高眼压状态下急性闭角型青光眼术后前部巩膜厚度的研究

张少维，黄　毅，李　琴

作者单位：(441000)中国湖北省襄阳市，湖北省文理学院附属襄阳中心医院眼科



·临床研究·

高眼压状态下急性闭角型青光眼术后前部巩膜厚度的研究

张少维，黄毅，李琴

作者单位：(441000)中国湖北省襄阳市，湖北省文理学院附属襄阳中心医院眼科

Changes of anterior scleral thickness after surgery in acute angle-closure glaucoma patients with high intraocular pressure

Shao-Wei Zhang, Yi Huang, Qin Li

Department of Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei Province, China

Correspondence to:Qin Li. Department of Ophthalmology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441000, Hubei Province, China. 17713182@qq.com

Received：2015-12-23Accepted：2016-03-16

Abstract

•AIM: To evaluate the changes of anterior scleral thickness in acute angle-closure glaucoma patients with high intraocular pressure (IOP) after phacoemulsification and intraocular lens implantation with ultrasound biomicroscope.

•METHODS: The prospective clinical study enrolled 65 cases(72 eyes) with primary acute angle-closure glaucoma and cataract of whom IOP were all over 50mmHg. IOP of all patients were still over 45mmHg with shallow anterior chamber after general and topical medical management. Phacoemulsification and intraocular lens implantation combined with goniosynechialysis were performed after vitreous aspiration in all patients. Ultrasound biomicroscope was performed preoperatively and at 1, 6mo postoperatively. The anterior chamber depth (ACD), anterior scleral thickness (AST) and angle opening distance at 500μm from the scleral spur (AOD500) were measured at superior, temporal, nasal and inferior to detect the changes of anterior segment parameters.

•RESULTS: The ACD were 1.532±0.316, 3.337±0.652 and 3.458±0.482mm preoperatively and at 1 and 6mo postoperatively, and there were significant differences between before and postoperatively (P<0.01). The postoperative nasal and inferior AST obviously increased (P<0.05), but the postoperative superior and temporal AST increased a little (P>0.05).Compared with preoperative, the mean AOD500increased by 0.007, 0.006, 0.014 and 0.019mm at superior, temporal, nasal and inferior, and the differences were significant compared to those before surgeries(allP<0.01).

•CONCLUSION: For acute angle-closure glaucoma patients with shallow anterior chamber and sustained high IOP and can’t be managed with drugs, cataract surgery can deepen the central ACD, increase the anterior scleral thickness, and widen the anterior chamber angle. But the change of scleral thickness needs larger sample study．

KEYWORDS:•acute angle-closure glaucoma;ultrasound biomicroscope;scleral thickness;anterior chamber depth;angle opening distance

Citation:Zhang SW, Huang Y, Li Q. Changes of anterior scleral thickness after surgery in acute angle-closure glaucoma patients with high intraocular pressure.GuojiYankeZazhi(IntEyeSci) 2016;16(4):695-697

摘要

关键词：急性闭角型青光眼；超声生物显微镜；巩膜厚度；前房深度；房角开放距离

引用：张少维，黄毅，李琴.高眼压状态下急性闭角型青光眼术后前部巩膜厚度的研究.国际眼科杂志2016;16(4):695-697

0引言

急性闭角型青光眼的发病因素包括眼前节结构变异，如眼轴短、前房浅、房角窄、晶状体较厚和晶状体较原位置靠前等[1-3]。长期的房角过窄或关闭，容易造成周边虹膜前粘连[4]，导致难以控制的高眼压(intraocular pressure，IOP)[5]。高眼压对巩膜厚度、巩膜及筛板硬度均有影响，不同个体的巩膜组织特性尤其筛板处的巩膜组织结构异常是高眼压下青光眼视神经损害的危险因素[6-7]。理论上，巩膜厚薄会影响其它眼部生物学参数，因此观测巩膜厚度变化可以在一定程度上预测和追踪青光眼的病情进展。目前，对于抗青光眼手术前后前部巩膜厚度(anterior sclera thickness，AST)改变的相关研究较少，本研究中我们利用超声生物显微镜(UBM)观察持续高眼压状态的急性闭角型青光眼患者行玻璃体放液+白内障超声乳化吸出+人工晶状体植入术后不同象限前部巩膜厚度的变化。

1对象和方法

1.1对象选取2013-01/2015-01急性闭角型青光眼合并白内障患者65例72眼，其中男22例22眼，女43例50眼，其中7例在1眼术后1wk内另1眼青光眼急性发作；……