Changes Of Optic Disc Parameters After Remission From A Major Attack Of Acute Angle-closure Glaucoma

BackgroundGlaucoma is recognized as an irreversible blinding disease in the world.The optic nerve head and its deep tissue are the basis of the development of glaucoma.The optic nerve head and deep tissue have been extensively studied.However,due to limited conditions,most of the previous studies were in vitro models.With the development of optical coherence tomography(OCT)and the introduction of spectral-domain optical coherence tomography(SD-OCT),high resolution images can be quickly captured.In particular,spectral-domain optical coherence tomography(SD OCT)with the enhanced depth technique makes the deep tissue of living optic nerve head became a hot spot.At present,most of the researches on the deep tissue of optic nerve head at home and abroad are about primary open-angle glaucoma,and there is a lack of research on the deep tissue of optic disc of primary angle-closure glaucoma,especially on the long-term morphology after the control of intraocular pressure in primary acute angle-closure glaucoma.ObjectivesIn this study,spectral-domain optical coherence tomography(SD-OCT)with enhanced depth imaging(EDI)technology were used to obtain the parameters of the optic nerve head 1 year after the operation.The morphological changes of the optic nerve head of APACG patients and the age-related cataract of the contralateral preclinical eyes were compared and analyzed,and the factors affecting the optic nerve parameters were determined to provide a basis for the preoperative intervention and treatment of glaucoma patients.MethodsThis thesis collects 30 patients with acute primary angle closure glaucoma,who is hospitalized in our hospital during January 2016 to January 2017,12 males,18 females.Divides their eyes into two groups,the ictal ones as the observation group and the others as the control group.At the same time,40 cases(45 eyes)of age-related cataracts hospitalized at the same period,19 males(22 eyes)and 21 females(23 eyes)were selected as the blank control group.Using spectral-domain optical coherence tomography(SD-OCT)gets the parameters of optic disc before and after the surgery,select central level optic nerve parameters and then manually measured by a clinician using Heidelberg Eye Explorer software(version 1.7.1.0,Heidelberg,Germany).Statistical analysis was performed using spss20.0.Results1.A total of 30 cases of APACG monocular first major attack patients and 40 cases of age related cataract patients were collected,including 30 eyes in the observation group,30 eyes in the contralateral group,and 45 eyes in the blank group.During the great attack,the mean intraocular pressure of the affected eyes was 45.2mmHg(30 ~ 60 mmHg),and the duration of the acute great attack was 3 ~ 130 h,with an average of 50.5h,19 patients underwent periiridotomy and 11 patients underwent external trabeculectomy.2.The study group was followed up preoperatively,1 month,3 months,6 months,and 1a postoperatively,and it was found that the prelaminar tissue thickness of the study group were higher than the level of BMO before and 1 month after surgery,and began to decline 3 months after the surgery,and tended to be stable 6 months after the surgery.The lamina thickness?the width of the minimum rim along the side of the nose and the width of the minimum rim of the temporal decreased gradually from 1 month after surgery to 6 months after surgery.3.Pairwise paired t-test was performed on the measurement results of the study group,control group and blank control group 1a after surgery and the results showed that there was no significant difference in optic nerve head parameters between the contralateral group and the blank contralateral group.Compared with the contralateral group,the optic cup of the study group becomes wider,and the thickness of the lamina cribiosa and the tissue in front of the lamina cribiosa become thinner.The difference is statistically significant(p<0.05).Whose open angle is less than 180 degrees are more obvious.4.Some relevant analysis shows that gender was related to BMO?cup width?cup depth? anterior lamina cribrosa surface depth,the eye axis was related to cup depth?anterior lamina cribrosa surface depth,while age and preoperative anterior chamber puncture was not related to the parameters of the optic nerve head parameters.Stepwise linear regression analysis was performed for all influencing factors.The time of the increase of the intraocular pressure at the time of the mager attack was an independent factor affecting lamina thickness?the width of the minimum rim along the side of the nose and the width of the minimum rim of the temporal 1 year after surgery,the degree of the increase of the intraocular pressure at the time of the mager attack was an independent factor affecting prelaminar tissue thickness ?lamina thickness?the width of the minimum rim along the side of the nose and the width of the minimum rim of the temporal 1 year after surgery.Conclusion1.The parameters of the optic disc in the mager attack eyes of APACG were stable 6 months after surgery.2.The optic cup of the mager attack eye becomes wider,and the thickness of the lamina cribiosa and the tissue in front of the lamina cribiosa become thinner 1year after surgery.The difference is statistically significant.Whose open angle is less than 180 degrees are more obvious.3.The time of the increase of the intraocular pressure at the time of the mager attack and the intraocular pressure at the time of the mager attack were independent factors affecting optic disc parameters 1 year after surgery.