CAJ | 학술논문

目的探讨原发性慢性闭角型青光眼(PCACG)患者激光周边虹膜切开(LPI)与周边虹膜切除(SPI)术对血-房水屏障的影响.方法临床随机对照试验.对60例早期PCACG患者,采用随机数字表法,随机分为LPI或SPI治疗组.应用FC-2000激光蛋白细胞检测仪定量测定术前、后的房水闪光值.同时观察眼压、中央角膜内皮细胞数、前房角粘连范围及其并发症.LPI组与SPI组房水闪光值比较,采用重复测量资料的两因素方差分析；应用Bonferroni法矫正检验水准α值后,进行组内两两比较的配对t检验.术后房水闪光值与眼压升高的相关性,采用Spearman秩相关分析法.结果术前及术后第3天,1、2、3及4周,LPI组各观察时间点平均房水闪光值分别为(5.47±1.09)、(11.96±3.07)、(8.08±2.18)、(5.68±0.83)、(5.80±1.00)、(5.69±1.12)光粒子数/ms；SPI组分别为(5.43±1.13)、(8.44±3.22)、(6.42±1.77)、(5.35±0.71)、(5.53±1.26)、(5.45±1.23)光粒子数/ms.LPI组和SPI组术后第3天(t=-12.753,-8.101)及术后1周(t=-5.971,-3.870)房水闪光值均分别高于术前(P＜0.05),而且LPI组房水闪光值明显高于SPI组(t=4.329,3.231；P＜0.05).术后4周内,LPI组高眼压发生率高于SPI组(X2=5.079,4.022;P ＜0.05)；术后第4周,LPI组平均应用局部降眼压药物种类数高于SPI组(Z=-1.984,P＜0.05).两组术后眼压升高与血-房水屏障损害程度呈正相关(r =0.899,0.833,P＜0.05).两组术后1周的平均中央角膜内皮细胞数(t=-0.696,0.008)和术后4周平均前房角粘连范围(Z=- 1.270,-1.490)与术前比较差异均无统计学意义(P＞0.05).两组术后各观察时间点均无明显并发症发生.结论 LP1和SPI术均影响PCACG患者正常的血-房水屏障,术后1周内LPI造成的影响较SPI更重,但术后2周基本恢复.早期血-房水屏障的破坏与术后的眼压波动相关,但对角膜内皮、前房角粘连无明显影响.
목적 탐토원발성만성폐각형청광안(PCACG)환자격광주변홍막절개(LPI)여주변홍막절제(SPI)술대혈-방수병장적영향.방법 림상수궤대조시험.대60례조기PCACG환자,채용수궤수자표법,수궤분위LPI혹SPI치료조.응용FC-2000격광단백세포검측의정량측정술전、후적방수섬광치.동시관찰안압、중앙각막내피세포수、전방각점련범위급기병발증.LPI조여SPI조방수섬광치비교,채용중복측량자료적량인소방차분석；응용Bonferroni법교정검험수준α치후,진행조내량량비교적배대t검험.술후방수섬광치여안압승고적상관성,채용Spearman질상관분석법.결과 술전급술후제3천,1、2、3급4주,LPI조각관찰시간점평균방수섬광치분별위(5.47±1.09)、(11.96±3.07)、(8.08±2.18)、(5.68±0.83)、(5.80±1.00)、(5.69±1.12)광입자수/ms；SPI조분별위(5.43±1.13)、(8.44±3.22)、(6.42±1.77)、(5.35±0.71)、(5.53±1.26)、(5.45±1.23)광입자수/ms.LPI조화SPI조술후제3천(t=-12.753,-8.101)급술후1주(t=-5.971,-3.870)방수섬광치균분별고우술전(P＜0.05),이차LPI조방수섬광치명현고우SPI조(t=4.329,3.231；P＜0.05).술후4주내,LPI조고안압발생솔고우SPI조(X2=5.079,4.022;P ＜0.05)；술후제4주,LPI조평균응용국부강안압약물충류수고우SPI조(Z=-1.984,P＜0.05).량조술후안압승고여혈-방수병장손해정도정정상관(r =0.899,0.833,P＜0.05).량조술후1주적평균중앙각막내피세포수(t=-0.696,0.008)화술후4주평균전방각점련범위(Z=- 1.270,-1.490)여술전비교차이균무통계학의의(P＞0.05).량조술후각관찰시간점균무명현병발증발생.결론 LP1화SPI술균영향PCACG환자정상적혈-방수병장,술후1주내LPI조성적영향교SPI경중,단술후2주기본회복.조기혈-방수병장적파배여술후적안압파동상관,단대각막내피、전방각점련무명현영향.
Objective To investigate the ocular blood-aqueous barrier (BAB) alteration after laser peripheral iridotomy (LPI) or surgery peripheral iridectomy (SPI) in patients with primary chronic angleclosure glaucoma (PCACG).Methods This was a clinical randomized controlled trial.Sixty eyes of 60 subjects with early stage of PCACG were randomly received either LPI or SPI and followed up postoperatively at day 3,week 1,2,3,and 4.Aqueous flare in anterior chamber was measured by FC-2000 flare-cell photometry,intraocular pressure (IOP) measured by tonometer,central corneal endothelium cell counted by endothelioscopy,peripheral anterior synechiae (PAS) detected by gonioscopy.Data were analyzed by using two-way ANOVA for repeated measures,independent samples t-test,paired t-test,nonparametric test,and Spearman rank correlation test.Results On follow-ups of pre-operative and post-operative 3 days,1 week (w),2w,3w and 4w respectively,the mean aqueous flare values for LPI group were (5.47 ± 1.09),( 11.96 ±3.07),(8.08 ± 2.18),(5.68 ±0.83 ),(5.80 ± 1.00),(5.69 ± 1.12) PC/ms,and for SPIgroup were (5.43 ±1.13),(8.44 ±3.22),(6.42 ±1.77),(5.35 ±0.71),(5.53 ± 1.26),(5.45 ±1.23) PC/ms.During post-operative 1w the flare values in both LPI and SPI groups were significantly higher than that on pre-operation (t =- 12.753,- 8.101,P ＜ 0.05 ; t =- 5.971,- 3.870 ; P ＜ 0.05 ) and LPI group had a significantly higher mean flare value than SPI group (t =4.329,3.231 ;P ＜0.05).The IOP spike in LPI group was significantly(x2 =5.079,4.022,P＜0.05) higher than that in SPI group at week 1 of post-operation.Increased IOP was positively correlated with BAB damage(r =0.899,0.833;P ＜0.05).The numbers of medications required to maintain IOP≤21 mm Hg(1 mm Hg=0.133 kPa) at week 4 of post-operation in LPI was significantly(Z =- 1.984,P ＜0.05)more than that in SPI group.There were no significant differences in central corneal endothelium cell count at week 1 ( t =- 0.696,0.008 ) and in extension of PAS at week 4 ( Z =- 1.270,- 1.490) of post-operation when compared to pre-operation ( P ＞0.05 ).No obvious complications occurred in both groups.Conclusions Our results demonstrated that IOP spike in both of LPI and SPI is due,at least in part,to BAB damage,which appears to be more severe in LPI group and can recover within two weeks.PAS progression and central corneal endothelium cell loss are not aggravated in 1 month after operation.