Clinical Observation Of The Choroidal Thickness In Primary Angle-closure Disease

Glaucoma is a irreversible blinding eye disease in the word,the morbidily is the first.Among them,primary angle-closure disease(PACD)is the most common type of glaucoma in China,accounting for about 47.5%.The pathogenesis has a close relationship with the abnormal anatomy of eyeball.The latest research reports that the choroid expansion is considered to be one of the pathogenesis of PACD.In recent years,with the improvement in eye equipment and ophthalmic technology,especially the emergence of the Enhanced depth imaging spectral—domain optical coherence tomography(EDI SD-OCT),it can expediently and clearly obtain the tomography of the choroid,and through the measurement of the patient to obtain the specific value of choroid thickness,and its dynamic changes can be observed.In this study,we analyzed the characteristics and changes of choroidal thickness in different types of PACD,and explored the role of choroid in the occurrence and development of primary angle closure.Objective:1 Investigate the different of choroidal thickness in patients with different subtypes of PACD,analyze the relationship between anterior chamber depth,axial length and choroidal thickness.2 Discuss the changes of choroidal thickness before and after operation in patients with primary angle-closure disease.3 Investigate the role of choroidal thickness in the development and progression of PACD.Methods:From the visits to the Department of Ophthalmology of the Second Hospirtal of Hebei Medical University between December 2015 to December 2016,155 eyes of 82 patients were diagnosed of PACD,including 24 eyes of 24 patients in primary angle-closure suspects,35 eyes of 28 patients in acute primary angle-closure,38 eyes of 30 patients in chronic primary angle-closure,58 eyes of 38 patients in primary angle-closure glaucoma.And 72 eyes of 72 age and healthy people were used for the control group.All the patient did the related medical records including age,sex,and medical history were collected.Eye examinations included best-corrected visual acuity(BCVA),intraocular pressure(IOP),slit lamp microscope,binocular indirect ophthalmoscope.The axial length and anterior chamber depth of the eyes were also measured by Intraoeular len master(IOL-Master).Choroidal thickness at the forea,1mm,3mm above,below,nasal to and temporal to the fovea and 1mm,2mm above,below,nasal to and temporal to the peripapillary were measured by EDI SD-OCT for both eyes.The 76 eyes of 55 patients in acute primary angle-closure and primary angle-closure glaucoma received operation treatment.And the affected eye was also examined by EDI SD-OCT at 7 days and 1 month after the surgery,and observed the choeoidal thickness.Results:1 SFCT and the choroidal thickness at other measurement points was different in every group.SFCT for primary angle-closure suspects(PACS)was 296.25±79.36μm,acute primary angle-closure(APAC)was 310.23±68.78μm,chronic primary angle-closure(CPAC)was 280.74 ± 64.34 μ m,primary angle-closure glaucoma(PACG)was 280.69±82.72μm,the normal control group was 232.19±72.21μm.Suggesting the subfoveal and different locations around the macular choroidal thickness were greater in the subtypes of PACD than the normal control group(all P<0.05).The SFCT and 1mm,3mm above,below,nasal to and temporal to the fovea were the greatest in the APAC group than the other subtypes of PACD,the PACG group was the thinnest.The mean macular CT was greatest at the subfovea in the subtypes of PACD and the normal control group.When the distance from the fovea was increased the choroidal thickness was decreased.There was significant difference between the APAC group and the other subtypes of PACD in the SFCT,but there was no significant difference among the PACS group,CPAC group and PACG group in the SFCT.2 The mean choroidal thickness at different location in peripapillary was different in every groupThe peripapillary choroidal thickness at all locations in the subtypes of PACD were thinner than the normal control group.However,none of the locations reached statistical significance.In the horizontal and vertical section,the subtypes of PACD and the normal control group showed a similar trend,when the distance from the optic disc was increased the choroidal thickness was increased.(P<0.05).3 The correlation analyze of the AL,ACD and SFCT of PACD:The negative correlation existed between the axial length and the subfoveal choroidal thickness(SFCT)of the PACD(r=-0.295,P=0.007),but no correlation was noted between SFCT and the anterior chamber depth(P>0.05).4 The eye of PACD patients SFCT and choroidal thickness at other measurement points before and after the surgery:Whether before the surgery or after the surgery,the mean macular CT was greatest at the subfovea,and when the distance from the fovea was increased the choroidal thickness was decreased.Before the surgery,the patients of PACD SFCT value was 281.76±63.51μm,7 days and 1 month after the surgery,the SFCT values were 318.41±75.48μm,and 295.89±66.25μm,respectively.The SFCT of 7 days and 1 month after the surgery were significantly increased compared to that of before the surgery(t1=﹣8.894,P1<0.001;t2=﹣2.032,P2=0.046).The SFCT of 1 month after the surgery was significantly decreased compared to 7 days after the surgery(t=3.384,P=0.001).5 The eye of PACD patients choroidal thickness at different location in peripapillary before and after the surgery:Whether before the surgery or after the surgery,when the distance from the optic disc was increased the choroidal thickness was increased at different location in peripapillary.The choroidal thickness at different locations in peripapillary of 7 days after the surgery was significantly increased compared to that of before the surgery(all P<0.05).The choroidal thickness at the 2mm above,1mm,2mm nasal to and 2mm temporal to the peripapillary of 1 month after the surgery were significantly increased compared to that of before the surgery(all P<0.05).The choroidal thickness at 2mm nasal to and 2mm temporal to the peripapillary of 1 month after the surgery were significantly decreased compared to 7 days after the surgery(all P<0.05).But there were no significant difference between 1 month after the surgery and 7 days after the surgery in the choroidal thickness at the 2mm above to and 1mm nasal to the peripapillary.Conclusions:1 The choroidal thickness was greater in patients with the PACS group,APAC group,CPAC group and PACG group than the normal control group,the difference was statistically significant.There was no significant difference in choroidal thickness between the different locations in peripapillary and the normal control group.2 The subfoveal and different locations around the macular choroidal thickness were greater in the APAC group than the other subtypes of PACD.3 The choroidal thickness was different at different locations in the subtypes of PACD and the normal control group.In the macular area,the SFCT was thickest,it decreased moving distally from the fovea.In the peripapillary area,the optic disc was the thinnest,the choroidal thickness increased moving distally from the optic disc.1 There was a negative correlation between the axial length of the PACD patients and the subfoveal choroidal thickness(SFCT),while the anterior chamber depth was not correlated with the SFCT.5 The mean choroidal thickness around the macular and peripapillary locations in the patients with PACD increased following the operation in the short term,but a month later,there had a downward trend for choroidal thickness.