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
孙毅 1朱敬 1郭娟 1何元旭 1王展峰1
作者信息
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.
Abstract
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Key words
Glaucoma/Trabeculectomy/Anterior segment optical coherence tomography/Filtering bleb引用本文复制引用
基金项目
四川省卫生和计划生育委员会科研课题(18PJ088)
出版年
2024
国家科技期刊平台
NSTL
万方数据