正常人群暗室激发试验中瞳孔对前房形态变化的影响

Influence of pupil on anterior chamber morphology change after darkroom provocative test in healthy subjects

摘要:

目的：观察正常人群暗室激发试验及联合缩瞳前后眼压、前房形态的变化。

方法：前瞻性系列病例研究。研究对象为20～35岁的健康受试者30例60眼。所有受试时间均在10：00～12：00进行。首次试验：受试者位于暗室，反坐于椅子上，头低俯在椅背上1h，受试前后测量眼压，Pentacam测量眼前节参数； 缩瞳后试验：毛果芸香碱缩瞳后进行二次暗室激发试验，收集前后眼压及眼前节参数，将数据进行分析对比。

结果：首次试验：受试后眼压显著升高(P=0.000)，瞳孔直径明显缩小(P=0.000)，差异显著有统计学意义； 前房容积缩小(P=0.008)，前房角度增宽(P=0.017)，差异有统计学意义； 中央前房深度无变化(P=0.261)，差异无统计学意义。缩瞳后试验：受试后眼压升高、前房容积缩小、前房角度变窄、中央前房深度变浅(P=0.000)，差异显著有统计学意义； 瞳孔直径无变化(P=0.193)，差异无统计学意义。缩瞳前后眼压变化不明显(P=0.21)，差异无统计学意义； 前房容积变小(P=0.002)，差异有统计学意义； 前房角度变窄、中央前房深度、瞳孔直径明显缩小(P=0.000)，差异显著有统计学意义。

结论：前房容积减少、前房角变窄是暗室激发试验阳性的基础； 毛果芸香碱使房角变宽，是其降眼压解剖基础之一； Pentacam测量眼前节参数分析中要考虑瞳孔造成的误差。

Abstract:

AIM: To observe intraocular pressure(IOP)and anterior chamber of healthy subjects by use of miotic in darkroom provocative test.

METHODS: Series of cases were prospectively analyzed. Thirty healthy cases(60 eyes)aged 25～35 years-old were the objects of study. All tests were performed from 10:00 a.m.～12:00 a.m. All subjects were sitted 1h in the chairs opposite to let head bend down at the back of chair for 1h in the first test. IOP and anterior segment paramater were measured by Pentacam before and after darkroom provocative test. The second test was repeated by use of pilocarpine as the above, and the data was compared with that of the previous test.

RESULTS:IOP was increased significantly than before(P=0.000), pupil size(P=0.000), anterior chamber volume reduced(P=0.008)and anterior chamber angle was widened(P=0.017)which were significant difference in the first test. But central anterior chamber depth was not siginificant(P=0.261). IOP, anterior segment volume, anterior chamber angle and central anterior chamber depth were significant difference(P=0.000)in the second test. But there was no siginificant dfifference for pupil size(P=0.193). By use of pilocarpine anterior chamber volume(P=0.002), anterior chamber angle, central anterior chamber depth and pupil size were significant difference(P=0.000). IOP was not siginificant(P=0.21).

CONCLUSION:Reduced anterior chamber volume and narrowed anterior chamber angle are the basis of positive darkroom provocative test. Pilocarpine can make anterior chamber angle widened and make it possible to decrease IOP. Physician should take pupil size into account when measure anterior segment paramater by Pentacam.