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急性闭角型青光眼(acute angle closure glaucoma, AACG)发病多见于40岁以上的中年人,病人的眼球多为窄房角、浅前房、晶状体前移、短眼轴,集中体现为前房结构拥挤[1]。因为双眼有相似的解剖基础,一旦单眼AACG发作,未发作眼为则进入AACG临床前期[2]。进一步AACG病人的晶状体厚度增加及悬韧带松弛诱发晶体位置前移,使晶状体表面与瞳孔缘紧密接触,增加房水越过瞳孔阻力,导致瞳孔阻滞,因此晶状体的因素在AACG的发病过程起着关键作用[3-4]。AACG常合并白内障,临床治疗白内障常需手术摘除白内障并联合人工晶体植入,因白内障治疗可加深前房增宽房角,可降低和改善AACG的发作[5]。本研究拟比较AACG合并白内障的病人已发作眼与未发作眼的眼前节测量参数,进一步探讨AACG发作的病因,探讨单纯行白内障摘除治疗AACG合并白内障的时机和远期预后。
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治疗前,2组眼轴、晶体厚度、晶体厚度/眼轴差异无统计学意义(P>0.05)(见表 1),未发作组的AOD500及ACD均明显大于发作组(P < 0.01)(见表 1、2)。未作组和发作组治疗后ACD较治疗前均加深(P < 0.01和P < 0.05),发作组眼压较治疗前明显降低(P < 0.01),未发作组治疗前后眼压均为正常值无明显变化(P>0.05)(见表 2)。发作组去除未达到静息状态5例后, 2组ACD差异无统计学意义(P>0.05),未发作组AOD500明显大于发作组(P < 0.01)(见表 3)。
分组 n 眼轴
[M(QR)]/mm晶状体
厚度/mm晶状体厚度/
眼轴[M(QR)]AOD500/
mm未发作组 30 22.82(1.02) 4.36±0.08 0.19(0.01) 0.08±0.02 发作组 30 22.93(0.79) 4.40±0.09 0.19(0.01) 0.05±0.01 合计 60 22.88(0.82) 4.39±0.09 0.19(0.01) 0.062±0.02 Z — 0.05 1.97 1.49 9.84* P — >0.05 >0.05 >0.05 < 0.01 *示t值 表 1 2组治疗前眼轴、晶体厚度、晶体厚度/眼轴、AOD500的比较($\overline x \pm s$)
分组 n ACD/mm 眼压/mmHg 治疗前 治疗后 治疗前 治疗后 未发作组 30 1.75±0.09 4.18±0.21** 15.91±4.17 12.90±2.52 发作组 30 1.68±0.11 3.76±0.96* 53.31±7.47 14.91±8.41** t — 2.70 2.34 23.95 1.25 P — <0.01 <0.05 <0.01 >0.05 组内配对t检验:*P < 0.05,**P < 0.01 表 2 2组ACD、眼压治疗前后比较($\overline x \pm s$)
分组 n ACD/mm AOD500/mm 未发作组 30 1.75±0.09 0.08±0.02 发作组 25 1.71±0.07 0.05±0.93 t — 1.94 9.03 P — >0.05 <0.01 表 3 去除5例发作期未恢复静息状态2组术前ACD与AOD500比较($\overline x \pm s$)
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治疗后,未发作组视力提高率93.33%(28/30)高于发作组的73.33%(23/30)(χ2=4.32,P < 0.05);术后并发症方面,未发作组发生1例后发性白内障,发作组发生后发性白内障1例,残余青光眼2例,白内障加重4例,合计7例;未发作组发生率3.33%(1/30),低于发作组的23.3%(7/30)(χ2=5.19,P < 0.05)。
急性闭角型青光眼合并白内障双眼解剖参数及治疗效果的对比研究
Comparative study on binocular anatomic parameters and therapeutic effect of acute angle closure glaucoma complicated with cataract
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摘要:
目的 比较急性闭角型青光眼(AACG)合并白内障病人发作眼与未发作眼解剖结构的差异,探讨AACG合并白内障病人行单纯白内障摘除的时机。 方法 收集30例(60眼)AACG合并白内障病人,1眼急性发作(1次或多次)(发作组),对侧眼为未发作眼(未发作组),两眼的矫正视力≤0.3。比较2组眼治疗前的眼轴、晶状体厚度和房角开放距离500(angle opening distance,AOD500)、前房深度(anteriorchamber depth,ACD),对比2组治疗前后的视力提高及并发症比例。 结果 治疗前,2组眼轴、晶体厚度、晶体厚度/眼轴差异无统计学意义(P>0.05),未发作组的AOD500及ACD均明显大于发作组(P < 0.01)。未发作组和发作组治疗后ACD较治疗前均加深(P < 0.01和P < 0.05),发作组眼压较治疗前明显降低(P < 0.01),未发作组治疗前后眼压均为正常值无明显变化(P>0.05)。发作组去除未达到静息状态5例后,2组ACD差异无统计学意义(P>0.05),未发作组AOD500明显大于发作组(P < 0.01)。治疗后,未发作组视力提高率93.33%(28/30)高于发作组的73.33%(23/30)(P < 0.05);术后并发症方面,未发作组发生1例后发性白内障,发作组发生后发性白内障1例,残余青光眼2例,白内障加重4例,合计7例;未发作组发生率3.33%(1/30),低于发作组的23.3%(7/30)(P < 0.05)。 结论 AACG合并白内障病人发作眼静息状态下周边房角参数AOD500明显小于未发作组,临床前期的AACG合并明显白内障病人未发作期行白内障摘除有效减少急AACG的发作,远期视力明显提高。 Abstract:Objective To compare the difference of anatomical structure between seizer eyes and nonseizer eyes of patients with acute angle closure glaucoma (AACG) complicated with cataract, and explore the time of simple cataract extraction in AACG patients complicated with cataract. Methods The clinical data of 30 cases (60 eyes) with AACG complicated with cataract were collected, which included one eye with acute seizer (1 or more times), contralateral eye with nonseizer, and correction vision of both eyes ≤0.3.The axis, lens thickness, angle opening distance 500 (AOD500) and anterior chamber depth (ACD) between two groups before treatment were compared.The visual acuity improvement and incidence rate of complications after treatment were compared between two groups. Results Before treatment, there was no statistical significances in eye axis, crystal thickness and crystal thickness/eye axis between two groups (P>0.05), and the AOD500 and ACD in seizer group were greater than those in nonseizer group (P < 0.01).After treatment, the ACD in nonseizer group and seizer group was deeper than that before treatment (P < 0.01 and P < 0.05), the IOP in seizer group was lower than that before treatment (P < 0.01), and the IOP in nonseizer group was normal after treatment (P>0.05).After 5 patients without reaching the resting state in seizer group were removed, the difference of ACD between two groups was not statistically significant (P>0.05), and the AOD500 in nonseizer group was greater than that in seizer group (P < 0.05).In terms of postoperative complications, one case with posterior cataract in nonseizer group, and 1 case with posterior cataract, 2 cases with residual glaucoma and 4 cases with cataract aggravation in seizer group were found.The incidence rate of which in nonseizure group[3.33% (1/30)] was lower than that in seizer group[23.3% (7/30)] (P < 0.05). Conclusion The peripheral angle parameter AOD500 of patients with AACG complicated with cataract in resting state of the seizer eye is significantly less than that in nonseizer eye.The cataract extraction in pre-clinical patients with AACG complicated with cataract during nonseizer can effectively reduce the incidence rate of AACG, and improve the long-term vision. -
Key words:
- acute angle closure glaucoma /
- cataract /
- anatomic parameters
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表 1 2组治疗前眼轴、晶体厚度、晶体厚度/眼轴、AOD500的比较(
)$\overline x \pm s$ 分组 n 眼轴
[M(QR)]/mm晶状体
厚度/mm晶状体厚度/
眼轴[M(QR)]AOD500/
mm未发作组 30 22.82(1.02) 4.36±0.08 0.19(0.01) 0.08±0.02 发作组 30 22.93(0.79) 4.40±0.09 0.19(0.01) 0.05±0.01 合计 60 22.88(0.82) 4.39±0.09 0.19(0.01) 0.062±0.02 Z — 0.05 1.97 1.49 9.84* P — >0.05 >0.05 >0.05 < 0.01 *示t值 表 2 2组ACD、眼压治疗前后比较(
)$\overline x \pm s$ 分组 n ACD/mm 眼压/mmHg 治疗前 治疗后 治疗前 治疗后 未发作组 30 1.75±0.09 4.18±0.21** 15.91±4.17 12.90±2.52 发作组 30 1.68±0.11 3.76±0.96* 53.31±7.47 14.91±8.41** t — 2.70 2.34 23.95 1.25 P — <0.01 <0.05 <0.01 >0.05 组内配对t检验:*P < 0.05,**P < 0.01 表 3 去除5例发作期未恢复静息状态2组术前ACD与AOD500比较(
)$\overline x \pm s$ 分组 n ACD/mm AOD500/mm 未发作组 30 1.75±0.09 0.08±0.02 发作组 25 1.71±0.07 0.05±0.93 t — 1.94 9.03 P — >0.05 <0.01 -
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