使用AS-OCT评价小梁切除术后滤过泡形态指标的临床意义  

The clinical significance of evaluating the morphological features of filtering blebs after trabeculectomy using anterior segment optical coherence tomography

作　　者：孙毅 朱敬 郭娟[1] 何元旭[1] 王展峰[1] Sun Yi;Zhu Jing;Guo Juan;He Yuanxu;Wang Zhanfeng(Depart-ment of Ophthalmology,Chengdu Third People's Hospital,Chengdu 610031,China)

机构地区：[1]成都市第三人民医院眼科,610031

出　　处：《临床眼科杂志》2024年第3期221-228,共8页Journal of Clinical Ophthalmology

基　　金：四川省卫生和计划生育委员会科研课题(18PJ088)。

摘　　要：目的探讨眼前节相干光层析成像光术(AS⁃OCT)测量青光眼小梁切除术后滤过泡形态指标与眼压及手术结果的关系。方法前瞻性病例研究。对小梁切除术后患者于术后1年进行6次随访,使用AS⁃OCT辅助获得常见滤过泡形态学指标。分析所有指标的变化趋势,以及与眼压及手术结果的关系。结果术后1年眼压和形态学数据分布中,术后2周眼压显著低于术后3、6、12个月(P<0.00238)。术后2周微囊泡变分布广泛的患者最多,无微囊泡的患者最少。在术后1年内扁平⁃轻度隆起的滤过泡占比逐渐增加,“宽”滤过泡的占比逐渐下降。结膜下囊泡多的患者术后6个月后逐渐减少。术后2周时包囊范围、血管化、微囊泡变范围皆为眼压的影响因素(P<0.05);术后2周的AS⁃OCT下形态分类是远期手术结果的影响因素(P<0.001)。结论AS⁃OCT用于检测滤过泡准确有效。术后2周滤过泡形态为弥散型更易获得远期成功,包囊型更易获得手术失败。Objective To investigate the relationship between the morphological characteristics of the filtering bleb following trabeculectomy and intraocular pressure and surgical outcome.Methods A prospective study.Patients who had undergone trabeculectomy were followed six times over one year.Morphologic features were assessed by anterior seg⁃ment optical coherence tomography(AS⁃OCT).The variance of each feature,the relationships between features and intra⁃ocular pressure(IOP),and the surgical outcomes were investigated.Results IOP at postoperative week 2 was signifi⁃cantly lower than at postoperative 3,6 and 12 months(P<0.00238).Patients with a broader distribution of microcysts were predominant at two weeks postoperatively,while those without microcysts were the least prevalent.The proportion of blebs with flat-mild bulge gradually increased within 1-year postoperatively,while the proportion of“wide”blebs gradually decreased.Patients with more subconjunctival cysts gradually decreased after 6 months postoperatively.At postoperative week 2,the indicator of IOP is encapsulation,vascularity,and microcysts(P<0.05).Morphological classification under AS⁃OCT at two weeks postoperatively was a significant predictor of long-term surgical outcomes(P<0.001).Conclu⁃sions AS⁃OCT is an effective tool for evaluating blebs.Diffuse blebs at postoperative 2 weeks are more likely to achieve long-term success,while encapsulated blebs are more likely to fail.

关 键 词：青光眼 小梁切除术 眼前节相干光层析成像术 滤过泡 

分 类 号：R779.6[医药卫生—眼科]