(AOD500)、방각은와면적750(ARA750)、소량홍막협각(T-I각)、소량첩상체거리(TCPD)、주변홍막후도(IT1)、홍막현인대거리(IZD)、홍막근부부착위치、중앙전방심도(ACD).대량조수거채용독립양본t검험급량양본질화검험진행분석.결과 LPI후암배경하UBM검사지소일개상한발생접촉성방각관폐적유20례,점37％.반영방각개방정도적지표(AOD500、ARA750、T-I각)화반영첩상체위치적지표(TCPD):접촉성방각관폐(+)조소우(-)조(t=1 1.741、11.089、12.175、4.349,P균＜0.01)；반영홍막형태화위치적지표IT1:접촉성방각관폐(+)조대우(-)조(t=-3.300,P=0.002)；IZD、홍막근부부착위치급ACD비교,량조차이무통계학의의(t=-1.880,P=0.066；Z=-1.423,P=0.155; t=0.072,P=0.942).결론 APAC대측안LP1후재암배경하잉유일정비례발생접촉성방각관폐,방각착、첩상체전위、주변홍막후시LPI후발생접촉성방각관폐적해부학특점,제시LPI후구유저사해부특점적APAC환자유가능진전위만성방각관폐.
Objective To investigate the frequency and anatomical characteristics of appositional angle closure after laser peripheral iridotomy in the fellow eyes of acute primary angle closure.Methods Prospective study.Fifty-four fellow eyes of acute primary angle closure without peripheral anterior synechia after laser peripheral iridotomy were studied.Mean age of (67.1±7.2)years (range 54-83 years).Uhrasounic biomicroscopy (UBM) were performed in darkness.Qualitative analysis of appositional angle closure and quantitative measurements of the angles from UBM images were taken.It was compared between the eyes of positive and negative appositional angle closure groups in intraocular pressure,gonioscopy and UBM parameters,including angle opening distance500 (AOD500),angle recess area750 (ARA750),trabecular-iris angle (T-I angle),trabecular-ciliary process distance (TCPD),peripheral iris thickness (IT1),iris-zonule distance (IZD),the position of iris insertion and central anterior chamber depth (ACD).All analyses were performed using a two-tailed Student's t test and two independent samples rank sum tests of SPSS 12.0 statistical software.Results Twenty patients (37％) were found to have appositional angle closure in at least one quadrant from UBM images in darkness after laser peripheral iridotomy,The indexes showing angle open degree (AOD500,ARA750,T-I angle) and the index showing ciliary body position (TCPD) in appositional angle closure positive group were less than those in negative group (t=11.741,11.089,12.175 and 4.349 respectively,P＜0.01).The index showing iris configuration and position IT1 in appositional angle closure positive group was more than that in negative group (t=-3.300,P=0.002).There were no significant differences in 1ZD,position of iris insertion and center anterior chamber depth between the two groups (t=-1.880,P=0.066; Z=-1.423,P=0.155; and t=0.072,P=0,942 respectively).Conclusion The fellow eyes of acute primary angle closure still appear appositional angle closure in darkness proportionally after laser peripheral iridotomy.The narrower angle,the more anterior position of the ciliary body,and the thicker peripheral iris,are the anatomical characteristics associated with appositional angle closure after laser peripheral iridotomy.It suggests the possibility of chronic angle closure development in the eyes having these anatomical characteristics in acute primary angle closure after laser peripheral iridotomy.