| Objective For patients with primary angle closure suspect（PACS）and primary angle closure（PAC）,laser iridotomy（LPI）with argon laser peripheral iridoplasty（ALPI）was performed.The anterior segment and objective optical imaging quality parameters were measured by the Pentacam anterior segment analyzer system and OPD-Scan III aberrometer in preoperative and 1 week after operation,to observe the effect of laser surgery on the anterior segment and optical imaging quality.Methods A total of 36 eyes with PACS and PAC in the ophthalmology clinic of the Second Hospital of Lanzhou University were included as the research objects.The central anterior chamber depth（CACD）,peripheral anterior chamber depth（PACD）,anterior chamber volume（ACV）,mean anterior chamber angle（m ACA）,central corneal thickness（CCT）,corneal optical density,root mean square（RMS）corresponding to corneal aberrations and pupil diameter were observed by Pentacam before and 1 week after surgery.Use OPD-Scan Ⅲ to observe the photopic pupil diameter,mesopic pupil diameter,RMS value corresponding to wavefront aberration,the area ratio（AR）corresponding to modulation transfer function（MTF）curve,and the strehl ratio（SR）corresponding to point spread function（PSF）curve.SPSS25.0 software was used for statistical analysis,and paired samples t test was used to compare the related values before operation and 1 week after operation,and P<0.05 was considered statistically significant.Pearson test was used to test the correlation between age and pupil diameter,age and SR value,and P<0.05 was considered statistically significant.Results（1）Visual acuity: The visual acuity at 1 week after LPI with ALPI（0.63±0.30）had no significant change compared with preoperative（0.69±0.35）（P=0.052）.（2）Intraocular pressure: The intraocular pressure（14.33±2.96）mm Hg after LPI with ALPI was significantly lower than that before operation（16.67±3.10）mm Hg（P=0.000）.（3）Anterior chamber depth: preoperative CACD,superior PACD,inferior PACD,nasal PACD,and temporal PACD were:（1.81±0.29）mm,（0.76±0.28）mm,（1.06±0.28）mm,（0.82±0.26）mm,（1.08±0.29）mm,CACD,superior PACD,inferior PACD,temporal PACD and nasal PACD at 1 week after operation were:（1.86±0.29）mm,（0.96±0.28）mm,（1.27±0.27）mm,（1.03±0.24）mm,（1.31±0.28）mm.The anterior chamber depth in all directions at 1 week after LPI with ALPI was significantly higher than that before operation（P=0.000,P=0.000,P=0.000,P=0.000,P=0.000 respectively）.（4）ACV: LPI with ALPI at 1 week after surgery（79.70±20.57）mm3 was significantly higher than that before surgery（63.08±20.73）mm3（P=0.000）.（5）m ACA: The m ACA（24.97±4.49）°at 1 week after LPI with ALPI was significantly wider than that before surgery（23.22±5.94）°（P=0.015）.（6）CCT: The CCT（541.15±55.21）μm at 1 week after LPI with ALPI increased compared with the preoperative（533.41±45.01）μm（P=0.008）.（7）Corneal optical density: The optical density of the anterior corneal surface of the central,upper,lower,upper nasal,lower nasal,upper temporal,and lower temporal before surgery were:（21.17±2.21）,（23.47±3.72）,（20.11±3.46）,（22.95±3.14）,（21.24±2.64）,（20.60±2.22）,（19.96±3.32）,and the optical density of the anterior corneal surface of the central,upper,lower,upper nasal,lower nasal,upper temporal,and lower temporal at 1 week after operation were:（22.26±3.58）,（24.57±4.68）,（20.78±3.91）,（23.92±4.64）,（22.93±5.63）,（20.93±4.59）,（20.67±3.31）,the optical density of 7 points on the anterior surface of the cornea at 1 week after LPI with ALPI increased compared with that before operation.And 1 week after the operation,the optical density of the upper,upper nasal and lower nasal points increased compared with that before the operation,which was statistically significant（P=0.006,P=0.038,P=0.016 respectively）.There was no significant difference in corneal optical density on the posterior corneal surface of the cornea 1 week after LPI with ALPI compared with that before surgery（P>0.05）.（8）Corneal surface elevation: The surface elevation cornea front at 1 week after LPI with ALPI（177.53±6.47）μm was not significantly different from that before operation（177.65±6.58）μm（P=0.365）.The surface elevation cornea back（222.82±9.49）μm after LPI with ALPI was slightly increased compared with the preoperative（222.19±9.33）μm（P=0.013）.（9）RMS value of wavefront aberration: When using OPD-Scan III analysis,the pupil diameter was set to 3 mm,there was no statistical difference in the total ocular aberration（0.68±0.47）μm at 1 week after LPI with ALPI compared with the preoperative（0.58±0.49）μm（P=0.951）.There was no significant difference in intraocular aberration（0.61±0.47）μm at 1 week after LPI with ALPI compared with preoperative（0.61±0.52）μm（P=0.950）.When the pupil diameter was set to 4mm,the total ocular aberration at 1 week after LPI with ALPI was（1.08±0.98）μm compared with preoperative（1.00±0.84）μm,no statistical difference（P=0.395）.There was no significant difference in intraocular aberration of（1.23±1.05）μm after LPI with ALPI compared with preoperative（1.07±0.89）μm（P=0.214）.Corneal aberration measured by Pentacam,corneal aberration（2.44±1.82）μm at 1 week after LPI with ALPI had no significant change compared with preoperative（2.39±1.68）μm（P=0.769）.（10）AR value: using OPD-Scan III analysis,when the pupil diameter was3 mm,the AR value of LPI with ALPI at 1 week after operation（29.29±14.67）was not significantly different from that before operation（26.57±12.08）（P=0.177）.When the pupil diameter was 4 mm,the AR value at 1 week after LPI with ALPI（28.51±12.51）was not significantly different from that before surgery（27.83±11.93）（P=0.499）.（11）SR value: Using OPD-Scan III analysis,when the pupil diameter was 3 mm,the SR value of LPI with ALPI at 1 week after operation（0.32±0.22）was not statistically different compared with that before operation（0.31±0.21）（P=0.777）.When the pupil diameters were 4 mm,the SR value of LPI with ALPI at 1 week after operation（0.13±0.10）was not significantly different from that before operation（0.13±0.10）（P=0.600）.（12）Pupil diameter: The photopic pupil diameter measured by OPD-Scan III at 1 week after LPI with ALPI（3.56±0.76）mm was significantly larger than that before surgery（3.14±0.57）mm（P=0.005）.The pupil diameter of mesopic pupil measured by OPD-Scan III at 1 week after operation（4.71±0.86）mm was not significantly different from that before operation（4.67±0.83）mm（P=0.730）.The pupil diameter measured by Pentacam 1 week after surgery（3.25±0.99）mm was significantly larger than that before surgery（2.68±0.47）mm（P=0.000）.Through correlation analysis,age was negatively correlated with pupil diameter.Conclusions LPI with ALPI can significantly increase anterior chamber depth,ACV,and reduce intraocular pressure.LPI with ALPI is safe and effective.Under the same pupil diameter,LPI with ALPI did not change the objective optical imaging quality parameters: RMS value of wavefront aberration,AR value,SR value.It was speculated that the postoperative visual impairment of LPI with ALPI might be related to the decreased transparency of the cornea and the increased photopic pupil diameter.Pentacam and OPD-Scan III can be used as means of follow-up observation after LPI with ALPI. |
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