晶状体半脱位继发急性闭角型青光眼误诊中的眼部表现。
Ocular manifestations for misdiagnosing acute angle closure secondary to lens subluxation.
作者信息
Wang Xinyu, Wang Qian, Song Wenqi, Yang Yu, Zhang Ruixuan, Lifen Gao, Lu Hui
机构信息
Zibo Central Hospital, Zibo, Shandong, China.
出版信息
Front Med (Lausanne). 2024 Oct 7;11:1410689. doi: 10.3389/fmed.2024.1410689. eCollection 2024.
INTRODUCTION
The objective of this study was to assess the clinical characteristics and biometric parameters, as measured by the IOLMaster, of patients suffering from acute secondary angle closure due to zonular dialysis (ASAC-ZD) who were misdiagnosed with acute primary angle closure (APAC).
METHODS
In this retrospective study, 34 ASAC-ZD and 39 APAC eyes were examined. Sex, age, best-corrected visual acuity, axial length (AL), anterior chamber depth (ACD), anterior chamber depth standard deviation (ACDSD), lens thickness (LT), and lens thickness standard deviation (LTSD) were measured using the IOLMaster and compared between the two groups. In addition, the difference in ACD (ACD difference) between the affected eye and the contralateral eye was analyzed. Logistic regression analysis was performed to determine the predictive factors of lens subluxation. To determine the appropriate cutoff values for biometric parameters, ROC curves were constructed to distinguish between ASAC-ZD, APAC, and cataracts.
RESULTS
Compared to the APAC group, the ASAC-ZD group was younger (69.92 ± 9.345, 63.74 ± 6.947), had longer AL (22.39 ± 0.7852, 23.23 ± 1.168), shallower ACD (2.120 ± 0.2986, 1.889 ± 0.5167), higher ACDSD (7.605 ± 5.425, 9.941 ± 6.120), higher LTSD (28.00 ± 19.52, 39.79 ± 22.74), and larger ACD differences (-0.1249 ± 0.2349, -0.7306 ± 0.5332) in the affected eye. Younger age, longer AL, lower ACD, higher LTSD, and higher ACD differences were associated with lens subluxation in the univariate logistic regression analysis. ACD difference ( = 0.0003), age ( = 0.0024), and ACD ( = 0.0491) were significantly associated with lens subluxation in the multivariable logistic regression analysis. Furthermore, the ROC curve analysis showed that the cutoff values for lens subluxation were a difference in ACD of 0.225 mm and 1.930 mm.
CONCLUSION
Asymmetric ACD in both eyes with normal AL and increasing ACDSD and LTSD may support the clinical diagnosis of lens subluxation.
引言
本研究的目的是评估因晶状体悬韧带断裂导致急性继发性闭角型青光眼（ASAC-ZD）却被误诊为急性原发性闭角型青光眼（APAC）的患者的临床特征和生物测量参数（通过IOLMaster测量）。
方法
在这项回顾性研究中，对34只ASAC-ZD眼和39只APAC眼进行了检查。使用IOLMaster测量性别、年龄、最佳矫正视力、眼轴长度（AL）、前房深度（ACD）、前房深度标准差（ACDSD）、晶状体厚度（LT）和晶状体厚度标准差（LTSD），并在两组之间进行比较。此外，分析患眼与对侧眼之间的ACD差异（ACD差值）。进行逻辑回归分析以确定晶状体半脱位的预测因素。为了确定生物测量参数的合适截断值，构建ROC曲线以区分ASAC-ZD、APAC和白内障。
结果
与APAC组相比，ASAC-ZD组年龄更小（69.92±9.345，63.74±6.947），AL更长（22.39±0.7852，23.23±1.168），ACD更浅（2.120±0.2986，1.889±0.5167），ACDSD更高（7.605±5.425，9.941±6.120），LTSD更高（28.00±19.52，39.79±22.74），患眼的ACD差值更大（-0.1249±0.2349，-0.7306±0.5332）。在单因素逻辑回归分析中，年龄较小、AL较长、ACD较低、LTSD较高和ACD差值较大与晶状体半脱位相关。在多因素逻辑回归分析中，ACD差值（=0.0003）、年龄（=0.0024）和ACD（=0.0491）与晶状体半脱位显著相关。此外，ROC曲线分析表明，晶状体半脱位的截断值为ACD差值0.225mm和1.930mm。
结论
双眼AL正常但ACD不对称以及ACDSD和LTSD增加可能支持晶状体半脱位的临床诊断。
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