中华实验眼科杂志
中華實驗眼科雜誌
중화실험안과잡지
CHINESE JOURNAL OF EXPERIMENTAL OPHTHALMOLOGY
2012年
2期
155-159
,共5页
姚宝群%吴玲玲%张纯%王欣
姚寶群%吳玲玲%張純%王訢
요보군%오령령%장순%왕흔
急性原发性房角关闭%周边虹膜切除术%接触性房角关闭%暗室试验
急性原髮性房角關閉%週邊虹膜切除術%接觸性房角關閉%暗室試驗
급성원발성방각관폐%주변홍막절제술%접촉성방각관폐%암실시험
Acute primary angle closure%Laser peripheral iridotomy%Appositional angle closure%Darkroom provocative test
背景 激光周边虹膜切除术( LPI)能解除瞳孔阻滞,是治疗急性原发性房角关闭(APAC)的有效手段,但术后仍有一部分患者虹膜周边前粘连(PAS)形成或加重.目的 了解APAC对侧眼LPI后接触性房角关闭与暗室试验结果之间的关系.方法 选择APAC的对侧眼作为研究对象,其均未发生PAS,利用超声生物显微镜(UBM)观察LPI后在暗环境下是否发生房角接触性关闭,以及与暗室试验结果的关系.结果 共有54例患者纳入本研究.APAC对侧眼LPI后暗环境下UBM检查发现,至少一个象限发生接触性房角关闭者有20例,占37.0％.其中51例进行了暗室试验,阳性者9例,占17.6％.按照发生接触性房角关闭的象限数分组,0～2个象限组46例中有5例暗室试验阳性,3～4个象限组5例中有4例暗室试验阳性,差异有统计学意义(P=0.003).且APAC对侧眼LPI后暗室试验眼压升高值与其暗环境下接触性房角关闭的象限数呈正相关( r=0.397,P=0.004).结论 APAC对侧眼LPI后仍有一定比例的患者在暗环境下发生接触性房角关闭和暗室试验阳性,且两者有一定的关系,这意味着APAC对侧眼LPI后仍有房角关闭的可能；同时也提示具有相同眼前节解剖结构的APAC眼本身也具有同样的风险,LPI后需要长期随访治疗.
揹景 激光週邊虹膜切除術( LPI)能解除瞳孔阻滯,是治療急性原髮性房角關閉(APAC)的有效手段,但術後仍有一部分患者虹膜週邊前粘連(PAS)形成或加重.目的 瞭解APAC對側眼LPI後接觸性房角關閉與暗室試驗結果之間的關繫.方法 選擇APAC的對側眼作為研究對象,其均未髮生PAS,利用超聲生物顯微鏡(UBM)觀察LPI後在暗環境下是否髮生房角接觸性關閉,以及與暗室試驗結果的關繫.結果 共有54例患者納入本研究.APAC對側眼LPI後暗環境下UBM檢查髮現,至少一箇象限髮生接觸性房角關閉者有20例,佔37.0％.其中51例進行瞭暗室試驗,暘性者9例,佔17.6％.按照髮生接觸性房角關閉的象限數分組,0～2箇象限組46例中有5例暗室試驗暘性,3～4箇象限組5例中有4例暗室試驗暘性,差異有統計學意義(P=0.003).且APAC對側眼LPI後暗室試驗眼壓升高值與其暗環境下接觸性房角關閉的象限數呈正相關( r=0.397,P=0.004).結論 APAC對側眼LPI後仍有一定比例的患者在暗環境下髮生接觸性房角關閉和暗室試驗暘性,且兩者有一定的關繫,這意味著APAC對側眼LPI後仍有房角關閉的可能；同時也提示具有相同眼前節解剖結構的APAC眼本身也具有同樣的風險,LPI後需要長期隨訪治療.
배경 격광주변홍막절제술( LPI)능해제동공조체,시치료급성원발성방각관폐(APAC)적유효수단,단술후잉유일부분환자홍막주변전점련(PAS)형성혹가중.목적 료해APAC대측안LPI후접촉성방각관폐여암실시험결과지간적관계.방법 선택APAC적대측안작위연구대상,기균미발생PAS,이용초성생물현미경(UBM)관찰LPI후재암배경하시부발생방각접촉성관폐,이급여암실시험결과적관계.결과 공유54례환자납입본연구.APAC대측안LPI후암배경하UBM검사발현,지소일개상한발생접촉성방각관폐자유20례,점37.0％.기중51례진행료암실시험,양성자9례,점17.6％.안조발생접촉성방각관폐적상한수분조,0～2개상한조46례중유5례암실시험양성,3～4개상한조5례중유4례암실시험양성,차이유통계학의의(P=0.003).차APAC대측안LPI후암실시험안압승고치여기암배경하접촉성방각관폐적상한수정정상관( r=0.397,P=0.004).결론 APAC대측안LPI후잉유일정비례적환자재암배경하발생접촉성방각관폐화암실시험양성,차량자유일정적관계,저의미착APAC대측안LPI후잉유방각관폐적가능；동시야제시구유상동안전절해부결구적APAC안본신야구유동양적풍험,LPI후수요장기수방치료.
Background Laser peripheral iridotomy(LPI) can break the pupillary block,and is an effective method of treating acute primary angle closure (APAC).However,a part of APAC eyes may gradually develop a formation and extension of peripheral anterior synechia(PAS) and increased intraocular pressure(IOP) after LPI.Objective To investigate the relationship between appositional angle closure and darkroom provocative test(DRPT) in the fellow eyes with APAC after LPI. Methods Fellow eyes of APAC without PAS after LPI were studied.Ultrasounic biomicroscopy(UBM) were performed in darkness to observe whether appositional angle closure occurred and compare the relationship between the quadrants with appositional angle closure and the results of DRPT.Results Fifty-four patients were included in the study.Appositional angle closure was observed in at least one quadrant in 20(37.0％ ) of the 54 fellow eyes with APAC after LPI.Fifty-one patients were given DRPT and positive result in 9 patients( 17.6％ ).According to the quadrants with appositional angle closure,there were 5 patients with DRPT positive results in 46 patients with appositional angle closure 0 to 2 quadrants,and 4 patients with DRPT positive results in 5 patients with appositional angle closure 3 to 4 quadrants ( P =0.003 ).Bivariate correlation analysis indicated a positive correlation between the value of the increased IOP in DRPT and the number of quadrants with appositional angle closure in darkness( r =0.397,P =0.004). Conclusions A certain proportional fellow eyes of APAC appeared appositional angle closure in darkness and DRPT positive result after LPI.The more the quadrants of appositional angle closure after LPI,the greater the likelihood of a positive DRPT.It suggests that the APAC fellow eyes and attack eyes with the same anatomical configuration still have the possibility of angle closure after LPI,and need follow-up and treatment for a long time.
