Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, South Korea.
Am J Ophthalmol. 2018 Jul;191:54-63. doi: 10.1016/j.ajo.2018.04.005. Epub 2018 Apr 12.
To assess long-term changes in the anterior segment (AS) of eyes with different angle-closure mechanisms.
Retrospective cohort study.
In total, 133 eyes (from 75 participants) with angle closure were enrolled. All eyes received laser iridotomy (LI) during the follow-up period. Serial anterior segment optical coherence tomography (AS-OCT) imaging was performed during a mean follow-up of 4 years. Participants were categorized into 4 groups according to angle-closure mechanisms, based on baseline AS-OCT images: pupillary block (PB), plateau iris configuration (PIC), thick peripheral iris roll (TPIR), and exaggerated lens vault (ELV). Linear mixed-effect models were applied to evaluate the longitudinal changes in AS-OCT parameters (anterior chamber depth [ACD], lens vault [LV], and angle opening distance [AOD]).
Forty-six eyes (35%) were classified as PB, 30 (23%) as PIC, 34 (26%) as TPIR, and 23 (17%) as ELV. The follow-up period was 41-54 months. At baseline, ACD was shallowest in ELV, followed by PB, TPIR, and PIC, in order. The PIC group showed significantly wider AOD than the other groups at baseline. ACD decreased and LV increased over time in all groups, especially in the PIC group. After LI, the angle widened in the PB and TPIR groups, but not in the PIC and ELV groups.
AS parameters changed differently in the 4 groups. The effects of LI on AOD also differed among groups. Identification of the angle-closure mechanism may help predict progressive changes in AS parameters in eyes with angle closure.
评估不同类型闭角型青光眼眼前节（AS）的长期变化。
回顾性队列研究。
共纳入 133 只眼（75 名患者），均接受激光虹膜切开术（LI）治疗。所有患者在随访期间均接受了连续的眼前节光学相干断层扫描（AS-OCT）检查。平均随访 4 年后，根据基线 AS-OCT 图像，将患者分为 4 组：瞳孔阻滞（PB）、平坦型虹膜、虹膜膨隆（TPIR）和晶状体悬韧带（ELV）。采用线性混合效应模型评估 AS-OCT 参数（前房深度 [ACD]、晶状体悬韧带 [LV]和房角开放距离 [AOD]）的纵向变化。
46 只眼（35%）被分类为 PB，30 只眼（23%）为 PIC，34 只眼（26%）为 TPIR，23 只眼（17%）为 ELV。随访时间为 41-54 个月。在基线时，ELV 的 ACD 最浅，其次是 PB、TPIR 和 PIC。在基线时，PIC 组的 AOD 明显宽于其他组。所有组的 ACD 随时间减少，LV 随时间增加，尤其是 PIC 组。LI 后，PB 和 TPIR 组的房角增宽，但 PIC 和 ELV 组无此变化。
4 组的 AS 参数变化不同。LI 对 AOD 的影响也因组而异。确定闭角型青光眼的机制可能有助于预测闭角型青光眼患者眼前节参数的进展性变化。
