方法：选取2015-01/12在我院肾内科接受血液透析治疗的慢性肾衰竭患者52例52眼(均取右眼为观察眼)，根据Shaffer分级法并结合超声生物显微镜将52眼分为四组：宽房角组、窄房角组、极窄房角组及闭角组。分别在血液透析前和透析后60s内采取静脉血以计算血浆渗透压。采用回弹式眼压计分别在血液透析开始前30min内、透析2h后和透析结束后30min内测量眼压。在血液透析前和透析后30min内，分别采用角膜内皮细胞仪、眼部A超和超声生物显微镜进行中央角膜厚度、中央前房深度、晶状体厚度、房角开放距离、小梁虹膜角、虹膜根部厚度和睫状体厚度的测定。

结果：血液透析后血浆渗透压降低，差异有统计学意义(t=3.04，P<0.05)。血液透析不同时间点患者眼压的均数不全相同，差异有统计学意义(F=41.69，P<0.01)，透析前眼压与透析2h眼压相比差异有统计学意义(P<0.01)，透析后眼压与透析2h眼压相比差异有统计学意义(P<0.01)。血液透析不同分组患者眼压的均数不全相同，差异有统计学意义(F=6.44， P<0.01)，宽角组眼压与极窄房角组眼压相比差异有统计学意义(P<0.05)，窄房角组眼压和极窄房角组眼压相比差异有统计学意义(P<0.01)。血液透析后各组睫状体厚度均变薄，但只有宽房角组与透析前相比差异有统计学意义(t = 2.61，P<0.05)。血液透析后中央角膜厚度、中央前房深度、房角开角距离、小梁虹膜角和虹膜根部厚度均降低，而晶状体厚度增加，但这些改变均没有统计学意义。

结论：血液透析对眼压的影响与前房角功能状态相关，其中极窄房角是透析过程中眼压升高的危险因素，窄房角可能是危险因素，宽房角患者则相对安全。应及早对透析患者进行眼部筛查，关注窄房角结构的患者。

METHODS: Fifty-two patients(take right eye as study one)with hemodialysis that were diagnosed with chronic renal failure by nephrology in our hospital from January 2015 to December 2015 were collected. Fifty-two eyes were divided into four groups based on Shaffer classification combined with ultrasound biomicroscopy(UBM)and gonioscopy manifestations: wide angle group, narrow angle group, extremely narrow group and close angle group. Venous blood was collected to get plasma colloid osmotic pressure before HD and within 60s after HD. IOP was measured with rebound intraocular pressure gauge in a supine positon approximately 30min before starting HD, 2h after HD begin and approximately 30min after HD ending. Approximately 30min before and after HD, central corneal thickness was measured with corneal endothelial cell counter, central anterior chamber depth and lens thickness were taken by A scan, angle opening distance, trabecular iris angle, iris thickness and ciliary body thickness were measured by UBM.

RESULTS: Plasma osmotic pressure reduced after HD, the difference was statistically significant(t=3.04, P<0.05). The means of IOPs among three measurement points were not all the same(F=41.69, P<0.01). The IOP in 2h after HD had significant difference compared with before HD(P<0.01).The IOP in 30min after HD ending had significant difference compared with 2h after HD(P<0.01). The means of IOPs among three groups were not all the same(F=6.44, P<0.01). The IOP in extremely narrow angle group had significant difference compared with that in wide angle group and narrow angle group(P<0.05). Ciliary body thickness decreased after HD in every group, while only in wide angle group showed significant change after ending HD(t=2.61, P<0.05). Central corneal thickness, central anterior chamber depth, angle opening distance, trabecular iris angle and iris thickness decreased, while lens thickness increased after HD. But all these changes between before HD and after HD in every group had no significant difference.

CONCLUSION: The influence of hemodialysis on IOP is related to the biometric structure of the anterior chamber. And extremely narrow angle is risk factor of elevated IOP during hemodialysis, narrow angle may be a risk factor. While patients with wide angle is relatively safe. We suggest to take ocular examination as early as possible for patients with hemodialysis, and focus on patients with narrow angle.