摘要
目的探讨闭角型青光眼(ACG)患者隐匿性晶状体悬韧带异常的发生情况和晶状体悬韧带异常的相关危险因素。方法病例对照研究。连续收集2020年11月1日至2021年10月31日在首都医科大学附属北京同仁医院北京同仁眼科中心拟接受超声乳化晶状体摘除人工晶状体植入联合房角分离术(简称青白联合术)的ACG患者(ACG组, 包括急性ACG亚组和慢性ACG亚组)及同期拟接受超声乳化白内障摘除人工晶状体植入术的年龄相关性白内障患者(对照组)。根据术中连续环形撕囊时前囊膜是否出现皱褶等体征确定晶状体悬韧带异常状况, 记录并比较组间和亚组间隐匿性晶状体悬韧带异常(术前未能诊断)的比例及术前诊断率(非晶状体摘除术中诊断率)、晶状体悬韧带异常的比例、人口学特征、中央前房深度(ACD)、眼轴长度、双眼ACD的差值(对侧眼ACD减去研究眼ACD), 分析相关危险因素。采用双侧t检验(正态分布数据两组间比较)、非参数检验(非正态分布数据两组间比较)、χ2检验(分类变量)、单因素和多因素Logistic回归分析法进行统计学分析。结果 ACG患者(ACG组)104例(104只眼), 其中急性ACG患者63例(63只眼), 慢性ACG患者41例(41只眼);年龄相关性白内障患者(对照组)117例(117只眼)。两组年龄(P=0.29)和性别(P=0.07)差异无统计学意义;与对照组比较, ACG组ACD更浅(P<0.001), 眼轴长度更短(P<0.001), 双眼ACD差值更大(P<0.001)。ACG组晶状体悬韧带异常比例为46.2%(48/104), 明显高于对照组6.0%(7/117), 差异有统计学意义(P<0.001)。对照组全部为晶状体悬韧带松弛;ACG组以晶状体悬韧带松弛为主, 占68.8%(33/48), 断裂占31.3%(15/48)。急性ACG亚组晶状体悬韧带异常比例为57.1%(36/63), 明显高于慢性ACG亚组的29.3%(12/41)(P=0.006)。ACG组中术前根据裂隙灯显微镜和(或)超声生物显微镜检查诊断晶状体悬韧带异常14例, 隐匿性晶状体悬韧带异常占70.8%(34/48)。ACD≤2.0 mm的急性ACG患者及ACD≤1.9 mm的慢性ACG患者全部合并晶状体悬韧带异常。多元Logistic回归结果显示, 双眼ACD差值大(P=0.025)和ACG类型(与对照组比较, 急性ACG的P<0.001;慢性ACG的P=0.023)与晶状体悬韧带异常相关。结论隐匿性晶状体悬韧带异常在ACG患者中发生比例较高, 临床有待寻找更为有效的非晶状体摘除术中诊断方法。在ACG患者尤其急性ACG患者中, 晶状体悬韧带异常患者不少见, 提示晶状体悬韧带异常可能与ACG的发病机制有关。ACD越小, 晶状体悬韧带异常的发生风险越大, 双眼ACD差值大、急性和慢性ACG类型是晶状体悬韧带异常的相关危险因素。(本文于2022年3月11日优先出版在中华医学会杂志社优秀科研成果优先出版平台)
Objective To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma(ACG)patients and to explore the related risk factors.Methods Case-control study.Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery[ACG group,including acute angle closure glaucoma(AACG)and chronic angle closure glaucoma(CACG)]from November 1,2020 to October 31,2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period(control group)were included.The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis.The proportion of zonulopathy,preoperative diagnosis rate of zonulopathy,demographic characteristics,anterior chamber depth(ACD),axis length,difference of ACD in both eyes(ACD of the contralateral eye minus ACD of the operated eye)were compared between the two groups.The related risk factors were explored.The paired t-test(comparison between two groups of normally distributed data),non-parametric test(comparison between two groups of non-normally distributed data),Chi-square test(categorical variables),univariate and multivariate logistic regression analysis were used.Results There were 104 ACG patients(104 eyes),including 63 AACG patients(63 eyes)and 41 CACG patients(41 eyes),and 117 controls(117 eyes).There was no significant difference in age(P=0.29)and gender(P=0.07)between the two groups.The ACG group had shallower anterior chamber(P<0.001),shorter axial length(P<0.001)and more ACD difference in both eyes(P<0.001).In the ACG group,the proportion of zonulopathy was 46.2%(48/104),which was significantly higher than that(6.0%,7/117)in the control group(P<0.001).In the control group,only zonular laxity was found,while in the ACG group,besides the predominant zonular laxity(68.8%,33/48),there was zonular dehiscence(31.3%,15/48).The eyes with AACG(57.1%,36/63)had a higher proportion of zonulopathy than those with CACG(29.3%,12/41)(P=0.006).In the ACG group,only 14 cases(29.8%)were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy.The proportion of underdiagnosed zonulopathy was 70.8%in the ACG group(34/48).A smaller ACD was found to be related to the zonulopathy in the ACG group.All AACG cases with an ACD≤2.0 mm and CACG cases with an ACD≤1.9 mm had zonulopathy.Multivariate logistic regression showed that the ACD difference in both eyes(P=0.025)and the diagnosis of ACG(AACG vs.cataract,P<0.001;CACG vs.cataract,P=0.023)were independent risk factors associated with zonulopathy.Conclusions The proportion of underdiagnosed zonulopathy among ACG patients is high.Better preoperative diagnostic methods for zonulopathy are needed.Zonulopathy is common in ACG patients,especially in AACG patients,suggesting that zonulopathy may be related to the pathogenesis of ACG.The shallower the ACD,the riskier the zonulopathy.ACD differences between two eyes and ACG types(including AACG and CACG)were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11,2022)
作者
乔春艳
张慧
张烨
张烁
李栋军
宋旭东
杨一佺
王晓飞
姚宁
陈琛
王立肖
刘莛
郭倩
蔺涛
曹凯
梁静
王宁利
Qiao Chunyan;Zhang Hui;Zhang Ye;Zhang Shuo;Li Dongjun;Song Xudong;Yang Yiquan;Wang Xiaofei;Yao Ning;Chen Chen;Wang Lixiao;Liu Ting;Guo Qian;Lin Tao;Cao Kai;Liang Jing;Wang Ningli(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Ophthalmology&Visual Science Key Lab,Beijing Ophthalmic Institute,Beijing 100730,China;Key Laboratory of Biomechanics and Mechanobiology,Ministry of Education,Beijing Advanced Innovation Center for Biomedical Engineering,School of Biological Science and Medical Engineering,Beihang University,Beijing 100083,China)
出处
《中华眼科杂志》
CAS
CSCD
北大核心
2022年第11期872-881,共10页
Chinese Journal of Ophthalmology
