前房角镜检查性房角关闭眼中虹膜小梁接触情况的评估

Assessment of Iris Trabecular Contact in Eyes with Gonioscopic Angle-Closure.

作者信息

Zhang Xiulan, Guo Philip Yawen, Lin Chen, Li Fei, Nguyen Anwell, Sakata Rei, Higashita Risa, Okamoto Keiichiro, Yu Marco, Aihara Makoto, Aung Tin, Lin Shan, Leung Christopher Kai-Shun

机构信息

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, PRC.

Department of Ophthalmology, The University of Hong Kong, Hong Kong, PRC.

出版信息

Ophthalmology. 2023 Jan;130(1):111-119. doi: 10.1016/j.ophtha.2022.08.017. Epub 2022 Oct 27.

DOI:10.1016/j.ophtha.2022.08.017

PMID:36652194

Abstract

PURPOSE

To investigate the extent of iris trabecular contact (ITC) measured by anterior segment OCT (AS-OCT) and its association with primary angle-closure (PAC) and PAC glaucoma (PACG) in eyes with gonioscopic angle-closure and to determine the diagnostic performance of ITC for detection of gonioscopic angle-closure.

DESIGN

Multicenter, prospective study.

PARTICIPANTS

A total of 119 healthy participants with gonioscopic open-angle and 170 patients with gonioscopic angle-closure (94 with PAC suspect and 76 with PAC/PACG) were included.

METHODS

One eye of each subject was randomly selected for AS-OCT imaging. Angle-opening distance (AOD500) and trabecular iris space area (TISA500) were measured every 10° for 360°. Two criteria of ITC500 were examined: (1) AOD500 = 0 mm and (2) TISA500 = 0 mm. The association between the extent of ITC500 and PAC/PACG in eyes with gonioscopic angle-closure was analyzed with logistic regression analysis.

MAIN OUTCOME MEASURES

Sensitivity and specificity of ITC500 for detection of gonioscopic angle-closure; odds ratio (OR) of PAC/PACG.

RESULTS

The sensitivity of ITC500 ≥ 10° for detection of gonioscopic angle-closure ranged from 82.4% (AOD500 = 0 mm) to 84.7% (TISA500 = 0 mm), and the specificity was 85.7% (for both AOD500 = 0 mm and TISA500 = 0 mm). The extent of ITC500 determined by AS-OCT, not cumulative gonioscopy score (i.e., the sum of the modified Shaffer grades over 4 quadrants), was associated with the odds of PAC/PACG in eyes with gonioscopic angle-closure; the odds of PAC/PACG increased by 5% for every 10° increase in ITC500 (OR, 1.051, 95% confidence interval [CI], 1.022-1.080 for AOD500 = 0 mm; OR, 1.049, 95% CI, 1.022-1.078 for TISA500 = 0 mm). Axial length and anterior chamber depth were not associated with PAC/PACG in eyes with gonioscopic angle-closure (P ≥ 0.574).

CONCLUSIONS

A greater extent of ITC measured by AS-OCT, not angle-closure determined by gonioscopy, was associated with a greater odds of PAC/PACG in eyes with gonioscopic angle-closure.

摘要

目的

通过眼前节光学相干断层扫描（AS-OCT）研究虹膜小梁接触（ITC）的范围，及其与房角镜检查显示房角关闭的眼中原发性房角关闭（PAC）和PAC青光眼（PACG）的相关性，并确定ITC检测房角镜检查显示房角关闭的诊断性能。

设计

多中心前瞻性研究。

参与者

共纳入119名房角镜检查显示开角的健康参与者和170例房角镜检查显示房角关闭的患者（94例PAC可疑患者和76例PAC/PACG患者）。

方法

为每位受试者的一只眼睛随机选取进行AS-OCT成像。每10°测量360°的房角开放距离（AOD500）和小梁虹膜空间面积（TISA500）。检查ITC500的两个标准：（1）AOD500 = 0 mm和（2）TISA500 = 0 mm。采用逻辑回归分析，分析房角镜检查显示房角关闭的眼中ITC500范围与PAC/PACG之间的相关性。

主要观察指标

ITC500检测房角镜检查显示房角关闭的敏感性和特异性；PAC/PACG的比值比（OR）。

结果

ITC500≥10°检测房角镜检查显示房角关闭的敏感性范围为82.4%（AOD500 = 0 mm）至84.7%（TISA500 = 0 mm），特异性为85.7%（AOD500 = 0 mm和TISA500 = 0 mm两者）。AS-OCT确定的ITC500范围，而非累计房角镜检查评分（即4个象限改良Shaffer分级的总和），与房角镜检查显示房角关闭的眼中PAC/PACG的可能性相关；ITC500每增加10°，PAC/PACG的可能性增加5%（OR，1.051，95%置信区间[CI]，AOD500 = 0 mm时为1.022 - 1.080；OR，1.049，95% CI，TISA500 = 0 mm时为1.022 - 1.078）。眼轴长度和前房深度与房角镜检查显示房角关闭的眼中PAC/PACG无关（P≥0.574）。