房角关闭机制指导下可疑原发性房角关闭患者激光干预的疗效评价

目的 根据房角关闭的不同机制，对可疑原发性房角关闭（PACS）患者行激光周边虹膜切除（LPI）术或LPI联合激光周边虹膜成形（LPIP）术，通过超声生物显微镜（UBM）评估PACS患者激光早期干预的疗效。设计 前瞻性病例系列。 研究对象2016年1月-11月在河北省邯郸市眼科医院连续就诊的PACS患者50例（65眼）。方法 根据房角关闭的不同机制，通过UBM评估患眼，对所有入选患眼均首先行LPI治疗，术后第3天复查UBM，检查提示仍存在至少一个象限房角呈接触性关闭的患者再进一步联合LPIP治疗。术后3天复查UBM，根据测量的相关参数的前后变化评价治疗效果。主要指标 UBM图像中的中央前房深度（ACD），巩膜突前500 μm处的房角开放距离（AOD）、小梁虹膜夹角（TIA）、房角隐窝面积（ARA）、小梁睫状体距离（TCPD）、虹膜厚度（IT）。结果 65眼中，47眼（72.3%）行LPI治疗后3天UBM检查未发现存在至少一个象限的房角接触性关闭，术后AOD、TIA、TCPD、ARA较术前均明显增加（P均<0.01），IT较术前无明显变化（P=0.465）；18眼（27.7%）行LPI术后3天，UBM提示存在至少一个象限的房角接触性关闭，联合LPIP治疗后AOD、TIA、TCPD、ARA较术前均明显增加（P均<0.01），IT较LPI术后减少更明显（P<0.01）。结论 LPI后UBM可用于判断房角关闭的机制，并据此考虑是否联合LPIP，可进一步改善非单纯性瞳孔阻滞机制的可疑房角关闭患者的疗效。

Evaluation of therapeutic efficiency of laser peripheral iridotomy with or without laser peripheral iridoplasty under the guidance of angle closure mechanisms in eyes with primary angle closure suspect

Objective To quantitatively measure the changes in anterior segment morphology by using ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) with or without laser peripheral iridoplasty under the guidance of angle closure mechanisms in eyes with primary angle closure suspect (PACS). Design Prospective case series. Participants Sixty-five eyes in 50 PACS consecutive patients with PACS were enrolled from Jan. to Nov. 2016 in Handan Eye Hospital. Methods Each pre-operated eyes was evaluated by UBM according to the different mechanisms of angle closure. All selected patients were first treated with LPI. UBM examination were performed again 3 days after LPI. If there are still at least one quadrant angle contact closure, laser peripheral iridoplasty (LPIP) will be combined. Three days after LPLP, UBM was reviewed, and the therapeutic effects were evaluated according to the changes of UBM measurement parameters. Main Outcome Measures The parameters of anterior chamber angle in UBM images, including central anterior chamber depth (ACD), angle of anterior chamber opening distance(AOD), trabecular iris angle(TIA), angle crypt area(ARA)、trabecular ciliary body distance (TCPD)、iris thickness (IT). Results Forty-seven eyes were only treated by LPI, which showed pure pupillary block. AOD, TIA, ARA, TCPD were significantly widen after LPI than that at presentation in eyes (all P<0.01). IT were unchanged after LPI than that at presentation in eyes (P=0.465). Eighteen eyes were treated by LPI combined LPIP, which presented multiplemechanism, the AOD, TIA, ARA, TCPD were significantly widen after LPI+LPIP than that at presentation in eyes (all P<0.01). IT were thinner after LPIP than that at presentation and after LPI in eyes (P<0.01). Conclusion After LPI, UBM can be used to determine the mechanism of angle closure, and to consider whether combined LPIP, which can further improve the efficacy of multiplemechanism PACS.