原发性房角关闭眼行激光虹膜周边切开术后眼前节形态改变的观察和分析
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摘要
目的
1.Pentacam前节分析系统与超声生物显微镜(ultra-sonographic biomicroscope,UBM)对原发性闭角型青光眼(primary angle-closure glaucoma,PACG)中央前房深度(anterior chamber depth, ACD)的对比测量研究。
2.通过Pentacam眼前节分析系统观察原发性可关闭房角眼(primary angle closure,PAC)激光虹膜切开术(laser peripheral iridotomy,LPI)后不同时间角膜厚度,角膜曲率,前房的动态变化。并对各个测量值之间进行整体的综合分析,为临床工作提供参考依据。
方法
1.选取PACG患者77例(77眼),分为2组：急性闭角型青光眼(acute primary angle-closure glaucoma, APACG)患者37例(37眼),慢性闭角型青光眼(chronic primary angle-closure glaucoma, CPACG)患者40例(40眼)。应用Pentacam及UBM分别测量其中央ACD。
2.选择2008年12月至2009年3月在我院门诊就诊的PAC患者共29人,39眼。应用Pentacam眼前段分析系统在患者行激光周边虹膜切开术前,及术后1天,1周,1月,3月进行眼前段摄像图像分析,并分别测定角膜水平子午线和垂直子午线曲率、角膜厚度以及前房深度、前房角、前房容积等前房相关量化指标。采用SPSS11.5统计软件包对数据进行统计学分析。
结果
1.急性闭角型青光眼组Pentacam测得的中央ACD为(1.65±0.27)mm,UBM测得的中央ACD为(1.56±0.27)mm,差异有统计学意义(t=-7.259,P<0.01),2种方法在测量中央ACD时呈正相关(r=0.939,P<0.01)。慢性闭角型青光眼组Pentacam测得的中央ACD为(2.06±0.23)mm,UBM测得的中央ACD为(1.96±0.22)mm,差异有统计学意义(t=-10.433,P<0.01),两种方法在测量中央ACD时呈正相关(r=-0.967,P<0.01)。应用Bland-Altman分析对两种测量方法进行一致性评价,两种方法测量中央ACD值的结果具有较好的一致性。
2.瞳孔区中央角膜厚度,最薄处角膜厚度在LPI术后1天、1周、1月、3月与术前相比差别无统计学意义。
3.角膜平均水平曲率、垂直曲率在LPI术后1天、1周、1月、3月与术前相比差别无统计学意义。角膜散光在LPI术后各个随访点与术前差别无统计学意义。Ecc值在LPI术后1天,1周,1月,3月比术前较小,但差别无统计学意义。
4.中央前房深度在LPI术后1天、1周、1月、3月较术前加深,但差别无统计学意义。前房容积在LPI术后各个随访点都较术前增加,差别有统计学意义。前房角在LPI术后1天,1周,1月,3月都较术前变窄,差别有统计学意义。眼压在LPI术后1天,1周,1月,3月都较术前降低,差别有统计学意义。
5.通过Scheimpflug图像可显示LPI术后虹膜形态由术前的膨隆变平坦,以视轴为中心,距离视轴4mm的颞侧,下方,鼻侧,上方4个点的前房深度在LPI术后1天,1周,1月,3月都分别较术前加深,差别有统计学意义。而术后各个时间点相互之间的差异无统计学意义。以视轴为中心,距离视轴2mm的正上方、颞上方、颞下方、正下方、鼻下方、鼻上方6个点的前房深度在LPI术后1天,1周,1月,3月都分别较术前加深,差别有统计学意义。而术后1天,1周,1月,3月相互之间的差异无统计学意义。
6.LPI术前的中央前房深度、周边前房深度分别与前房容积进行Pearson相关性分析以及回归分析,得出LPI术前的中央前房深度与前房容积呈线性正相关。LPI术后以视轴为中心,距离视轴4mm增加的平均周边前房深度与术后同时间点增加的前房容积进行Pearson相关性分析及回归分析,得出LPI术后各时间点以视轴为中心,距离视轴4mm增加的平均周边前房深度与术后相同的时间点增加的前房容积呈线性正相关。
结论
1.Pentacam作为一种新型的三维眼前节分析诊断系统,在测量PACG的中央ACD时与UBM有一定差异,但其差异在临床可接受范围内,其值可相互替代使用。在临床工作中应把二者的优势结合起来,综合分析。
2.对于原发性房角关闭的患者,激光周边虹膜切开术后,患眼的角膜厚度,角膜水平曲率,垂直曲率,角膜的散光以及Ecc值都较术前没有明显的变化,说明激光周边虹膜切开术对角膜的影响较小。
3.对于原发性房角关闭的患者,激光周边虹膜切开术后,前房容积,周边前房深度都有明显的增加,虹膜形态由术前的膨隆变平坦。LPI短期内可以有效的预防PAC患者的急性发作。
Objective
1.The aim of this study is to explore the difference and agreement in the measurement of anterior chamber depth (ACD) between Pentacam and ultra-sonographic biomicroscope (UBM) of primary angle-closure glaucoma (PACG) patients.
2. To study changes in anterior segment morphology after laser peripheral iridotomy (LPI) in Chinese primary angle closure (PAC) patients using Pentacam.
Methods
1.Seventy-seven eyes of 77 PACG patients aged (69.96±7.87) were divided into two groups. Thirty-seven eyes with acute primary angle-closure glaucoma (APACG) were assigned to group 1, and forty eyes with chronic primary angle-closure glaucoma (CPACG) were assigned to group 2. Central ACD was measured with Pentacam and UBM, respectively. The Bland-Altman method was used to evaluate the agreement of the two methods.
2.In this prospective study, Pentacam was used to record the pre-LPI, 1day,1 week, 1 month and 3 month post-LPI morphology of the anterior segment. LPI was performed on 39 eyes of 29 Chinese PAC patients. The parameters included the horizontal and vertical curvature, the corneal thickness, the Ecc, the central ACD, anterior chamber volume (ACV), anterior chamber angle (ACA), the intraocular pressure (IOP) and the peripheral ACD. All the data were analysed by the SPSS 11.5 statistical software package.
Results
1. The central ACD value measured by Pentacam and UBM were (1.65±0.27) mm and (1.56±0.27) mm respectively in APACG, indicating a significant difference (t=-7.259, P<0.01) and a positive linear correlation between the results of these two methods (r=0.939, P<0.01). The central ACD value measured by Pentacam and UBM were (2.06±0.23) mm and (1.96±0.22) mm respectively in CPACG eyes with a significant difference between them(t=-10.433, P<0.01) and a significant linear correlation between these two outcomes (r=0.967, P<0.01). The Bland-Altman method showed that the two modalities had comparable results for central ACD.
2. The differences between Pachy Pupil and Pachy T values taken before LPI and those taken at 1day,1 week,1 month and 3 month after LPI were not statistically significant.
3. The differences between the horizontal and vertical curvature, the astigmatism, the Ecc values taken before LPI and those taken at 1day,1 week,1 month and 3 month after LPI were not statistically significant.
4. The differences between Central ACD values taken before LPI and those taken at 1day,1 week,1 month and 3 month after LPI were not statistically significant. The ACV, ACA and IOP changed significantly after LPI at 1 day,1 week,1 month and 3 month respectively.
5. LPI changed the iris contour from convex to flat by Scheimpflug images. The peripheral ACD from 4mm of optical axis in the superior, temporal, inferior and nasal meridians all increased significantly after LPI at 1day,1 week,1 month and 3 month respectively. The peripheral ACD from 2mm of optical axis all increased significantly after LPI at 1day,1 week,1 month and 3 month, respectively.
6. Both the central ACD and the peripheral ACD was correlated significantly with the ACV before LPI. The average increase in peripheral ACD(ΔPACD) from 4mm of optical axis was correlated significantly with the average increase ACV (AACV) at 1day,1 week,1 month and 3month, respectively.
Conclutions
1.Pentacam, as a new 3-dimensional mathematical model of the anterior segment, presents some different results from UBM in the measurement of central ACD, but it is not clinically significant. Combination of Pentacam and UBM may be available for the clinical measurement of central ACD.
2. To PAC patietns, the horizontal and vertical curvature, the astigmatism and the Ecc values didn't change after LPI. LPI does not affect the corneal morphology.
3. LPI leads the increase of ACV, the peripheral ACD from 4mm of optical axis and the peripheral ACD from 2mm of optical axis. The great change of ACV after LPI was mostly because of the flattening of the iris shape. LPI could prevented development of PAC into PACG in a short period.
1.Pentacam前节分析系统与超声生物显微镜(ultra-sonographic biomicroscope,UBM)对原发性闭角型青光眼(primary angle-closure glaucoma,PACG)中央前房深度(anterior chamber depth, ACD)的对比测量研究。
2.通过Pentacam眼前节分析系统观察原发性可关闭房角眼(primary angle closure,PAC)激光虹膜切开术(laser peripheral iridotomy,LPI)后不同时间角膜厚度,角膜曲率,前房的动态变化。并对各个测量值之间进行整体的综合分析,为临床工作提供参考依据。
方法
1.选取PACG患者77例(77眼),分为2组：急性闭角型青光眼(acute primary angle-closure glaucoma, APACG)患者37例(37眼),慢性闭角型青光眼(chronic primary angle-closure glaucoma, CPACG)患者40例(40眼)。应用Pentacam及UBM分别测量其中央ACD。
2.选择2008年12月至2009年3月在我院门诊就诊的PAC患者共29人,39眼。应用Pentacam眼前段分析系统在患者行激光周边虹膜切开术前,及术后1天,1周,1月,3月进行眼前段摄像图像分析,并分别测定角膜水平子午线和垂直子午线曲率、角膜厚度以及前房深度、前房角、前房容积等前房相关量化指标。采用SPSS11.5统计软件包对数据进行统计学分析。
结果
1.急性闭角型青光眼组Pentacam测得的中央ACD为(1.65±0.27)mm,UBM测得的中央ACD为(1.56±0.27)mm,差异有统计学意义(t=-7.259,P<0.01),2种方法在测量中央ACD时呈正相关(r=0.939,P<0.01)。慢性闭角型青光眼组Pentacam测得的中央ACD为(2.06±0.23)mm,UBM测得的中央ACD为(1.96±0.22)mm,差异有统计学意义(t=-10.433,P<0.01),两种方法在测量中央ACD时呈正相关(r=-0.967,P<0.01)。应用Bland-Altman分析对两种测量方法进行一致性评价,两种方法测量中央ACD值的结果具有较好的一致性。
2.瞳孔区中央角膜厚度,最薄处角膜厚度在LPI术后1天、1周、1月、3月与术前相比差别无统计学意义。
3.角膜平均水平曲率、垂直曲率在LPI术后1天、1周、1月、3月与术前相比差别无统计学意义。角膜散光在LPI术后各个随访点与术前差别无统计学意义。Ecc值在LPI术后1天,1周,1月,3月比术前较小,但差别无统计学意义。
4.中央前房深度在LPI术后1天、1周、1月、3月较术前加深,但差别无统计学意义。前房容积在LPI术后各个随访点都较术前增加,差别有统计学意义。前房角在LPI术后1天,1周,1月,3月都较术前变窄,差别有统计学意义。眼压在LPI术后1天,1周,1月,3月都较术前降低,差别有统计学意义。
5.通过Scheimpflug图像可显示LPI术后虹膜形态由术前的膨隆变平坦,以视轴为中心,距离视轴4mm的颞侧,下方,鼻侧,上方4个点的前房深度在LPI术后1天,1周,1月,3月都分别较术前加深,差别有统计学意义。而术后各个时间点相互之间的差异无统计学意义。以视轴为中心,距离视轴2mm的正上方、颞上方、颞下方、正下方、鼻下方、鼻上方6个点的前房深度在LPI术后1天,1周,1月,3月都分别较术前加深,差别有统计学意义。而术后1天,1周,1月,3月相互之间的差异无统计学意义。
6.LPI术前的中央前房深度、周边前房深度分别与前房容积进行Pearson相关性分析以及回归分析,得出LPI术前的中央前房深度与前房容积呈线性正相关。LPI术后以视轴为中心,距离视轴4mm增加的平均周边前房深度与术后同时间点增加的前房容积进行Pearson相关性分析及回归分析,得出LPI术后各时间点以视轴为中心,距离视轴4mm增加的平均周边前房深度与术后相同的时间点增加的前房容积呈线性正相关。
结论
1.Pentacam作为一种新型的三维眼前节分析诊断系统,在测量PACG的中央ACD时与UBM有一定差异,但其差异在临床可接受范围内,其值可相互替代使用。在临床工作中应把二者的优势结合起来,综合分析。
2.对于原发性房角关闭的患者,激光周边虹膜切开术后,患眼的角膜厚度,角膜水平曲率,垂直曲率,角膜的散光以及Ecc值都较术前没有明显的变化,说明激光周边虹膜切开术对角膜的影响较小。
3.对于原发性房角关闭的患者,激光周边虹膜切开术后,前房容积,周边前房深度都有明显的增加,虹膜形态由术前的膨隆变平坦。LPI短期内可以有效的预防PAC患者的急性发作。
Objective
1.The aim of this study is to explore the difference and agreement in the measurement of anterior chamber depth (ACD) between Pentacam and ultra-sonographic biomicroscope (UBM) of primary angle-closure glaucoma (PACG) patients.
2. To study changes in anterior segment morphology after laser peripheral iridotomy (LPI) in Chinese primary angle closure (PAC) patients using Pentacam.
Methods
1.Seventy-seven eyes of 77 PACG patients aged (69.96±7.87) were divided into two groups. Thirty-seven eyes with acute primary angle-closure glaucoma (APACG) were assigned to group 1, and forty eyes with chronic primary angle-closure glaucoma (CPACG) were assigned to group 2. Central ACD was measured with Pentacam and UBM, respectively. The Bland-Altman method was used to evaluate the agreement of the two methods.
2.In this prospective study, Pentacam was used to record the pre-LPI, 1day,1 week, 1 month and 3 month post-LPI morphology of the anterior segment. LPI was performed on 39 eyes of 29 Chinese PAC patients. The parameters included the horizontal and vertical curvature, the corneal thickness, the Ecc, the central ACD, anterior chamber volume (ACV), anterior chamber angle (ACA), the intraocular pressure (IOP) and the peripheral ACD. All the data were analysed by the SPSS 11.5 statistical software package.
Results
1. The central ACD value measured by Pentacam and UBM were (1.65±0.27) mm and (1.56±0.27) mm respectively in APACG, indicating a significant difference (t=-7.259, P<0.01) and a positive linear correlation between the results of these two methods (r=0.939, P<0.01). The central ACD value measured by Pentacam and UBM were (2.06±0.23) mm and (1.96±0.22) mm respectively in CPACG eyes with a significant difference between them(t=-10.433, P<0.01) and a significant linear correlation between these two outcomes (r=0.967, P<0.01). The Bland-Altman method showed that the two modalities had comparable results for central ACD.
2. The differences between Pachy Pupil and Pachy T values taken before LPI and those taken at 1day,1 week,1 month and 3 month after LPI were not statistically significant.
3. The differences between the horizontal and vertical curvature, the astigmatism, the Ecc values taken before LPI and those taken at 1day,1 week,1 month and 3 month after LPI were not statistically significant.
4. The differences between Central ACD values taken before LPI and those taken at 1day,1 week,1 month and 3 month after LPI were not statistically significant. The ACV, ACA and IOP changed significantly after LPI at 1 day,1 week,1 month and 3 month respectively.
5. LPI changed the iris contour from convex to flat by Scheimpflug images. The peripheral ACD from 4mm of optical axis in the superior, temporal, inferior and nasal meridians all increased significantly after LPI at 1day,1 week,1 month and 3 month respectively. The peripheral ACD from 2mm of optical axis all increased significantly after LPI at 1day,1 week,1 month and 3 month, respectively.
6. Both the central ACD and the peripheral ACD was correlated significantly with the ACV before LPI. The average increase in peripheral ACD(ΔPACD) from 4mm of optical axis was correlated significantly with the average increase ACV (AACV) at 1day,1 week,1 month and 3month, respectively.
Conclutions
1.Pentacam, as a new 3-dimensional mathematical model of the anterior segment, presents some different results from UBM in the measurement of central ACD, but it is not clinically significant. Combination of Pentacam and UBM may be available for the clinical measurement of central ACD.
2. To PAC patietns, the horizontal and vertical curvature, the astigmatism and the Ecc values didn't change after LPI. LPI does not affect the corneal morphology.
3. LPI leads the increase of ACV, the peripheral ACD from 4mm of optical axis and the peripheral ACD from 2mm of optical axis. The great change of ACV after LPI was mostly because of the flattening of the iris shape. LPI could prevented development of PAC into PACG in a short period.
引文
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