CAJ | 학술논문

目的调查常规体检人群中可疑原发性房角关闭(PACS)的发生率,及经过YAG激光周边虹膜切除术(YAG-LPI)后患者周边前房深度和房角的变化情况.方法前瞻性临床研究.对2011年1月至2012年12月共24个月期间,在浙江省中西医结合医院接受常规体检的28 516例对象(57 032眼)使用裂隙灯显微镜观察其周边前房深度.对周边前房深度≤1/2角膜厚度的受检者进一步行包括眼压、屈光度、中央前房深度、眼轴、晶状体厚度、角膜厚度、房角镜等指标的检查.筛选出PACS患者,并对纳入患者行YAG-LPI干预,观察干预前后的周边前房深度和房角的变化.数据采用重复测量的方差分析和符号秩和检验.结果周边前房深度≤1/2角膜厚度的共有5 116眼(占总体检眼数的8.97％),接受进一步检查的有2 548眼,其中187眼为PACS(7.34％),考虑无应答偏倚后,PACS的患病率约为0.66％.187只PACS眼中40眼接受YAG-LPI,术后1周及6个月接受随访.接受YAG-LPI治疗人群的眼轴、中央前房深度、晶状体厚度、角膜厚度、眼压和屈光度在治疗前后无明显变化,治疗前后周边前房深度比较差异有统计学意义(Z=-5.657,P＜0.01).40眼中35眼(88％)解除PACS状态.结论 YAG-LPI可以解除PACS状态,从而进一步预防原发性闭角型青光眼的发作,是一种安全有效的方法.
목적 조사상규체검인군중가의원발성방각관폐(PACS)적발생솔,급경과YAG격광주변홍막절제술(YAG-LPI)후환자주변전방심도화방각적변화정황.방법 전첨성림상연구.대2011년1월지2012년12월공24개월기간,재절강성중서의결합의원접수상규체검적28 516례대상(57 032안)사용렬극등현미경관찰기주변전방심도.대주변전방심도≤1/2각막후도적수검자진일보행포괄안압、굴광도、중앙전방심도、안축、정상체후도、각막후도、방각경등지표적검사.사선출PACS환자,병대납입환자행YAG-LPI간예,관찰간예전후적주변전방심도화방각적변화.수거채용중복측량적방차분석화부호질화검험.결과 주변전방심도≤1/2각막후도적공유5 116안(점총체검안수적8.97％),접수진일보검사적유2 548안,기중187안위PACS(7.34％),고필무응답편의후,PACS적환병솔약위0.66％.187지PACS안중40안접수YAG-LPI,술후1주급6개월접수수방.접수YAG-LPI치료인군적안축、중앙전방심도、정상체후도、각막후도、안압화굴광도재치료전후무명현변화,치료전후주변전방심도비교차이유통계학의의(Z=-5.657,P＜0.01).40안중35안(88％)해제PACS상태.결론 YAG-LPI가이해제PACS상태,종이진일보예방원발성폐각형청광안적발작,시일충안전유효적방법.
Objective To investigate the prevalence of primary angle closure suspects (PACS) in a population that underwent routine physical examinations; to survey the changes in peripheral anterior chamber depth and angle after YAG laser peripheral iridectomy (YAG-LPI).Methods Prospective clinical study.Peripheral anterior chamber depth was investigated prospectively in 28 516 people (57 032 eyes) who had received routine physical examinations from January 1,2011 to December 31,2012 in the Zhejiang Hospital of Traditional Chinese and Western Medicine.Subjects with a peripheral anterior chamber depth ≤ 1/2 corneal thickness agreed to further testing for glaucoma,including axial length,central anterior chamber depth,lens thickness,central corneal thickness,intraocular pressure,refraction,and gonioscopic examination.PACS patients voluntarily agreed to undergo a YAG-LPI procedure.The changes in peripheral anterior chamber depth and angle were surveyed before and after surgery.Results A peripheral chamber depth ≤ 1/2 corneal thickness was found in 5 116 eyes (8.97％).Among them,2 548 eyes were examined further,and 187 eyes (7.34％) were diagnosed as PACS.In view of the non-response bias,the prevalence rate of PACS was estimated to be 0.66％.YAG-LPI was performed on 40 of the 187 PACS eyes and patients were examined at 1 week and 6 months postoperatively.There were no significant differences for axial length,central anterior chamber depth,lens thickness,central corneal thickness,intraocular pressure or refraction before and after surgery.However,peripheral anterior chamber depth and angle significantly increased after surgery (Z--5.657,P＜0.01).In these 40 eyes,35 eyes (88％) were no longer classified as PACS.Conclusion YAG-LPI is a safe and effective method to relieve PACS state and prevent the development of primary angle closure glaucoma.