摘要：
目的:应用增强深部成像的光学相干断层扫描(EDI-OCT)技术测量原发性房角关闭(PAC)患者行Nd∶YAG激光周边虹膜切开术(LPI)术前及术后脉络膜厚度,并与正常人的脉络膜厚度进行比较.方法:前瞻性队列研究.选择2015年10月至2017年2月在绍兴市人民医院眼科门诊就诊的符合PAC诊断的患者30例(48眼)作为PAC组,选择同期门诊正常体检的人群30例(50眼)作为正常对照组.测量正常对照组及PAC组LPI术前,术后1周、1个月、3个月、6个月的眼压、中央前房深度,并采用EDI-OCT分别测量黄斑中心凹下(SF)以及距离黄斑中心凹鼻侧(N1、N2、N3)、颞侧(T1、T2、T3)、上侧(S1、S2、S3)、下侧(I1、I2、I3) 0.5、1.5、3.0 mm处共13个点的脉络膜厚度(CT).采用重复测量方差分析对组间各不同时间点的数据进行比较;绘制脉络膜厚度的受试者工作特征曲线确定最佳诊断界限值;脉络膜厚度与眼压、中央前房深度的相关性采用Person相关分析;2组之间的比较采用独立样本t检验.结果:PAC组术前中央前房深度浅于正常对照组(t=-14.383,P＜0.001).PAC组术前,术后1周、1个月、3个月、6个月各时间点的中央前房深度差异具有统计学意义(F=10.313,P=.001),且术前、术后1周、1个月、3个月的中央前房深度依次变深(P＜0.01).PAC组术前13个点的脉络膜厚度均厚于正常对照组(均P＜0.01).PAC组各时间点的脉络膜厚度总体差异具有统计学意义(F=240.512,P＜0.001),术后1周、1个月、3个月、6个月的脉络膜厚度均较术前变薄(P＜0.001).2组所有受试者的脉络膜厚度与中央前房深度在SF、T1、T2、T3、S2、S3、I1、I2、I3位置呈负相关(r=-0.249、-0.239、-0.416、-0.330、-0.184、-0.176、-0.189、-0.184、-0.160,P＜0.001),而脉络膜厚度与眼压、眼轴均无相关性.结论:PAC患者脉络膜厚度较正常人厚,行LPI术可使PAC患者的脉络膜厚度变薄.脉络膜厚度在PAC的早期诊断、病情观察及LPI手术治疗效果的评估方面具有一定的作用.%Objective:To measure the choroidal thickness of patients with primary angle closure (PAC) before and after Nd:YAG laser peripheral iridotomy (LPI) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT);and to compare the difference between the choroidal thickness of patients with PAC and normal subjects.Methods:This was a prospective cohort study.Thirty patients (48 eyes) who were diagnosed with PAC were selected as the PAC group in the ophthalmology clinic of Shaoxing People's Hospital from October 2015 to February 2017.Thirty patients (50 eyes) undergoing regular physical examination were selected as normal controls in our hospital during the same period.Intraocular pressure and central anterior chamber depth were measured in the normal control group and PAC group before LPI,and 1 week,1 month,3 months and 6 months a~er LPI.Choroidal thickness was measured with EDI-OCT at the subfovea,as well as at 0.5,1.5 and 3.0 mm from the fovea superiorly,inferiorly,temporally,and nasally.Repeated measures ANOVA was used to compare data between the two groups at different time points,and to plot the choroidal thickness of the receiver operating characteristic curve to determine the best diagnostic limits.Pearson correlation analysis was used to assess the correlation among choroidal thickness,intraocular pressure and central anterior chamber depth.Independent t test was used to compare between the two groups.Results:The central anterior chamber depth of the PAC group was more shallow than that of the normal control group (t=-14.383,P＜0.001).The difference in central anterior chamber depth was statistically significant before LPI and 1 week,1 month,3 months and 6 months after LPI (F=10.313,P=0.001).And the central anterior chamber depth of the PAC group became deeper from preoperation to 3 months postoperation (P＜0.01).The choroidal thickness of the PAC group was greater than that of the normal control group at 13 points before LPI (all P ＜ 0.01).The difference in choroidal thickness was statistically significant before and after LPI (F=240.512,P＜ 0.001).The choroidal thickness of the PAC group at 1 week,1 month,3 months and 6 months after LPI was significantly thinner than that at pre-operation (P＜0.001).The choroidal thickness of all subjects in the two groups was negatively correlated with the depth of the central anterior chamber at SF,TI,T2,T3,S2,S3,I1,I2 and I3 (r=-0.249,-0.239,-0.416,-0.330,-0.184,-0.176,-0.189,-0.184,-0.160,P＜0.001).There was no correlation between choroidal thickness,intraocular pressure or axial length.Conclusions:The choroid in patients with PAC is thicker than in the normal group.The choroid in PAC patients became thinner after LPI surgery.Choroidal thickening may be one of the pathogenic factors of PACG.In addition,choroidal thickness plays a role in the early diagnosis of PAC and the disease observation and assessment of the therapeutic effect of LPI.
