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Advances in Clinical Medicine
Vol. 12  No. 02 ( 2022 ), Article ID: 48931 , 7 pages
10.12677/ACM.2022.122186

原发性急性闭角型青光眼与可疑性原发性房角关闭UBM眼前节相关参数的比较

马静静1,2，姜楠2*，姜薇1,2，封喆1,2

1青岛大学，山东 青岛

2青岛大学附属医院，山东 青岛

收稿日期：2022年1月21日；录用日期：2022年2月11日；发布日期：2022年2月24日

摘要

目的：利用超声生物显微镜(UBM)观察正常人、可疑性原发性房角关闭(PACS)与原发性急性闭角型青光眼(APACG)眼前节相关测量参数的不同。方法：将2018年1月~2020年11月在青岛大学附属医院拟行白内障手术的APACG组26例(50眼)、PACS组39例(50眼)和正常对照组32例(50眼)纳入研究。术前除视力、非接触式眼压、眼轴(AL)、眼部超声等常规检查外，还应用UBM观察并定量测量眼前节生物学参数，包括：中央前房深度(ACD)、两端睫状突的最大横径(STS)、晶状体前顶点与睫状突两端最大横径的垂直距离(h)，计算中央前房深度占眼轴长的比例(ACD/AL)和晶状体前顶点与睫状突两端最大横径的垂直距离与睫状突横径比值(h/STS)，以及测量4个钟点位(12点，3点，6点，9点)的AOD500 (角张开距离)、IZD (虹膜小带距离)、IT (虹膜厚度)、TCPA (小梁网睫状突夹角)。结果：APACG组、PACS组及正常对照组三组之间ACD、AL、ACD/AL、h、h/STS、4个钟点位IZD和4个钟点位TCPA测量参数值的比较差异均有统计学意义(P < 0.05)；APACG组、PACS组与正常对照组相比，4个钟点位AOD500的差异均有统计学意义(P < 0.05)，而APACG组和PACS组间相比，差异无统计学意义(P > 0.05)。STS和4个钟点位IT在三组之间比较差异均无统计学意义。结论：UBM可准确观察和测量正常人、APACG组、PACS组相关眼前节参数的差异，提示各组间眼前节解剖结构的差异，对于临床诊断与治疗具有重要临床意义。

关键词

原发性急性闭角型青光眼，可疑性原发性房角关闭，超声生物显微镜，眼前节

Comparison of Parameters Related to UBM Anterior Segment between Acute Primary Angle Closure Glaucoma and Suspicious Primary Angle Closure

Jingjing Ma1,2, Nan Jiang2*, Wei Jiang1,2, Zhe Feng1,2

1Qingdao University, Qingdao Shandong

2The Affiliated Hospital of Qingdao University, Qingdao Shandong

Received: Jan. 21st, 2022; accepted: Feb. 11th, 2022; published: Feb. 24th, 2022

ABSTRACT

Aim: To investigate the difference in related parameters of anterior segment between acute primary angle closure glaucoma (APACG) patients, suspicious primary angle closure (PACS) patients and normal patients by ultrasound biomicroscopy (UBM). Methods: From January 2018 to November 2020, 26 patients (50 eyes) with APACG in the ophthalmology department of Qingdao University Affiliated Hospital who underwent phacoemulsification and intraocular lens implantation were selected as the APACG group. 39 patients (50 eyes) with PACS in the ophthalmology department of Qingdao University Affiliated Hospital who underwent phacoemulsification and intraocular lens implantation were selected as the PACS group. 32 patients (50 eyes) who underwent phacoemulsification and intraocular lens implantation were selected as the normal group. In addition to routine preoperative examinations such as visual acuity, non-contact intraocular pressure, axis length (AL), and ocular B-ultrasound examination, UBM examinations were also applied to observe and quantitatively measure the parameters of the anterior segment, including measuring the central anterior chamber depth (ACD), the maximum transverse diameter of the ciliary process at both ends (STS), the vertical distance between the anterior apex of the lens and the maximum transverse diameter at both ends of the ciliary processes (h), and angle-opening distance (AOD500), iris-zonule distance (IZD), iris thickness (IT), trabecular ciliary process angle (TCPA) at four quadrants (superior, nasal, inferior, temporal quadrants). Results: There were significant differences in ACD, AL, ACD/AL, h, h/STS, IZD and TCPA at four quadrants (superior, nasal, inferior, temporal quadrants) between APACG group, PACS group and normal group (P < 0.05). Compared with normal group, APACG group and PACS group had differences in AOD500 at four quadrants (superior, nasal, inferior, temporal quadrants) (P < 0.05); however, there was no significant difference between APACG group and PACS group in AOD500 at four quadrants (superior, nasal, inferior, temporal quadrants) (P > 0.05). There were no significant differences in STS and IT at four quadrants (superior, nasal, inferior, temporal quadrants) among the three groups (P > 0.05). Conclusion: UBM can accurately observe and measure the difference in related parameters of the anterior segment among normal group, APACG group and PACS group, revealing the difference in anterior segment, which has important clinical significance.

Keywords:Acute Primary Angle Closure Glaucoma, Suspicious Primary Angle Closure, Ultrasound Biomicroscopy, Anterior Segment

Copyright © 2022 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

我国是青光眼患者人数最多的国家，青光眼是一组以特征性视神经萎缩和视野缺损为共同特征的疾病，为全球第二位致盲眼病，严重威胁人类的视觉健康 [1]。原发性闭角型青光眼(primary angle closure glaucoma, PACG)是我国青光眼的主要类型，原发性急性闭角型青光眼(primary angle closure glaucoma, APACG)是由于房角突然关闭，引起房水循环受阻，导致眼压急性升高的一类青光眼。APACG的病因机制尚未充分阐明，但有研究认为，最主要的病因是眼球局部的解剖结构异常，包括眼轴较短、角膜较小、前房浅、房角狭窄、晶状体厚、晶状体位置相对靠前，这种解剖结构异常是有遗传倾向的 [2]。国际上关于PACG的分类是基于疾病进程，即原发性可疑性房角关闭(PACS)、原发性房角关闭(PAC)、原发性闭角型青光眼(PACG)，能够充分反映PACG的发病和进展。另有研究表明，大约有25%的PACS患者在5年后会发展成为PAC，而PAC可进一步演变为PACG [3] [4] [5]。因此我们运用UBM对正常人、PACS患者和APACG患者眼前节解剖结构进行测量并比较差异，对其临床资料总结如下。

2. 资料与方法

2.1. 一般资料

收集2018年1月~2020年11月在青岛大学附属医院就诊的正常对照组32例(50眼)、APACG患者26例(50眼)以及PACS组39例(50眼)。所有研究对象均合并年龄相关性白内障并且行白内障超声乳化吸除联合人工晶体植入术，术前均行UBM检查及IOLMaster测量。所有研究过程均遵循赫尔辛基宣言。

纳入标准：1) APACG组：临床诊断为APACG，就诊时为急性发作期。原发性房角关闭伴有视神经损伤。2) PACS组：① 暗室下静态房角镜检查≥270˚范围的前房角不可见后部小梁网；② 不存在虹膜周边前粘连以及青光眼特征性视神经损害和视野缺损；③ 眼压不超过21 mmHg [6] [7]。3) 正常对照组：所有纳入眼房角按Shaffer分级标准分为III-IV级，均无角膜病史，未接受药物治疗(尤其是去甲肾上腺素、胆碱能以及肾上腺素能受体激动剂或拮抗剂)。

排除标准：① 角膜异常、感染、白斑者；② 先前进行过内眼手术或者激光引起眼前节结构改变者；③ 滴用对睫状肌有影响的药物；④ 曾有眼部外伤史者；⑤ 合并视网膜病变等其他眼科疾病；⑥ 合并精神系统、免疫系统疾病者；合并严重传染性疾病、恶性肿瘤者。

2.2. 方法

所有研究对象均完成病史询问及专科检查：裸眼视力和最佳矫正视力、眼压、裂隙灯、眼底镜检查、暗室下房角镜检查。

UBM检查方法：检查仪器采用MD-300L眼科超声生物显微镜。患者取仰卧位，用盐酸奥布卡因滴眼液对受检眼进行表面麻醉后选择合适的眼杯轻轻放置于眼球表面，向眼杯内倒入适量的灭菌注射用水，把探头放于杯内并靠近眼球，嘱患者依次按下、颞、上、鼻方向转动眼睛，检查者一边扫描一边观察机器屏幕，调整扫描方向和部位来获得最佳图像，取得上方、下方、鼻侧和颞侧房角的图像，打印四个象限的扫描图像对房角进行分析 [8] [9] [10]。

生物测量参数及定义

中央前房深度(ACD)：角膜内皮面最高顶点到晶状体前表面的垂直距离；眼轴(AL)：眼球前后径；晶状体前表面顶点到两端睫状突最大横径的垂直距离(h)；两端睫状突之间最大横径(STS)；角张开距离(AOD500)：以巩膜突为顶点，其前500 um处小梁上的一点，垂直于角膜作一直线与虹膜相交，两点间距离为AOD500；虹膜小带距离(IZD)：睫状突与悬韧带的接点至虹膜后表面作垂线，接点和交点的距离为虹膜悬韧带距离；小梁网睫状突夹角(TCPA)：巩膜突为顶点，小梁网角膜内皮连线与睫状突前表面间的夹角；虹膜厚度(IT)：距虹膜根部500 um，于虹膜后表面作垂线于虹膜前表面相交，两点间的距离。

2.3. 统计学分析

采用SPSS19.0统计软件包对所得数据进行统计学分析，计量资料以均数 ± 标准差( x ¯ ± s)表示，采用独立样本t检验；计数资料用频数表示，率的比较采用x2检验，以P < 0.05表示差异有统计学意义。

3. 结果

3.1. APACG组、PACS组和正常对照组一般资料比较

纳入研究的APACG组26例50眼中，年龄36~69岁，平均(61.22 ± 10.09)岁，男11例25眼，女15例25眼；PACS组39例50眼中，年龄32~78岁，平均(60.96 ± 10.02)岁，男17例25眼，女22例25眼；正常对照组33例50眼中，年龄35~75岁，平均(57.24 ± 11.23)岁，男19例26眼，女14例24眼。三组之间年龄、性别以及眼别两两比较的差异均无统计学意义(P > 0.05)。见表1。

Table 1. Basic Information among APACG group, PACS group, and normal group

表1. APACG组、PACS组和正常对照组一般资料比较

P1：APACG组与正常组比较；P2：PACS组与正常组比较；P3：APACG组与PACS组比较。

3.2. 三组间UBM测量眼前节参数值的比较

APACG组、PACS组及正常对照组三组之间ACD、AL、ACD/AL、h、h/STS、4个钟点位IZD和4个钟点位TCPA测量参数值的组间比较差异均有统计学意义(P < 0.05)，其中测量参数值ACD、AL、ACD/AL、4个钟点位IZD及4个钟点位TCPA在APACG组中均小于PACS组，在正常对照组中大于以上两组，测量参数值h及h/STS在APACG组中均大于PACS组，在正常对照组中小于以上两组。在三组之间，与正常对照组相比，APACG组和PACS组4个钟点位的AOD500均有差异(P < 0.05)，而APACG组和PACS组相比，4个钟点位的AOD500均无差异(P > 0.05)。STS及4个钟点位IT在APACG组、PACS组及正常对照组三组间比较差异均无统计学意义(P > 0.05)。APACG组、PACS组分别与正常对照组相比，中央前房深度较浅，眼轴较短，4个钟点位的IZD较短以及4个钟点位的AOD500和TCPA较小，此外，ACD/AL比值较正常组相比较小、h和h/STS比值较大；而APACG组较PACS组的中央前房深度更浅，眼轴更短，4个钟点位的IZD更短，4个钟点位的TCPA更小，APACG组ACD/AL比值比PACS组更小，h和h/STS比值比PACS组更大，差异具有统计学意义。见表2。

Table 2. Comparison of anterior segment parameters among APACG group, PACS group, and normal group

表2. APACG组、PACS组和正常对照组眼前节参数的比较

P1：APACG组与正常组比较；P2：PACS组与正常组比较；P3：APACG组与PACS组比较。

4. 讨论

本研究是通过测量UBM图像上眼前节的相关参数值来比较APACG患者、PACS患者和正常人眼前节解剖结构的差异 [11] [12]。UBM是一种新型的检查仪器，有较高的分辨率，是利用高频超声波对眼前节的组织结构进行量化测量的检查，可快速、有效、准确地观察眼前部解剖结构 [13] [14] [15] [16]。本研究纳入处于急性期的PACG患者以及术前眼压正常的PACS患者和正常人为研究对象，并对APACG组、PACS组和正常对照组的基本信息以及UBM相关参数进行定量化采集，提供包括中央前房深度、两端睫状突的最大横径、晶状体前顶点与睫状突两端最大横径的垂直距离，以及测量4个钟点位的角张开距离、虹膜小带距离、虹膜厚度、小梁网睫状突夹角等一系列数据，可以为患者眼前节结构提供精确的量化指标。其中较短的AL和较小的ACD/AL是发生青光眼的解剖学因素；晶状体前顶点与睫状突两端最大横径的垂直距离h可反应晶状体前突或膨胀的程度，有研究证实h/STS比值越大，晶状体突出的程度就越高 [17]；AOD500和TCPA可反应房角开放的程度，AOD500和TCPA越小，房角就越狭窄；IZD可反应睫状体前旋程度，IZD越短，睫状突前旋程度越大 [8]。本研究结果发现，APACG、PACS与正常人眼的解剖结构存在差异，眼前节相关参数的测量结果显示，APACG、PACS分别与正常人相比，除STS和4个钟点位IT外其余测量参数值均有差异，ACD、AL、ACD/AL、4个钟点位IZD、4个钟点位AOD500和4个钟点位TCPA在APACG和PACS中均小于正常人，而h、h/STS在APACG和PACS中均大于正常人。APACG和PACS相比，除STS、４个钟点位AOD500和４个钟点位IT外其余测量参数值均有差异，ACD、AL、ACD/AL、4个钟点位IZD和4个钟点位TCPA在APACG中较小，而h、h/STS在APACG中较大。说明眼部解剖结构，尤其是眼前节解剖结果的差异在青光眼发病中起重要作用，即中央前房深度越浅、眼轴越短、房角越狭窄、晶状体突出程度越高以及睫状体前旋程度越大，发生青光眼的风险就越高，此外ACD/AL比值越小，发生青光眼的风险也会越高 [18] [19] [20]。

5. 总结

综上所述，我们可以通过UBM测量患者眼前节参数值ACD、h、STS、IZD、AOD500、和TCPA来推测患者发生PACG的风险，但本研究还存在一定的局限性，仍需扩大样本量来进一步研究。

文章引用

马静静,姜 楠,姜 薇,封 喆. 原发性急性闭角型青光眼与可疑性原发性房角关闭UBM眼前节相关参数的比较
Comparison of Parameters Related to UBM Anterior Segment between Acute Primary Angle Closure Glaucoma and Suspicious Primary Angle Closure[J]. 临床医学进展, 2022, 12(02): 1281-1287. https://doi.org/10.12677/ACM.2022.122186

参考文献

  1. 1. Guo, C., Zhao, Z., Zhang, D., Liu, J., Li, J., Zhang, J., et al. (2019) Anterior Segment Features in Nanophthalmos with Secondary Chronic Angle Closure Glaucoma: An Ultrasound Biomicroscopy Study. Investigative Ophthalmology & Visual Science, 60, 2248-2256. https://doi.org/10.1167/iovs.19-26867

  2. 2. Xu, L., Zhang, L., Xia, C.R., Li, J.J., Hu, L.N., Ma, K., et al. (2005) The Prevalence and Its Effective Factors of Primary Angle-Closure Glaucoma in Defined Populations of Rural and Urban in Beijing. Chinese Journal of Ophthalmology, 41, 8-14.

  3. 3. Foster, P.J., Oen, F.T., Machin, D., Ng, T.P., Devereux, J.G., Johnson, G.J., et al. (2000) The Prevalence of Glaucoma in Chinese Residents of Singapore: A Cross-Sectional Population Survey of the Tanjong Pagar District. Archives of Ophthalmology, 118, 1105-1111. https://doi.org/10.1001/archopht.118.8.1105

  4. 4. Jiang, Y., Chang, D.S., Zhu, H., Khawaja, A.P., Aung, T., Huang, S., et al. (2014) Longitudinal Changes of Angle Configuration in Primary Angle-Closure Suspects: The Zhongshan Angle-Closure Prevention Trial. Ophthalmology, 121, 1699-1705. https://doi.org/10.1016/j.ophtha.2014.03.039

  5. 5. Holladay, J.T., Piers, P.A., Koranyi, G., van der Mooren, M. and Norrby, N.E. (2002) A New Intraocular Lens Design to Reduce Spherical Aberration of Pseudophakic Eyes. Journal of Refractive Surgery, 18, 683-691. https://doi.org/10.3928/1081-597X-20021101-04

  6. 6. Razeghinejad, M.R. and Myers, J.S. (2018) Contemporary Approach to the Diagnosis and Management of Primary Angle-Closure Disease. Survey of Ophthalmology, 63, 754-768. https://doi.org/10.1016/j.survophthal.2018.05.001

  7. 7. Mansoori, T. and Balakrishna, N. (2017) Anterior Segment Morphology in Primary Angle Closure Glaucoma Using Ultrasound Biomicroscopy. Journal of Current Glaucoma Practice, 11, 86-91. https://doi.org/10.5005/jp-journals-10028-1230

  8. 8. Henzan, I.M., Tomidokoro, A., Uejo, C., Sakai, H., Sawaguchi, S., Iwase, A., et al. (2011) Comparison of Ultrasound Biomicroscopic Configurations among Primary Angle Closure, Its Suspects, and Nonoccludable Angles: The Kumejima Study. American Journal of Ophthalmology, 151, 1065-1073.e1. https://doi.org/10.1016/j.ajo.2010.11.030

  9. 9. Bezzina, A.M. (1992) Ultrasound Biomicroscopy of Anterior Segment Structures in Normal and Glaucomatous Eyes. American Journal of Ophthalmology, 114, 516-517. https://doi.org/10.1016/S0002-9394(14)71878-1

  10. 10. 沈琳, 王霄娜, 李栋军, 王子杨, 陈伟, 赵琦, 等. 扫频源前节相干光层析成像术与超声生物显微镜测量老年性白内障患者眼前节参数的一致性分析[J]. 中华眼科杂志, 2018, 54(9): 678-682.

  11. 11. 缪娜, 唐雪林, 黄永志, 李汭澧, 范玮. 超声生物显微镜对白内障患者术前晶状体悬韧带的观察研究[J]. 华西医学, 2016, 31(12): 1995-1999.

  12. 12. Tello, C., Liebmann, J., Potash, S.D., Cohen, H. and Ritch, R. (1994) Measurement of Ultrasound Biomicroscopy Images: Intraobserver and Interobserver Reliability. Investigative Ophthalmology & Visual Science, 35, 3549-3552.

  13. 13. Jiang, Y., He, M., Huang, W., Huang, Q., Zhang, J. and Foster, P.J. (2010) Qualitative Assessment of Ultrasound Biomicroscopic Images Using Standard Photographs: The Liwan Eye Study. Investigative Ophthalmology & Visual Science, 51, 2035-2042. https://doi.org/10.1167/iovs.09-4145

  14. 14. Kwon, J., Sung, K.R., Han, S., Moon, Y.J. and Shin, J.W. (2017) Subclassification of Primary Angle Closure Using Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopic Parameters. Ophthalmology, 124, 1039-1047. https://doi.org/10.1016/j.ophtha.2017.02.025

  15. 15. Subbiah, S., Thomas, P.A. and Nelson Jesudasan, C.A. (2017) Comparison of Ultrasound Biomicroscopy and Ultrasonographic Parameters in Eyes with Phacomorphic Glaucoma and Eyes with Mature Cataract. International Ophthalmology, 37, 849-858. https://doi.org/10.1007/s10792-016-0343-z

  16. 16. 梁雄姿, 彭华琮, 裘俊, 彭祎琳, 轩凤霞, 吴岚. 原发性闭角型青光眼合并晶体悬韧带松弛的超声生物显微镜观察[J]. 中国社区医师, 2019, 35(2): 127-128+132.

  17. 17. Sihota, R., Ghate, D., Mohan, S., Gupta, V., Pandey, R.M. and Dada, T. (2008) Study of Biometric Parameters in Family Members of Primary Angle Closure Glaucoma Patients. Eye, 22, 521-527. https://doi.org/10.1038/sj.eye.6702687

  18. 18. Sihota, R., Lakshmaiah, N.C., Agarwal, H.C., Pandey, R.M. and Titiyal, J.S. (2000) Ocular Parameters in the Subgroups of Angle Closure Glaucoma. Clinical & Experimental Ophthalmology, 28, 253-258. https://doi.org/10.1046/j.1442-9071.2000.00324.x

  19. 19. Quigley, H.A., Congdon, N.G. and Friedman, D.S. (2001) Glaucoma in China (and Worldwide): Changes in Established Thinking Will Decrease Preventable Blindness. British Journal of Ophthalmology, 85, 1271-1272. https://doi.org/10.1136/bjo.85.11.1271

  20. 20. Sihota, R., Gupta, V., Agarwal, H.C., Pandey, R.M. and Deepak, K.K. (2000) Comparison of Symptomatic and Asymptomatic, Chronic, Primary Angle-Closure Glaucoma, Open-Angle Glaucoma, and Controls. Journal of Glaucoma, 9, 208-213. https://doi.org/10.1097/00061198-200006000-00002

    21. NOTES

    *通讯作者Email: yankejiang@126.com

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