Pentacam前房分析仪测量原发性闭角型青光眼YAG激光周边虹膜切除术前后前房形态参数的对比研究

摘要

目的 应用Pentacam三维前房分析仪,测量原发性闭角型青光眼患者YAG激光周边虹膜切除术前、后前房形态参数变化,寻找以该检测方法评价前房形态变化的敏感指标.方法 前瞻性对照研究.早期原发性闭角型青光眼(PACG)患者47例(47眼),其中急性PACG患者21例,慢性PACG患者26例,行YAG激光周边虹膜切除术.术前及术后2周分别行Pentacam三维前房分析仪检查,观察前房形态变化并分析术前、术后前房形态参数,即中央前房深度、前房容积及前房夹角的变化;同时比较急性PACG与慢性PACG以及用药与未用药组激光后前房形态参数变化.激光前、后眼前段参数比较采用配对t检验,激光后两组前房形态参数变化的比较采用独立样本t检验.结果 PACG患者激光术前中央前房深度为(1.84±0.31)mm,前房容积为(65.04±20.68)mm3,前房夹角为(25.44±6.38)°;激光术后中央前房深度为(1.89±0.28)mm,前房容积为(92.19±21.07)mm3,前房夹角为(23.86±5.96)°;术后中央前房深度、前房容积较术前变大,差异有统计学意义(t=-3.10,P=0.003;t=-17.02,P=0.000),前房夹角无明显改变(t=1.91,P=0.060).激光后,急性PACG患者前房容积增加值为(29.76±10.84)mm3,慢性PACG患者为(23.31±10.07)mm3,差异有统计学意义(t=2.09,P=0.040).随访1年以上,未用药眼压保持稳定者激光后前房容积增加值为(31.93±11.99)mm,经用药而使眼压保持稳定者为(18.71±7.06)mm3,差异有统计学意义(t=3.17,P=0.005).结论 YAG激光周边虹膜切除术可改善PACG患者的浅前房状态,前房容积与中央前房深度是应用Pentacam三维前房分析仪衡量前房形态变化的较敏感的参数.急性PACG患者激光后前房容积增加值较慢性PACG患者大,未用药眼压保持稳定的患者激光后前房容积增加值较经用药患者大.%Objective To evaluate the changes in anterior chamber morphology with the Pentacam three-dimension anterior segment analysis system after YAG laser peripheral iridectomy (LPI) in early primary angle closure glaucoma (PACG) patients in order to investigate the sensitive parameters of the anterior chamber changes. Methods Prospective control study. Forty-seven eyes of 47 PACG patients (acute PACG 21 eyes and chronic PACG 26 eyes) were enrolled in this study.Pentacam examination was performed before and 2 weeks after LPI to measure the central anterior chamber depth (ACD), the anterior chamber volume (ACV) and the peripheral anterior chamber angle (ACA). Statistical analysis included paired t test and independent samples t test. Results ACD increased significantly from (1.84±0.31)mm to (1.89±0.28)mm and ACV increased significantly from (65.04±20.68)mm3 to (92.19±21.07)mm3 after LPI in PACG (t=-3.10, P=0.003; t=-17.02, P=0.000).There was no statistical significance on the changes of ACA [(23.86±5.96)° vs (25.44±6.38)°, t=1.91,P=0.060) after LPI in PACG. The changes of ACV were (29.76±10.84)mm3 in acute PACG and (23.31±10.07)mm3 in chronic PACG. There was statistical significance between two groups (t=2.09, P=0.040).The changes of ACV were (31.93±11.99)mm3 in the patients without medicine and (18.71±7.06)mm3 in the patients with medicine. There was statistical significance between two groups (t=3.17, P=0.005).Conclusion LPI could increase the ACV and deepen the ACD in PACG. ACV and ACD are the sensitive parameters of the anterior chamber changes with Pentacam. The changes of ACV in acute PACG are more significant than that in chronic PACG. The changes of ACV in patients without medicine are more significant than that in patients with medicine.