裂隙灯照相法观察成功的小梁切除术后滤过泡形态的一年演变  

The one-year changes of filtering bleb configuration after successful trabeculectomy: photographs analysis of slit-lamp microscopy

作　　者：辛晨[1] 王宁利[2] 乔利亚[2] 

机构地区：[1]首都医科大学附属北京安贞医院眼科,100029 [2]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所北京市眼科学与视觉科学重点实验室,100005

出　　处：《眼科》2014年第1期31-36,共6页Ophthalmology in China

摘　　要：目的观察成功小梁切除术后滤过泡形态的演变过程。设计前瞻性病例系列。研究对象薄壁滤过泡与厚壁滤过泡患者各5例。方法术后1-2、3周、1、3、6、12个月进行裂隙灯显微镜检查并行滤过泡照相，利用Photoshop软件对滤过泡形态相关指标进行定量测量。主要指标滤过泡面积，滤过泡高度，滤过泡上方边界及下方边界距角膜缘最大距离，被动Sheild试验。结果薄壁滤过泡患者术后3周滤过泡下缘与角膜缘间的距离较术后1周缩短（P=0．042），面积减小（P=0．043），滤过泡中央小片苍白无血管区；术后1个月，滤过泡面积较术后3周显著缩小（P=0．043），高度增高（P=0．042），滤过泡中央苍白区变大；术后3个月，滤过泡中央苍白区变大，绝大多数血管于滤过泡周边区形成末端吻合状，终止于滤过泡边缘，泡壁明显变薄；术后6、12个月滤过泡形态无显著变化。厚壁滤过泡患者术后3周，滤过泡边界上缘略向下方扩展（P=0．043），面积明显减小（P=0．043），滤过泡中央小片无血管区；术后1个月滤过泡边界上缘与角膜间距缩短（P=0．042），面积明显缩小（P=0．043），滤过泡中央苍白区无明显变化，血管走行成树枝状，未形成末端吻合状；术后3、6及12个月滤过泡形态无显著变化。结论成功小梁切除术后3个月内滤过泡形态变化较为明显，薄壁滤过泡下界逐渐向角膜缘内侵入。3个月后，厚壁滤过泡组患者滤过泡形态稳定，薄壁滤过泡患者滤过泡中央苍白区进一步扩大，泡壁进一步变薄。Objective To observe the one-year changes of filtering bleb configuration with photographs of slit-lamp microscopy af- ter trabeculectomy. Design Prospective case series. Participants Five patients with thin-wall bleb and five patients with thick-wall bleb were included. Methods The configuration of filtering bleb on photographs of slit-lamp microscopy were compared and analyzed with Photoshop software at 1~2, 3 weeks, 1, 3, 6 and 12 months after trabeculectomy. Main Outcome Measures The area of the bleb, the distance between the upper edge of the bleb and the corneal limbus, the distance between the lower edge of the bleb and the corneal limbus, the height of the bleb and Shield＇s test. Results In the thin-wall bleb group, at 3 week after the trabeculectomy, the distance between the lower edge of the bleb and the corneal limbus shortened significantly than that at 1-2 weeks after the surgery （P=0.042）. The area of bleb decreased （P=0.043）. There is no pale area in the bleb. At 1 month after trabeculectomy, the area of bleb decreased significantly （P=0.043）, as well as the height of the bleb （P=0.042）. The pale area increased. At 3 month after trabeculectomy, the pale area increased. Most vessels anastomosed around the margin of the bleb. The wall of the bleb thinned. No significant changes happened at 6 and 12 months after trabeculectomy. In thick-wall bleb group, after 3 weeks, the distance between the upper edge of the bleb and the corneal limbus shortened significantly （P=0.043） and the area of bleb decreased （P=0.043）. Small pale area emerged. After 1 month, the distance between the upper edge of the bleb and the corneal limbus shortened significantly （P=0.042）. The area of bleb decreased （P=0.043）. Vessels around the bleb were dendrimer. No significant changes happened at 3, 6, 12 months after trabeculectomy. Conclu- sion In the 3 months after trabeculectomy, the bleb configuration changed dramatically, The lower edge of the thin-wall bleb invaded in- to the corneal limbus.

关 键 词：青光眼 外科学 薄壁滤过泡 厚壁滤过泡 

分 类 号：R779.6[医药卫生—眼科]