原发性闭角型青光眼的晶状体厚度及晶状体相对位置超声生物测量

摘要

目的 观察原发性闭角型青光眼(PACG)的晶状体厚度及晶状体相对位置,并探讨晶状体因素在发病机制中的作用.方法 用A超对急性闭角型青光眼(APACG)急性发作眼22眼、APACG对侧未发作眼23眼、慢性闭角型青光眼(CPACG)药物控制未手术20眼、CPACG小梁切除术后18眼及正常30眼行晶状体厚度(LT)、前房深度(ACD)和眼轴长度(AL)生物学测量,同时计算晶状体相对位置(RLL)及晶状体厚度/眼轴长度系数(LT/AL),各项行单因素方差分析.结果 PACG的相对晶状体位置前移,较正常眼差异有统计学意义(P＜0.01)；APACG发作眼的晶状体厚度最大、晶状体相对位置前移明显、前房最浅,与正常眼差异有统计学意义(P＜0.01)；CPACG的小梁术后相对晶体位置没有改变,差异无统计学意义(P＞0.01).结论 随年龄增大,晶状体厚度增加,晶状体相对位置前移,导致晶状体阻滞,是PACG重要发病机制；CPACG在小梁切术后晶状体相对位置没有发生改变.提示APACG的急性发作与晶状体相对位置密切相关,关注晶状体相对位置对PACG手术时机和手术方式的选择具有重要意义.%Objective To assess the biological measurement of the thickness of lens, relative location of lens (RLL) and the effect on lens through mechanisms in patients with primary angle-closure glaucoma. Methods 22 APACG patients with acute episode eyes, 23 APACG patients with contralateral eyes were accessed, without acute episode at the onset, 20 CPACG patients with treatment by medicine, 18 CPACG patients with treatment after primary trabeculectomy (PT) , and 30 normal eyes. Were accessed structures of ocular anterior segment including the lens thickness (LT) and anterior chamber depth (ACD) were measured by a contact ultrasound A-scan machine. The relative location of lens (RLL) and LT/ AL ratio were also calculated. One-way ANOVA test was used to compare between 5 groups. Results Compared with normal eyes, the relative location of lens (RLL) of APACG and CPACG moved forward and the differences were statistically significant (P<0. 01). The APCAG with acute episode Eyes had as hallowest ACD, thickest LT, more forward RLL, and biggest LT/AL factor. The relative location of lens (RLL) of CPACG patients with treatment by medicine and CPACG patients with (treatment) after primary trabeculectomy (PT) has no changes,with no statistical significant (P>0. 01). Conclusions With growing aging, LT(the lens thickness) of patients are thicker and the relative location of lens (RLL) are more forward, which result in lens block that is one of mechanism of PACG. The relative location of lens (RLL) of CPACG patients with treatment by medicine and CPACG patients after primary trabeculectomy (PT) has no changes. It is important to focus on the relative location of lens (RLL) of PACG for choice of operation time and the ways of surgery.