背景 Pentacam三维眼前节分析诊断系统(Pentacam)在对原发性闭角型青光眼(PACG)眼前节的定量评估中比裂隙灯显微镜和超声生物显微镜(UBM)更为准确,但目前其在急性PACG临床前期眼和慢性PACG对侧眼的YAG激光虹膜周边切开术(LPI)后前房测量中的应用仍较少. 目的 评估Pentacam在早期PACG眼LPI手术前后前房形态变化及其应用价值. 方法 采用前瞻性自身对照研究设计,纳入2012年7月至2013年12月在河北医科大学第二医院确诊的PACG患者70例70眼,包括急性PACG对侧眼(临床前期眼)和慢性PACG对侧眼各35眼,所有受检眼均行LPI.采用Pentacam测量受检眼LPI术前与术后1、7和28 d的前房深度(ACD)、前房容积(ACV)和前房夹角(ACA),并比较急性PACG临床前期眼与慢性PACG对侧眼LPI术后前房形态参数的变化幅度. 结果 急性PACG临床前期眼各时间点ACD和ACV的总体比较差异均有统计学意义(ACD:F=6.783,P=0.004;ACV:F=19.090,P=0.000),各时间点ACA值变化差异无统计学意义(F=0.153,P=0.928),其中LPI术后各时间点ACD较术前加深,ACV较术前增加,差异均有统计学意义(均P＜0.05).慢性PACG对侧眼各时间点ACD和ACV的总体比较差异有统计学意义(ACD:F=21.576,P=0.000;ACV:F=47.506,P=0.000),而各时间点间ACA比较差异无统计学意义(F=0.581,P=0.629),其中LPI术后各时间点ACD较术前加深,ACV较术前增加,差异均有统计学意义(均P＜0.05).急性PACG临床前期眼术后28 d,ACD和ACV与术前的变化值分别为(0.064±0.022) mm和(27.840±4.963) mm3,明显高于慢性PACG对侧眼的(0.047±0.020) mm和(21.000±3.278) mm3,组间差异均有统计学意义(ACD:t=2.783,P=0.008;ACV:t=5.749,P=0.000). 结论 Pentacam可以用来量化评价PACG患者LPI后的眼前节形态和参数的变化,急性PACG临床前期眼术后ACD和ACV的增加值大于慢性PACG对侧眼.%Background Pentacam anterior segment analysis system (Pentacam) is more accurate in the quantitative evaluation of ocular anterior segment in primary angle-closure glaucoma (PACG) eyes than slit lamp microscope and ultrasound biomicroscope (UBM).However,its accuracy in the earlier stage of PACG before and after YAG laser peripheral iridotomy (LPI) is not fully elucidated.Objective This study was to assess the effect of YAG LPI in PACG patients with Pentacam.Methods A prospective self-controlled study was performed.Thirtyfive fellow eyes (pre-clinical stage of PACG) of acute PACG and 35 fellow eyes of chronic PACG were included in the Second Hospital of Hebei Medical University from July,2012 to December,2013.YAG LPI was performed on the eyes,and the parameters of ocular anterior segment including central anterior chamber depth (ACD),anterior chamber volume (ACV) and peripheral anterior chamber angle (ACA) were measured and compared by Pentacam before and 1 day,7 days,28 days after operation.This study was approved by the Ethic Committee of the Second Hospital of Hebei Medical University and informed consent was obtained from all subjects.Results In pre-clinical stage of PACG eyes,the postoperative ACD and ACV values were increased in comparison with preoperation,showing significant differences among various time points (ACD:F =6.783,P =0.004;ACV:F =19.090,P =0.000),and no significant difference was found in ACA among different time points (F =0.153,P =0.928).In the fellow eyes of chronic PACG,the postoperative ACD and ACV values were larger than those of preoperation,with significant differences among various time points (ACD:F =21.576,P =0.000;ACV:F =47.506,P =0.000),and no significant difference was found in ACA among different time points (F=0.581,P=0.629).The change values of ACD and ACV were (0.064±0.022) mm and (27.840±4.963) mm3 in the eyes of pre-clinical stage of PACG,and those in the fellow eyes of chronic PACG were (0.047-± 0.020) mm and (21.000 ± 3.278) mm3,showing significant differences between the two groups (ACD:t=2.783,P=0.008;ACV:t=5.749,P=0.000).Conclusions Pentacam allows easy,fast,automatic and non-contact quantification and three-dimension image of the anterior chamber parameters before and after YAG LPI in pre-clinical stage of PACG eyes and fellow eyes of chronic PACG.The ACD deepens and ACV increases after LPI in glaucomous eyes,especially in the pre-clinical stage of PACG eyes.
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