Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Ophthalmol. 2024 Oct;38(5):342-353. doi: 10.3341/kjo.2024.0014. Epub 2024 Aug 16.
To compare changes in the swept-source (SS) anterior-segment optical coherence tomography (AS-OCT) parameters and intraocular pressure (IOP) control after lens extraction in various spectra of primary angle-closure disease (PACD).
A total 92 eyes from 92 patients with PACD who underwent lens extraction were included in the study. All patients underwent IOP measurement preoperatively and at 1 day, 1 week, and 1, 3, and 6 months postoperatively. SS AS-OCT was performed in all subjects preoperatively and 1 month postoperatively. All participants were divided into two groups depending on the presence of glaucomatous optic disc or visual field damage (group A, PAC suspect or PAC; group B, PAC glaucoma). The changes in IOP and anterior chamber angle parameters of SS AS-OCT of each group were compared. Regression analysis was performed to find factors associated with the degree of IOP reduction after lens extraction.
Preoperatively, there was no significant difference in IOP between the two groups (16.3 ± 2.5 mmHg vs. 16.9 ± 3.2 mmHg, p = 0.297), but the number of glaucoma medications used was greater in group B (0.6 ± 1.0 vs. 2.0 ± 0.9, p < 0.001). Postoperatively, IOP was not significantly different, but the number of medications used was greater in group B (0.2 ± 0.7 vs. 0.9 ± 0.8, p < 0.001). Anterior chamber angle parameters including angle opening distance and trabecular-iris angle had a greater increase in group B after lens extraction. However, the residual iridotrabecular contact (ITC) index was significantly greater in group B (5.6 ± 7.0 vs 10.7 ± 12.1, p = 0.014). A greater change in the ITC index was related to a greater degree of IOP reduction (β coefficient, 0.429; p < 0.001).
Eyes with PAC glaucoma had a greater residual ITC index after lens extraction compared with eyes of other PACD spectrum and required a greater number of glaucoma medications to maintain a similar level of IOP.
比较原发性闭角型青光眼（PAC）不同谱患者晶状体摘除术后眼前节光学相干断层扫描（AS-OCT）参数和眼压（IOP）的变化。
本研究共纳入 92 例 92 只眼 PAC 患者，均接受晶状体切除术。所有患者术前及术后 1d、1 周、1、3、6 个月行 IOP 测量。所有患者术前和术后 1 个月行 SS AS-OCT 检查。所有患者根据是否存在青光眼性视盘或视野损害分为两组（A 组：PAC 可疑或 PAC；B 组：PAC 青光眼）。比较两组患者的 SS AS-OCT 前房角参数和 IOP 的变化。采用回归分析寻找与晶状体切除术后 IOP 降低程度相关的因素。
术前两组患者的 IOP 差异无统计学意义（16.3±2.5mmHg 比 16.9±3.2mmHg，p=0.297），但 B 组患者使用的青光眼药物数量较多（0.6±1.0 比 2.0±0.9，p<0.001）。术后两组患者的 IOP 差异无统计学意义，但 B 组患者使用的药物数量较多（0.2±0.7 比 0.9±0.8，p<0.001）。晶状体切除术后，B 组患者的前房角参数（包括房角开口距离和小梁虹膜角）增加幅度较大。然而，B 组患者的残余虹膜小梁接触（ITC）指数明显较大（5.6±7.0 比 10.7±12.1，p=0.014）。ITC 指数的变化与 IOP 降低的程度相关（β系数，0.429；p<0.001）。
与其他 PAC 谱的患者相比，PAC 青光眼患者晶状体切除术后残余 ITC 指数较高，需要更多的青光眼药物来维持相似的 IOP 水平。
