目的：探讨中国西北地区60岁以上人群晶状体厚度（lens thickness, LT）和晶状体相对位置（relative lens position,RLP）的影响因素以及与眼前房角结构的相关性，为探索晶状体在原发性闭角型青光眼疾病中的作用机制提供依据。方法：横断面研究，纳入2024年4—6月在新疆喀什地区英吉沙县社区人群中检查的60岁以上正常受检者，采用眼前节相干光断层扫描仪等，测量双眼眼球生物学参数。将患者右眼纳入研究范围，通过相关性分析和线性回归模型分析晶状体参数变化与房角结构的相关性。结果：性别、腰围和眼轴长度（axial length, AL）为RLP的独立预测因子。年龄越大，晶状体越厚，70岁前LT与AL呈正相关，眼轴、LT和RLP是眼前房角巩膜突前500 μm开放距离（AOD500）的独立预测因子，其多元线性回归方程为：AOD500=-2.501 4+0.083 3AL-0.115 7LT+7.0211RLP-0.0026Sex-0.0010身高。 结论：新疆喀什地区60岁以上人群中，女性、腰围大和眼轴短提示晶状体相对位置靠前，而晶状体厚度、相对位置以及眼轴显著影响眼前房角开放距离，成为闭角型青光眼发病的潜在危险因素。

Objective: To explore the influencing factors of lens thickness (LT) and relative lens position (RLP) in individuals aged 60 and above in Northwestern China, as well as their correlation with anterior chamber angle structure. The aim is to provide evidence for exploring the role of the lens in the pathogenesis of primary angle - closure glaucoma. Methods: A cross - sectional study was conducted. Normal subjects aged 60 and above were enrolled from community - based examinations in Yingjisha County, Kashgar region, Xinjiang, between April and June 2024. An anterior segment optical coherence tomography was used to measure ocular biological parameters of both eyes. Only the right eyes of the subjects were included in the analysis. The correlation between changes in lens parameter and angle structure was examined through correlation analysis and linear regression models. Results: Gender, waist circumference and axial length emerged as independent predictors of the relative lens position. As age increased, the lens became thicker. Before the age of 70, lens thickness was positively correlated with axial length. Axial length, LT and RLP were identified as independent predictors of the anterior chamber angle scleral spur anterior 500 - μ m - opening distance (AOD500). The multiple linear regression equation is as follows: AOD500 (mm) = -2.5014 + 0.0833AL (mm) - 0.1157LT (mm) + 7.0211RLP - 0.0026Sex - 0.0010Height (cm). Conclusions: Among individuals aged 60 and above in Northwest China, being female, having a large waist circumference, and a short axial length are indicative of a relatively anterior lens position Furthermore, lens thickness, its relative position, and axial length significantly affect the anterior chamber angle opening distance, potentially contributing to the pathogenesis of angle-closure glaucoma.

房角镜辅助的内路360°小梁切开术(Gonioscopy-Assisted Transluminal Trabeculotomy,GATT)是近年来国内外开展的新型微创青光眼手术，是一种改良的小梁切开术。GATT将微导管(iTrack)环穿Schlemm's管后，利用微导管张力全周切开小梁网及Schlemm's管内壁，重建生理性房水流出通道，避免小梁网阻力，实现房水从前房直接进入集液管，通过增加房水流出机制降低眼压。GATT适应证广泛，主要应用于开角型青光眼，包括原发型开角型青光眼和继发性开角型青光眼，同时可运用于闭角型青光眼。GATT微创、不依赖滤过泡、能明显减少降眼压药物的使用、中远期疗效稳定、安全性高、较少发生威胁视力的并发症，可作为开角型青光眼的首选手术方式。本文将对GATT在青光眼中的应用、手术步骤、作用机制、有效性、并发症及影响疗效的因素等进行综述，以期为其临床运用提供参考。

As a modifed trabeculotomy, Gonioscopy-Assisted Transluminal Trabeculotomy (GAT) is a new type of minimally invasive glaucoma surgery developed at home and abroad in recent years. GAT inserts a microcatheter (iTrack) into the Schlemm's canal and advance the catheter through the canal circumferentially 360°, then circumferentially fracture the trabecular meshwork and inner wall of Schlemm’s canal. Tis method can reduce intraocular pressure by increasing the outfow of aqueous humor. Te physiological outfow pathway of aqueous humor is reconstructed, which can avoid the resistance of trabecular meshwork and realizing the direct entry of the aqueous humor directly into the collector channel from the anterior chamber. With a wide range of indications, GAT is mainly used in open-angle glaucoma, including primary open-angle glaucoma and secondary open-angle glaucoma, and is also used in primary closed- angle glaucoma. Additionally, GATT can be the preferred surgical modality for open-angle glaucoma, as it has the following advantages: minimally invasive, independent of fltration bleb, can signifcantly reduce the use of medications, stable medium- and long-term efcacy, high safety, and has fewer sight-threatening complications. In order to provide a reference for clinical application, this article reviews the indications, mechanism of action, surgical procedures, efectiveness, complication and factors afecting therapeutic efect.

目的：观察超声乳化白内障吸除人工晶状体植入术（phacoemulsification with intraocular lens implantation, PEI）联合房角分离术（goniosynechialysis, GSL）及房角切开术（goniotomy, GT）治疗中晚期原发性慢性闭角型青光眼（chronic primary angle-closure glaucoma , CPACG）合并白内障的安全性和有效性。方法：采用回顾性病例研究。收集2020年6月至2024年1月在成都市中西医结合医院行PEI联合GSL及GT的中晚期CPACG合并白内障患者94例133眼，观察最佳矫正视力（best corrected visual acuity, BCVA）、眼压、抗青光眼药物使用数量及术后并发症等情况。采用重复测量方差分析、Wilcoxon秩检验进行统计学处理。结果：术后1天，1周，1、3、6个月94例患者133眼的BCVA（logMAR）均较术前有所提升（P＜0.05）；从术后1天到6个月的所有随访时间点眼压均较术前明显下降（F = 189.79，P＜0.001）；术后6个月，患者使用的降眼压药物数量明显低于术前 ( Z = -2.392，P＜0.001)。术后1周中31眼（23%）出现角膜水肿，15眼（11%）出现前房积血，均在1周内消退；术后1个月内1眼出现眼压反跳，予以前房穿刺放液等治疗后眼压恢复到正常范围。术后6个月，121眼（91%）手术完全成功，10眼（8%）手术条件成功。结论：PEI联合GSL及GT治疗中晚期CPACG合并白内障可有效地提高视力、降低眼压，且无严重并发症。

Objective: To observe the safety and efficacy of phacoemulsification with intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) and goniotomy (GT) in treating advanced chronic primary angle-closure glaucoma (CPACG) complicated by cataract. Methods: This was a retrospective case series study. We collected data from a total of 94 patients (133 eyes) who had advanced CPACG along with cataract and underwent PEI+GSL+GT at Chengdu Integrated TCM&Western Medicine Hospital between June 2020 and January 2024. We observed the best corrected visual acuity (BCVA), intraocular pressure (IOP), the number of anti-glaucoma drugs used, and postoperative complications. Repeated measures ANOVA and Wilcoxon rank test were used for statistical analysis. Results: The BCVA (logMAR) at 1 day, 1 week, 1, 3, and 6 months after surgery showed significant improvement compared to the pre-surgical values (F = 189.79，P < 0.001); The IOP at 1 day, 1 week, 1, 3, and 6 months post-surgery was significantly lower than that pre-surgical IOP (P < 0.001). The number of IOP-lowering drugs used at 6 months after surgery was also significantly reduced compared to the pre-surgical (Z = -2.392, P < 0.001). One week after surgery, corneal edema occurred in 31 eyes (23%) and hyphema in 15 eyes (11%) , both of which resolved spontaneously within 1 week. Within one month after surgery, 1 eye experienced an IOP spike, and the intraocular pressure returned to normal range after treatments such as anterior chamber puncture and drainage. Six months after surgery, the operation was completely successful in 121 eyes (91%), and conditionally successful in 10 eyes (8%), resulting in an overall surgical success rate of 99%. Conclusions: PEI combined with GSL and GT can effectively improve vision and reduce IOP in patients with advanced CPACG complicated by cataract, without causing serious complications.

青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼（primary angle closure glaucoma，PACG）占 25%。激光周边虹膜切除术（laser peripheral iridotomy，LPI）已成为 PACG 和原发性房角关闭的一线治疗。LPI 机制为利用激光在周边虹膜上打孔，解除 PACG 的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明 LPI 在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。

Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy (LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle, restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.

青光眼是全球第二大致盲眼病，第一大不可逆性致盲眼病，其中原发性闭角型青光眼(primary angle closure glaucoma，PACG)占25%。激光周边虹膜切除术(laser peripheral iridotomy，LPI)已成为PACG和原发性房角关闭的一线治疗。LPI机制为利用激光在周边虹膜上打孔，解除PACG的瞳孔阻滞，加深前房，扩大房角，恢复生理性房水排出途径，从而降低眼压。研究表明LPI在原发性房角关闭各个疾病进程中均能比较好的控制眼压，是相对安全的治疗方法。

Glaucoma is the second leading cause of blindness and the most common cause of irreversible blindness worldwide. Primary angle closure glaucoma (PACG) accounts for 25% of glaucoma. Laser peripheral iridotomy(LPI) has become the first line treatment for PACG and primary angle closure (PAC). The mechanism of LPI is to use laser to create a hole in peripheral iris to relieve pupil block, deepen anterior chamber, expand chamber angle,restore pathway of physiological aqueous discharge and reduce intraocular pressure. Studies have shown that LPI can control intraocular pressure well in all stages of PAC, which is safe for PAC.

目的：比较单眼发作的原发性急性房角关闭(acute primary angle closure，APAC)患者发作眼与未发作眼眼部生物学参数的差异，分析急性房角关闭发作的可能危险因素。方法：回顾性分析2008年1月至2020年3月中山眼科中心青光眼科222例45岁以上单眼发作的APAC病例。排除双眼发作、另眼有发作史及晶状体源性、外伤性等继发因素。A超测量晶状体厚度、眼轴长度，超生生物显微镜测前房深度。对单眼发作APAC患者的发作眼与未发作眼眼轴长度、前房深度、晶状体厚度、晶状体相对位置等进行统计学分析。结果：患者发作年龄为(62.57±9.14)岁。发作眼与未发作眼前房深度分别为(1.75±0.27) mm和(1.88±0.31) mm，眼轴长度分别为(22.34±0.80) mm和(22.35±0.83) mm，晶状体厚度分别为(5.14±0.38) mm和(5.17±0.42) mm，晶状体相对位置分别为0.195和0.198。发作眼前房深度较浅，晶状体相对位置较靠前，差异有统计学意义(均P<0.001)，发作眼的眼轴长度、晶状体厚度较未发作眼差异无统计学意义(P>0.05)。APAC发作年龄较小(45~59岁)的患者双眼眼轴均短于发作年龄较大(60~69、70岁以上)的患者；发作年龄70岁以上患者双眼前房深度均较浅，双眼晶状体相对位置均较靠前，差异均有统计学意义(P<0.05)。相关性分析表明APAC发作年龄较小的患者双眼眼轴均较短(P<0.001)。结论：APAC发作眼的前房较浅、晶状体相对位置靠前。短眼轴、女性与不同个体的APAC发作相关。浅前房、晶状体厚、晶状体相对位置靠前可能是高龄人群APAC发作的危险因素。

Objective: To compare the ocular biometric parameters between the acute primary angle closure (APAC) eyes and the fellow eyes as well as the risk factors associated with APAC. Methods: From January 2008 to March 2020,222 monocular APAC patients over 45 years old from the Glaucoma Department of Zhongshan Ophthalmic Center, Sun Yat-sen University were retrospectively studied. Patients with binocular attack, previous attack in the fellow eyes, and secondary factors such as lens-induced and traumatic glaucoma were excluded. Ocular biometric parameters including axial length (AL) and lens thickness (LT) were measured with A-scan ultrasound, while the anterior chamber depth (ACD) was measured by ultrasonic biological microscope. AL, ACD, LT and relative lens position (RLP) were compared between the APAC and the fellows eyes. Results: The average age of onset was (62.57±9.14) years. The ACD was (1.75±0.27) and (1.88±0.31) mm, AL was (22.34±0.80) and (22.35±0.83) mm,LT was (5.14±0.38) and (5.17±0.42) mm, and the RLP was 0.195 and 0.198 for the APAC and the fellow eyes,respectively. Compared with the fellow eyes, the ACD of the APAC eyes was shallower, and the RLP was more anterior (both P<0.001), while the differences of AL and LT were not statistically significant (both P>0.05).Furthermore, AL of patients with a younger age of onset (aged 45 to 59 years) was shorter than that of those with an older age of onset (aged 60 to 69 or over 70 years); patients with an onset age of over 70 years have shallower ACD and more anterior RLP, all statistically significant (P<0.05). In addition, correlation analysis indicated that younger onset age was significantly correlated to shorter axial length of APAC eyes (P<0.001). Conclusion:APAC eyes had shallower ACD and more anterior RLP. Shorter AL and female were associated with APAC attack between individuals. Shallower ACD, thicker lens and more anterior RLP are potential risk factors for APAC among aged population.