【摘要】：目的利用超聲生物顯微鏡(UBM)篩查原發(fā)性前房角關(guān)閉(PAC),進(jìn)行預(yù)防性激光周邊虹膜切除術(shù)(LPI)或聯(lián)合激光周邊虹膜成形術(shù),比較前房角形態(tài)變化情況,探索房角關(guān)閉機(jī)制及阻止PAC向原發(fā)性閉角型青光眼(PACG)進(jìn)展的方法,以減少PACG的發(fā)生率。 方法1、應(yīng)用前瞻性干預(yù)性病例研究。30例(51眼)就診于遵義醫(yī)學(xué)院眼科門診的解剖窄房角(ANA)患者,進(jìn)行明、暗光線下UBM檢查,每眼檢查8個(gè)位點(diǎn),檢查位點(diǎn)中明、暗光線任一情況下有1個(gè)位點(diǎn)以上虹膜小梁網(wǎng)暫時(shí)性接觸者,判斷為PAC,記錄PAC的眼數(shù)。UBM觀察前房角及睫狀體圖像,測(cè)量指標(biāo)包括房角開放距離(AOD500)、小梁虹膜夾角(TIA)、周邊虹膜厚度(IT1)、虹膜睫狀體距離(ICPD)、小梁睫狀體距離(TCPD)、虹膜晶體夾角(ILA)、虹膜晶體接觸距離(ILCD)以及每眼的中央前房深度(ACD),對(duì)篩出的PAC進(jìn)行LPI治療,術(shù)后2周復(fù)查UBM,復(fù)查后對(duì)仍然存在虹膜小梁網(wǎng)暫時(shí)性接觸者進(jìn)行激光周邊虹膜成形術(shù),術(shù)后2周再次復(fù)查UBM,每次UBM檢查的照明條件及測(cè)量參數(shù)均同術(shù)前。2、應(yīng)用自身對(duì)照配對(duì)設(shè)計(jì)：(1)ANA眼明、暗光線下的PAC發(fā)生率采用自身配對(duì),檢驗(yàn)；(2)行LPI的PAC眼術(shù)前與術(shù)后PAC發(fā)生率采用Fisher精確概率法檢驗(yàn),其他UBM計(jì)量指標(biāo)采用自身配對(duì)t檢驗(yàn)；(3)LPI后仍為PAC者聯(lián)合應(yīng)用激光周邊虹膜成形術(shù),術(shù)前與術(shù)后UBM檢查參數(shù)的變化,采用自身配對(duì)t檢驗(yàn)。所有比較均以P0.05表示有統(tǒng)計(jì)學(xué)意義。 結(jié)果1、PAC的篩選：ANA患者經(jīng)UBM檢查,暗光線下PAC發(fā)生率為78.43%(40/51),明光線下PAC發(fā)生率為50.98%(26/51),暗光線下PAC發(fā)生率較高,差異有統(tǒng)計(jì)學(xué)意義(P=0.000,χ2值=23.588)。2、PAC眼LPI治療前后的UBM改變(28眼)：暗光線下LPI前PAC發(fā)生率為96.43%(27/28),LPI后PAC發(fā)生率為32.14%(9/28),LPI后PAC發(fā)生率降低,差異有統(tǒng)計(jì)學(xué)意義(P=0.000)；明光線下LPI前PAC發(fā)生率為67.86%(19/28),LPI后PAC發(fā)生率為7.143%(2/28),LPI術(shù)后PAC發(fā)生率降低,差異有統(tǒng)計(jì)學(xué)意義(P=0.000)。UBM參數(shù)變化情況：明、暗光線下AOD5o0、TIA術(shù)后較術(shù)前均增大(P0.05),LPI后房角寬度增加；明、暗光線下ILCD術(shù)后較術(shù)前增大、ILA術(shù)后較術(shù)前減小(P0.05),LPI后瞳孔阻滯力降低；明、暗光線下ACD、ICPD、TCPD術(shù)后無明顯變化(P0.05),LPI對(duì)中央前房深度及睫狀體位置無明顯影響；暗光線下比較IT1術(shù)后以上方點(diǎn)位變薄明顯,明光線下比較則以下方點(diǎn)位變薄明顯(P0.05),LPI后激光孔附近點(diǎn)位虹膜變薄。3、激光周邊虹膜成形術(shù)前后PAC變化情況(10眼)：術(shù)后在明、暗光線下房角均完全開放,房角關(guān)閉率為0；部分點(diǎn)位AOD500、TIA術(shù)后較術(shù)前增大(P0.05),激光周邊虹膜成形術(shù)能使LPI后的PAC房角增寬,而對(duì)其他UBM檢查指標(biāo)無明顯影響(P0.05)。4、初步探索房角關(guān)閉機(jī)制：根據(jù)PAC患者LPI前后的UBM圖像特征進(jìn)行初步分類：?jiǎn)渭兺鬃铚?4.28%(18/28),單純非瞳孔阻滯型占7.14%(2/28),混合機(jī)制型占28.57%(8/28)。 結(jié)論暗光線下UBM篩查ANA眼能較早發(fā)現(xiàn)PAC；PAC房角關(guān)閉的機(jī)制以瞳孔阻滯、混合機(jī)制為主,周邊虹膜肥厚或/和睫狀體前移是PAC眼LPI后仍然存在房角關(guān)閉的主要因素；聯(lián)合激光周邊虹膜成形術(shù)能使LPI后的PAC房角寬度增加,使得房角完全開放。
[Abstract]:Objective To screen primary angle closure (PAC) by ultrasound biomicroscopy (UBM) and perform preventive laser peripheral iridectomy (LPI) or combined with laser peripheral iridoplasty (LPI) to compare the morphological changes of the anterior chamber angle, to explore the mechanism of angle closure and to prevent the progression of PAC to primary angle closure glaucoma (PACG), so as to reduce the incidence of PACG. Rate of birth.
Methods 1. Prospective intervention case study. 30 patients (51 eyes) with anatomical narrow angle (ANA) were examined by UBM under light and dark light. Each eye was examined for 8 sites. Those who had temporary contact with more than one site of trabecular meshwork in light or dark light were judged to be PAC. Angle of anterior chamber and ciliary body were measured by UBM. Measurements included angle opening distance (AOD 500), trabecular iris angle (TIA), peripheral iris thickness (IT1), iris ciliary body distance (ICPD), trabecular ciliary body distance (TCPD), iris lens angle (ILA), iris lens contact distance (ILCD) and central anterior chamber depth (ACD) of each eye, and P to sieve out. Patients who had temporary contact with the trabecular meshwork underwent laser peripheral iridoplasty. UBM was reexamined 2 weeks after operation. The illumination conditions and measurement parameters of each UBM examination were the same as those of preoperative. 2. A self-matched design was used: (1) PAC incidence in light and dark light was used. The incidence of PAC before and after LPI was examined by Fisher's exact probability method, and other UBM measurements were examined by self-matched t-test. (3) Patients who were still PAC after LPI were combined with laser peripheral iridoplasty, and the changes of UBM parameters before and after LPI were examined by self-matched t-test. It has statistical significance.
Results 1. PAC screening: The incidence of PAC was 78.43% (40/51) in dark light, 50.98% (26/51) in bright light, and higher in dark light (P = 0.000, _2 = 23.588). The difference was statistically significant (P = 0.000, 2 = 23.588). The incidence of PAC after PI was 32.14%(9/28) and that after LPI was significantly lower (P = 0.000). The incidence of PAC before and after LPI was 67.86%(19/28) under bright light, 7.143%(2/28) after LPI and 7.143%(2/28) after LPI. The incidence of PAC after LPI was significantly lower (P = 0.000). The width of anterior chamber angle increased after LPI (P 0.05), the width of anterior chamber angle increased after LPI; the width of anterior chamber angle increased after ILCD under bright and dark light, decreased after ILA (P 0.05), and the pupil block force decreased after LPI; there was no significant change after ACD, ICPD and TCPD under light and dark light (P 0.05), but LPI had no significant effect on the depth of anterior chamber and ciliary body position after IT1 under dark light. After LPI, the iris near the laser hole became thinner. 3. The PAC changes before and after laser peripheral iridoplasty (10 eyes): The angle of the chamber was completely opened under light and dark light, the closure rate of the angle was 0; AOD500 was at some points, and it increased after TIA (P 0.05). Laser peripheral iridoplasty can widen the angle of PAC after LPI, but has no significant effect on other UBM parameters (P 0.05). 4. To explore the mechanism of angle closure: According to the characteristics of UBM images before and after LPI in PAC patients, we classified them as follows: simple pupil block (64.28%), simple non-pupil block (7.14%) and mixed mechanism type (2/28). Accounting for 28.57% (8/28).
Conclusion PAC can be detected early in the eyes with ANA screened by UBM under dark light. The mechanism of angle closure of PAC is mainly pupil block and mixed mechanism. Peripheral iris hypertrophy or/and ciliary body anterior displacement are the main factors of angle closure after LPI in PAC eyes. To open up.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R779.63

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