CAJ | 학술논문

目的探讨原发性慢性闭角型青光眼相关的危险因素及房角粘连与视野缺损的关系.方法 2008年9月至2010年9月经诊疗的原发性慢性闭角型青光眼病人80例(101只眼)及正常人90名(101只眼),分析其眼压、前房深度、眼轴长度及房角粘连程度与视野缺损的关系.其中有18例21只眼行虹膜周边激光切开术,24例32只眼行小梁切除联合虹膜根部切除术,一周后观察其变化情况.结果原发性慢性闭角型青光眼组中房角均有不同程度粘连(0～360度),治疗前眼压平均值(41.49±11.996)mm Hg,前房深度(2.0208±0.2274)mm,眼轴长(22.16±0.575 )mm;正常眼组眼压平均值(15.06±2.697 )mm Hg,前房深度(2.6378±0.3155 )mm,眼轴长(23.2411±1.1350)mm,两组间比较,差异有统计学意义(P＜0.01).在青光眼组视野平均缺损与房角粘连程度成正相关；眼压随房角粘连程度逐渐升高.虹膜周边激光切开术治疗一周后,房角粘连部分改善,眼压平均值(1657±4.094 )mm Hg,前房深度(2.1310±0.1839)mm.小梁切除联合虹膜根部切除术一周后复查,多数房角粘连者得到了改善,眼压平均值(13.91±2.668)mm Hg,前房深度(2.136±0.1462 )mm,与治疗前相比,各参数均有统计学意义(P＜0.01).结论本组病人与正常眼相比,具有眼轴短、前房浅的特点,容易发生房角粘连.视野缺损的程度与房角粘连程度成正相关,房角粘连范围愈广,视野缺损倾向愈大.眼压也与房角粘连程度成正相关,粘连的范围愈大,眼压值趋向愈高.提示房角粘连是慢闭发展的重要因素.虹膜周边激光切开术和小梁切除联合虹膜根部切除术都可以改善前房深度,但房角粘连范围大于180 °时,小梁切除术效果更明确,虹膜周边激光切开相对无效.
목적 탐토원발성만성폐각형청광안상관적위험인소급방각점련여시야결손적관계.방법 2008년9월지2010년9월경진료적원발성만성폐각형청광안병인80례(101지안)급정상인90명(101지안),분석기안압、전방심도、안축장도급방각점련정도여시야결손적관계.기중유18례21지안행홍막주변격광절개술,24례32지안행소량절제연합홍막근부절제술,일주후관찰기변화정황.결과 원발성만성폐각형청광안조중방각균유불동정도점련(0～360도),치료전안압평균치(41.49±11.996)mm Hg,전방심도(2.0208±0.2274)mm,안축장(22.16±0.575 )mm;정상안조안압평균치(15.06±2.697 )mm Hg,전방심도(2.6378±0.3155 )mm,안축장(23.2411±1.1350)mm,량조간비교,차이유통계학의의(P＜0.01).재청광안조시야평균결손여방각점련정도성정상관；안압수방각점련정도축점승고.홍막주변격광절개술치료일주후,방각점련부분개선,안압평균치(1657±4.094 )mm Hg,전방심도(2.1310±0.1839)mm.소량절제연합홍막근부절제술일주후복사,다수방각점련자득도료개선,안압평균치(13.91±2.668)mm Hg,전방심도(2.136±0.1462 )mm,여치료전상비,각삼수균유통계학의의(P＜0.01).결론 본조병인여정상안상비,구유안축단、전방천적특점,용역발생방각점련.시야결손적정도여방각점련정도성정상관,방각점련범위유엄,시야결손경향유대.안압야여방각점련정도성정상관,점련적범위유대,안압치추향유고.제시방각점련시만폐발전적중요인소.홍막주변격광절개술화소량절제연합홍막근부절제술도가이개선전방심도,단방각점련범위대우180 °시,소량절제술효과경명학,홍막주변격광절개상대무효.
Objective investigate the risk factors of chronic primary angle-closure glaucoma (CPACG) and the relationship between the peripheral anterior synechiae and the visual field defects.Methods From Sept,2008 to Oct.2010,80 cases (101eyes) with chronic primary angle-closure glaucoma and 90 normal persons (101eyes) were studied.The examination for eyes included the intraocular pressure (IOP),the anterior chamber depth (ACD),the axial length (AL),peripheral anterior synechiae (PAS) and the visual field.18 cases (21eyes) with CPACG treated with laser for peripherial iridectomy (LPI),The trabeculectomy performed in 24 cases (32eyes) with CPACG.Results PAS was commonly found in the eyes with CPACG,whose average IOP was 41.49± 11.996mmHg,the average ACDwas 2.02 ± 0.23mm;There was no PAS in normal eyes,whose average IOP was 15.06 ± 2.70mmHg,the average ACD was 2.64 ± 0.32mm.The difference between two groups was significant (P ＜0.01 ).The mean defect of visual field and the peripheral anterior synechiae in CPACG was positive correlation.The intraocular pressure gradually increased with the degree of peripheral anterior synechiae.After one week of treatement with laser,the average IOP was 16.57 ± 4.09mmHg,the averaage ACD was 2.13± 0.18mm,after one week of trabeculectomy,the average IOP was 13.91 ± 2.67mmHg,the average ACD was 2.14 ± 0.15mm.The peripheral anterior synechiae could partly improved.The results had statistically significant differences between treated and untreated group.Conclusions Compared with the normol eyes,the eyes with CPACG was shallow ACD.PAS occurred easy in those eyes.The intraocular pressure was positive correlation to PAS.With the expanding of the PAS,the IOP become higher,and the mean defect of the visual field become more serious.The trabeculectomy and LPI could all reduce the IOP and deepen the ACD.But the former is more effective when the PAS ＞180 degree.