Y HOC VIET NAM THANG 3 - SO 1/2012
UNG DUNG KY THUAT CHUP CAT L 6 P BAN PHAN TRU6C NHAN CAU VISANTE DCT DANH GIA SITTHAY OOI CUA TIEN PHONG VA GOC TIEN PHONG TRONG THUTNGHIEM BUONG TOI
TOM
TATMuc tieu: M6 ta su thay do kich thudc ci3a tien phong va goc tien phong trong thCr nghiem buong toi bSng may chup cSt ldp ban phan tn/dc nhan cau Visante OCT va nhan xet ve mot sd yeu io ii^n quan den ket qua cOa thd nghi&m. Ooi tugng. 64 mlt cua 41 ngi/6i c6 yeu to giai phlu nguy ca glocom goc dong, PhuOHgpWp: Nghien cilfu mo la c i t ngang Kei qua: Trong thijr nghiem buong toi dUong kinh dong tijf tang (p=0,000). do vong mong mat Ong (p=0,003), goc tien phong thu hep (p=0,000) va so goc dong tang (p=0,OOC), CO ^ nghla thong ke. Dp sau TP trung binh trong dieu kien sang, toi khong c6 su khac biet v6i p=0,083 So goc dong trong toi c6 moi lien quan chSt che den ket qua NA sau thCf nghiem v6i he so tu'dng quan Pearson r = 0,731, Do mc) goc tien phong trong toi CO moi lien quan chat che den ke't qua NA sau th{!r nghiem v6i he so tUOng quan Pearson r = - 0,691, Kei tuan: SC' dung may Visante OCT danh gia sy thay doi CLia goc TP trong thLf nghiem buong toi la mot bien phap sinh ly, CO kha nang phat hien s6m benh glocom goc dong tren nhQng ngUdi nguy cd cao.
Tir khoa: ThCr nghiem buong toi, glocom goc dong, may Visante OCT,
SUMMARY
ANTERIOR SEGMENT OCT STUDY OF CHANGES OF ANTERIOR CHAMBER AND ANGLE CONFIGURATION IN
THE DARK ROOM PROVOCATIVE TEST Purpose: To describe the changes of anterior chamber and angle configuration in the dark room provocative test (DRPT) using AS-OCT and to evaluate the correlation between these changes and the DRPT result. Method and Subject: subjects aged
> 35 years and whose penpheral anterior chamber were <1/4 corneal thickness were recruited The anterior segment of the eye was imaged under both light and dark conditions using AS-OCT The analyzed parameters were: (1) central anterior chamber depth {ACD); {2} pupil diameter (PD), (3) iris cun/ature (IC), (4) number of meridians with closea angles (NGA); (5) Anterior chamber angle (ACA). Statistical analyses include the difference in parameters between light and dark. Result: A total of 64 eyes of 41 subjects were recruited. ACD (p=0,083), PD (p=0.000), IC {p=0,003) ,NCA (p=0,000), ACA {p=0,000) were different significantly between light and dark. The NCA and ACA in the dark was significantly correlated with the amount of lOP elevation induced by Dark-room prone
" B$nh vi&n f<JiSt trung UOng
Phan bien khoa hgc: PGS.TS. Pham Thi Khanh Van
Oao Thj Lam Hirdng*
position provocative test (with r^O 731 and r= -0,691) Conclusion: The test may be useful in the early diagnosis of pnmary angle closure
Keywords: Dark-room test, angle closure glaucoma, Visante OCT,
I. OAT VAN DE
Glocom goc dong nguyen phat la benh ly nguy hiem co the d i n den mu loa khong c6 kha nSng hoi phuc. Tuy nhien, benh c6 the dUOc phat hi$n s6m 6 nhSng nguoi co nguy co cao de dieu tn dii phong giCip bao toan cac cau true cua nhan cau va chCrc nSmg thj giac [1], Mot trong nhCfng thCf nghiem thucfng dUOc sd dung la thCf nghiem buong toi - duoc Gronholm mo ta lan dau nam 1910 va sau do la Seidel nSm 1922, Day la mot thif nghiem mang tinh sinh 1^ an toan tuy nhien do nhay khong cao [3], [4]. Nhung nam gan day nhd co may chup cat 16p ban phan tru'dc nhan cau viec phat hien nguy co goc dong tro nen de dang hon [2], [6], Hien nay tai benh vien Mat trung UOng da dUa vao SLf dung may chup cat I6p ban phan trade Visante OCT nhtffig chua co bao cao nao ve ket qua nghien cuu utig dung may vao thCr nghiem buong toi phat hien sdm glocom goc dong, Vi vay, chiing toi tien hanh de tai nay nham muc tieu: W6 ta su thay doi kich thudc cOa tien phong va goc tien phong trong thd nghiem buong toi b^ng may chup cit ldp ban phan trddc nhan cau Visante OCT va nhan xet ve mot so yeu to lien quan den ket qua cda thi^ nghiem.
II. o6\ TUONG VA PHUONG PHAP NGHIEN CCfU 2.1. Do'i tufong nghien ciJu: Nhung ngudi tCr 35 tuoi tr6 len den kham mSt tai khoa Glocom benh vi6n Mat trung UOng tiT thang 5/2011 den thang 11/2011 co cac dac diem sau: do s§u goc tien phdng (TP) chu bien danh gia theo phu'Ong phap Van HerrJck < 1/4 be day giac mac, mat chua CO bieu hien benh cCra ngu'di benh glocom goc ddng nguyen phat.
Tieu chuan loai Iris: mat c6 benh ly lam thay ddi do sau goc TP, thay doi su luu thdng thuy dich qua gde TP hoac thay doi phan xa dong tCt; mat da duac chan doan goc ddng nguyen phat hoac
Y HOC VlgT NAM THANG 3 - s 6 1/2012 glocom goc dong nguyen phat trude dd. Ngudi gia
yeu, khdng phd'i hpp, khong dong y tham gia nghien cCiU,
2.2. Phu'dng phap nghien cdfu: Md ta cat ngang, khong dd'i chijng.
C9 m l u tinh theo cdng thCc:
7= p ( i - / ' )
Trong do:Z' Tra cu'u theo bang tUOng u'ng vdi gia tri a diTOc chon, bang 1,96
p: ty le nghiem phap buong toi du'dng tinh, Udc tinh khoang 28,6 %, lay ttr nghien cifu nam 2010 cua tac gia Bingson Wang [1]
a, mu'c y nghla thong ke {a = 0,05).
A: khoang sai lech giii'a ty le th*j du'dc tCr mau nghien cifu va ty le ciJa quan the, du'dc ti'nh theo gia trj tu'Ong doi e, A- (p.£)^, vdi £ chgn bang 0,4,
Tirih ra c3 mau n toi thieu la 60 m^t.
Ddi tupng nghien ciru duoc hoi benh, tien sijf, do thi luc (bang TL Snellen, ed ehinh kinh), kham ban phan trudc (sinh hien vi Inaml), soi gde TP (ki'nh Goldmann 1 mat guong). Tien hanh chyp ban phan trudc nhan cau trong dieu kien sang va toi bang may Visante OCT. TCr hinh anh thu dupc do, ghi nhan cac chi so': dp sau trung tam TP (mm), dudng kinh dong tQ (mm), dp vong ci!ia mong mat (mm), so g6c dong, dp md eCia goc tien phong.
Tie'n hanh lam thuf nghiem buong td'i tu the cui dau trong thdi gian mpt tieng. Ke't qua Ihuf nghiem dupe coi la duong tinh khi ehenh lech NA trudc va sau thCr nghiem > 8 mmHg [3],
Xif ly so lieu bang phan mem SPSS 17,0. So sanh cac gia tri trung binh.
III. KET QUA VA BAN LUAN
Nghien ciru da dugc tie'n hanh tren 64 mat cila 41 doi tUong tuoi tif 36 de'n 75, tuoi trung binh la 56,9 ± 7,7, ve gidi c6 10 nam (24,4%), 31 nu' (75,6%), Da so cac mat eo thi luc tdt, sd mat dat thi luc 20/50 la 41 (64,1%), khdng cd m i t nao thi life < 20/200.
• S u l h a y doi kich'thudc cOa tien phdng va gde tien phdng trong thif nghiem buong td'i do bang may Visante OCT
Bang 1: Ki'ch thUdc TP, dong tCf, mo'ng mat va goc TP trong dieu kien sang va td'i do bang may Visante OCT
06 sau trung tam TP(mm) Oi/dng ki'nti tJdng tCr (mm) Do vong cOa mong mat (mm) So goc dong
fi6 md dia goc TP C)
Dieu kien sang TB±SD, fmin - max]
2,13 ± 0,26 ri,56 • 2,851 3,37 ± 0,65 ri,77- 4,771 0,37 ± 0,06 [0,24 - 0,501 1,86 ± 1,76 ( 0 - 6 1 16,85 ± 5,80°
r7,7° • 30,3"1
Dieu kien toi TB±SD [mm - maxl
2,11± 0,27 tl,53 - 2,821 4,31 ± 0,85 12,26 - 6,111 0,39 ± 0,06 10,27 - 0,591 3,84 ± 2,15 10-81 10,14±5,58°
10" -23,55"1 P 0,083 0,000 0,003 0,000 0,000
Khi chuyen tir dieu kien sang sang dieu kien td'i, dp sau tien phdng trung binh cua nhom nghien ciru khdng cd s u t h a y doi cd ^ nghTa thd'ng ke (p=0,083). Dieu nay cd the giai thich do tren mat eiia nhung ngudi cdn the thiiy tinh, khi vao mdi trudng td'i vi tri eua the thiiy tmh so vdi true nhan cau thay ddi khong dang ke nen dp sau trung tam tien phdng it thay ddi.
Theo ket qua bang 1, cac chi so khac cua TP deu cd s u thay ddi cd y nghla thd'ng ke.
Di/dng kinh dong t i r t § n g len (p = 0,000) do phan xa anh sang sinh ly ciJa dong tir. Dong tif co lai khi lupng anh sang chieu vao vdng mac tSng va ngu'dc iai ddng tif gian ra khi lupng anh sang de'n
vdng mac giam. Do vdng cOa mdng mat cung tang len rd ret {p = 0,003). Dieu nay dupc giai thi'ch la do trong bdng tdi, dong t(s gian ra, dien tie'p xiic giiia ddng \Cs va be mat the thiiy tinh t§ng len gay hien tupng nghen ddng tif tupng ddi. Hien tupng nay lam thuy djch bj ii lai d hau phong va day vong mdng mat ra trudc. S d gde dong trong dieu kien tdi tang len so vdi trong dieu kien sang (p = 0,000), Do md ciia goc TP cung giam tCf 16,85 ± 5,80" trong dieu kien sang xudng 10,14
± 5,58° trong dieu kien td'i (p = 0,000). Ke't qua nghien cuu cho thay trong dieu kien tdi cac thay
24
Y HOC VIET NAM THANG 3 - 8 0 1 / 2 0 1 2 ddi 0 vimg goc TP gay can trd nSng thoat cda he
thdng dSn luu thiiy djch, hau qua la gay tang NA.
Ke't qua ciia chung toi cung phii hpp vdi nghien euu cOa eac tac gia nude ngoai. Leung CK [7]^da sir dung Visante OCT de danh gia su thay ddi ciia gde TP khi chuyen tir dieu kien sang sang td'i tren 37 ddi tUpng gde md va 18 ddi tUOng gde hep. Ket qua cho thay nhUng thay doi cua tien phdng khi ehuyen tif moi trudng sang sang td'i la sU tang len dudng kinh ddng ti!r va su thu hep ciia goc TP. Su thay doi ciia goc TP the hien
qua eac chi sd AOD 500 va TISA 500 lien quan ehat che de'n dudng kinh ciia dong tir. Tuy nhien, mire 66 thay ddi nay phy thupc vao tt/ng ca the.
Dacosta Shaun cung diing Visante OCT de danh gia su thay ddi gde TP trong dieu kien td'i tren 100 ngudi binh thudng, Ket qua la dp sau va 66 rpng ciia tien phdng khong ddi, trong khi do dudng kinh ddng tir tang len va dp md goc tien phdng giam di mdt each cd y nghTa [5]
• Mpt sd yeu td lien quan den ket qua cua thir nghiem budng tdi
Bang 2: Lien quan giufa sd goc ddng tren Visante OCT trong dieu kien td'i vdi ty le duong tinh cua thuf nghiem budng td'i.
So goc dong trong toi
<4;8 5/8 - 6/8 r/s - 8/8
n 36 17 11
So mat di/dng tinli 0 13 9
Ty le dirdnq tinti(%) 0%
76,5%
81,9%
Theo ket qua d bang 2, d nhung mat cd sd gde ddng dudi 5/8 thi ty le duong tfnh ciia thif nghiem bangO. 6nhCfng mat cd sd gde ddng tir 5/8 trd len thi ty le duong tinh tang cao (76,5% - 81,9%).
Bieu do 1. Lien quan giufa sd goc ddng tren Visante OCT trong d\m kien td'i va NA sau thit nghiem Sd goc ddng trong mdi trudng tdi lien quan chat che tdi ket qua do NA sau thif nghiem vdi r = 0,731. Sd goc ddng trong dieu kien tdi eang nhieu thi NA sau thir nghiem cang cao.
Bang 3: Lien quan giCfa dp md eGa gde tien phdng trong tdi vdi t^ le ket qua duong tinh ciia thif nghiem
Do md cua goc tien ptldng tronq toi
0"-<5*
5° <10°
10° < 2 0 "
20"-< 30"
>30°
n 10 17 31 5 1
So' m l t dudng tinh 10 12 0 0 0
Ty le duong tinii(%) 100%
70,6%
0%
0%
0%
Do md ciia goc TP trong dieu kien tdi tren Visante OCT cang nho thi ty le duong tinh eiia thif nghiem budng tdi cang eao. Theo ket qua d bang 3. d nhOng mat cd dp md goc dudi 5° ty le dUdng tinh ciia thijf nghiem la 100%. Trong khi do nhCfng mat cd do md goc Idn hon 10° thi ty le thif nghiem dUdng ti'nh bang 0%. Nhu vay d nhirng ngudi benh khi ehup OCT trong td'i cd dd md cQa gde TP dUdi 5 thi kha nang tang NA do ddng gde gan nhu la chac chan se xay ra.
Y HOC VIET NAM THANG 3 • SO 1/2012
Bieu do 2. Lien quan giua dp md eiia gde TP va NA sau thif nghiem B d md gde tien phdng trong dieu kien tdi ed
mdi hen quan chat che den NA sau thif nghiem vdi he sd tuong quan Pearson r = - 0,691. Dp md cua gde TP trong dieu kien tdi cang hep thi gia tri NA sau thd nghiem cang cao.
Sau khi tie'n hanh thi> nghiem budng tdi tu the eiii dau nham danh gia kha nang xuat hien tang NA that su do ddng gde tren cac mat ed nguy co cao phat hien bang Visante OCT, chiing tdi nhan tha'y ed su lien quan chat che giu'a sd gde ddng va 66 md eiia gde tien phdng trong mdi trUdng td'i danh gia tren Visante OCT den ket qua duong tinh ciia thd nghiem. Ket qua ciia chung tdi eijng tuong t y nhu ket qua cija tac gia Bingson Wang [3]. Chiing tdi cd ddng quan diem vdi tac gia rang d nhu'ng mat khi ehup OCT trong tdi tha'y ed sd gde ddng tren 5/8 va do md cua goc TP dudi 5" thi kha nang tang NA do ddng gde la rat eao, vi vay can chi dinh dieu tri dU phdng sdm cho ngudi benh.
IV. KET LUAN
Sif dung may Visante OCT danh gia sy thay ddi dp vdng eiia mdng mat va goc TP trong thd nghiem budng td'i la mot bien phap smh 1^, cd kha nang phat hien sdm benh gidcdm gde ddng tren nhiJTig ngudi nguy co cao.
TAI UEU T H A M KHAO
1. Tran Thj Nguyet Thanh, Pham Thj Thu Thuy, Tran An (2004), "Gloconn goc dong nguyen phat", Nhan khoa gian yeu, tap 2, Nha xuat ban y hoc.
Ha Noi, tr 256-283,
2. Tran Ke To (2007), "Chup egt I6p quang tioc ket hdp", Nhan khoa can lam sang, Nha xuat ban Y hoc, TP H6ChiMinh,lr.102-110,
3. Bingsong Wang, Nathan G. Congdon et al (2010), "Dark Room Provocative Test and Extent of Angle Closure An Anterior Segment OCT Study". Journal of glaucoma ,Vol 19-3, p.183-187.
4. Chul Hong, Tetsuyama Yamamoto (2007), Angle closure glaucoma. p,123 -133.
5. Dacosta Shaun, Gitanjali Fernandes (2008),
"Assessment of antenor segment parameters under photopic and scotopic conditions in Indian eyes using anterior segment optical coherence tomography". Indian J Ophthalmol. Jan-Feb;
56(1): p.17-22.
6. Huang David, Roger Steinert (2008), Anterior segment optical coherence tomography. Slack Incorporated led.
7. Leung CK, Cheung CY et al. (2007), "Dynamic analysis of dark light changes of the anterior chamber angle with anterior segment OCT", invest Ophthalmol 2007 Sep; 48 (9): p.4116-22.
NGHIEN Ciiu DAC DIEM BENH HOG LAM SANG RO KHE MANG H
Le M i n h K y *
TOM TAT
Ro khe mang I I la mgt d| tat bam smh tuong doi hiem gap, lien quan den sU phat trie'n bat thu'dng ciia viing mang. flfuc tieu: nghien ciru dac diem benh hpc lam sang benh ro khe mang I I . Doi tUdng va phu'dng phap nghien cdu: gom 30 benh nhan du'pc
* BV Tai MOI Hong Trung ddng
Phan bien khoa hoc: PGS.TS. Nguyin Dinh Phuc 26
chan doan nang va rd khe mang I I , vao phau thuat tai Benh Vien TMH TW tir thang 2 nam 2006 den thang 9 nam 2010. Phuong phap nghien cdu mo ta tdng ca co can thiep. /Cei qua: Nam chiem 66,6 %, nij' chiem 33,4%. Oa so benh nhan dUOc chan doan va phau thuat sdm, du'di 15 tudi (60,1%). Oa so co bieu hien
