Yan Yu-jie, Wu Ling-ling, Wang Xin, Xiao Ge-ge
Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, People's Republic of China Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, People's Republic of China.
Department of Ophthalmology, Peking University Third Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, People's Republic of China.
Invest Ophthalmol Vis Sci. 2014 Oct 16;55(12):8506-12. doi: 10.1167/iovs.14-14426.
To determine the prevalence of appositional angle closure (AAC) after laser peripheral iridotomy (LPI) in the eyes of Chinese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and to evaluate its pathogenesis by investigating anatomic characteristics.
This was a cross-sectional observational study. PAC and PACG subjects were consecutively enrolled after LPI. Ultrasound biomicroscopy (UBM) images, obtained in darkness, of each quadrant without peripheral anterior synechia (PAS) under gonioscopy were qualitatively assessed. Darkroom provocative test (DRPT) was also performed.
A total of 134 eyes of 134 patients were enrolled. AAC was observed in ≥ 1 quadrant of UBM image in 85 subjects (63.4%). There were 116 randomly selected quadrants without PAS for 134 patients (86.6%). AAC existed in 38 quadrants (32.8%). Among these, plateau iris accounted for 44.7%, anteriorly inserted iris for 13.2%, thick iris for 13.2%, and anteriorly inserted iris combined with thick iris for 18.4% of the total. One hundred fifteen patients underwent DRPT and its positive rate of eyes with AAC ≥ 2 quadrants (37.5% [12 of 32 patients]) was significantly higher than those ≤ 1 quadrant (16.9% [14 of 83 patients]; P = 0.018). However, no significant differences were found between eyes with nonsynechia plateau iris ≥ 2 quadrants (36.4% [4 of 11 patients]) and those ≤ 1 quadrant (21.2% [22 of 104 patients]; P = 0.266).
Approximately two-thirds of PAC and PACG eyes of Chinese patients after LPI had AAC. Plateau iris accounted for less than 50% of AAC. Other factors such as a thick peripheral iris and an anteriorly inserted iris also contributed to AAC. DRPT results suggested AAC might have more functional meaning than plateau iris.
确定中国原发性房角关闭（PAC）和原发性房角关闭型青光眼（PACG）患者行激光周边虹膜切开术（LPI）后并发性房角关闭（AAC）的患病率，并通过研究解剖特征评估其发病机制。
这是一项横断面观察性研究。LPI术后连续纳入PAC和PACG受试者。对在暗室中获得的、房角镜检查下无周边前粘连（PAS）的每个象限的超声生物显微镜（UBM）图像进行定性评估。还进行了暗室激发试验（DRPT）。
共纳入134例患者的134只眼。85例受试者（63.4%）的UBM图像中≥1个象限观察到AAC。134例患者中有116个随机选择的无PAS的象限（86.6%）。38个象限（32.8%）存在AAC。其中，高褶虹膜占总数的44.7%，虹膜前位插入占13.2%，虹膜肥厚占13.2%，虹膜前位插入合并虹膜肥厚占18.4%。115例患者接受了DRPT，AAC≥2个象限的眼的阳性率（37.5%[32例患者中的12例]）显著高于≤1个象限的眼（16.9%[83例患者中的14例]；P = 0.018）。然而，非粘连性高褶虹膜≥2个象限的眼（36.4%[11例患者中的4例]）与≤1个象限的眼（21.2%[104例患者中的22例]）之间未发现显著差异（P = 0.266）。
中国患者LPI术后约三分之二的PAC和PACG眼存在AAC。高褶虹膜占AAC的比例不到50%。其他因素如周边虹膜肥厚和虹膜前位插入也促成了AAC。DRPT结果表明，AAC可能比高褶虹膜具有更多的功能意义。
