Tzamalis Argyrios, Pham Duy-Thoai, Wirbelauer Christopher
Department of Ophthalmology, Vivantes Klinikum Neukölln, Berlin, Germany,
Jpn J Ophthalmol. 2014 May;58(3):252-60. doi: 10.1007/s10384-013-0301-5. Epub 2014 Feb 6.
The aim of this study was to assess the possibility of discriminating a narrow and occludable chamber angle by means of digital gonioscopy.
In a prospective controlled clinical study 40 eyes of 40 patients were enrolled. 20 patients that had suffered acute angle closure glaucoma (ACG) on the fellow eye were compared to 20 patients with open angle glaucoma (OAG). Anterior segment imaging with SL-OCT (Heidelberg Engineering, Heidelberg, Germany) enabled the delineation, by means of automatic signal analysis, of several important parameters of the anterior chamber angle region, which were compared to those revealed from direct contact glass gonioscopy and ultrasound biometry.
The anterior segment structures were automatically recognized by the SL-OCT software in 70 % of the ACG patients and in all of the OAG cases (100 %) (p = 0.025). Anterior chamber angle (ACA) was 15.55° ± 6.92° in the ACG group and 34.6° ± 8.9° in the OAG group, whereas angle opening distance (AOD) was 199.55 ± 62.29 μm in ACG and 452.67 ± 123.91 μm in OAG. A good correlation was found in the direct gonioscopic findings (r = 0.85, p < 0.001), but there were significant differences between both groups (p < 0.001). Mean real central anterior chamber depth (rACD) was evaluated to be 1.75 and 2.79 mm in ACG and OAG, respectively, showing a significant difference (p < 0.0001) and the highest (although not statistically significant) sensitivity and specificity above all other parameters tested in discriminating between OAG and ACG eyes. Discrimination criteria revealed a relevant narrowing of the anterior chamber angle region for values below 22° (ACA), 276 μm (AOD) and 2.08 mm (rACD).
Digital gonioscopy by means of SL-OCT allowed a non-invasive and objective imaging of the anterior chamber configuration that could be used as a screening method for narrow and occludable angles. The method could contribute to a timely identification of angle closure and alert clinicians to further determine whether a peripheral iridotomy should be performed.
本研究旨在评估通过数字前房角镜检查鉴别狭窄且可闭合房角的可能性。
在一项前瞻性对照临床研究中，纳入了40例患者的40只眼睛。将20例对侧眼曾患急性闭角型青光眼（ACG）的患者与20例开角型青光眼（OAG）患者进行比较。使用SL-OCT（德国海德堡海德堡工程公司）进行眼前节成像，通过自动信号分析能够勾勒出前房角区域的几个重要参数，并与直接接触式玻璃前房角镜检查和超声生物测量所显示的参数进行比较。
SL-OCT软件在70%的ACG患者和所有OAG病例（100%）中自动识别出眼前节结构（p = 0.025）。ACG组的前房角（ACA）为15.55°±6.92°，OAG组为34.6°±8.9°，而ACG组的房角开放距离（AOD）为199.55±62.29μm，OAG组为452.67±123.91μm。直接前房角镜检查结果显示出良好的相关性（r = 0.85，p < 0.001），但两组之间存在显著差异（p < 0.001）。ACG组和OAG组的平均实际中央前房深度（rACD）分别评估为1.75和2.79mm，显示出显著差异（p < 0.0001），并且在鉴别OAG和ACG眼的所有其他测试参数中，rACD具有最高（尽管无统计学意义）的敏感性和特异性。鉴别标准显示，当ACA低于22°、AOD低于276μm和rACD低于2.08mm时，前房角区域存在明显变窄。
通过SL-OCT进行数字前房角镜检查能够对前房结构进行非侵入性客观成像，可作为狭窄和可闭合房角的筛查方法。该方法有助于及时识别房角关闭情况，并提醒临床医生进一步确定是否应进行周边虹膜切开术。
