CAJ | 학술논문

目的通过应用眼前节光学相干断层扫描(AS-OCT)对青光眼滤过术后不同时期滤过泡内部结构的观察,了解各种类型滤过泡的内部结构特征和动态变化规律,以期寻找不同形态滤过泡与其功能间关系,为临床诊疗提供客观依据.方法前瞻性分析研究.对2009年3月至2009年12月在北京大学眼科中心行青光眼滤过手术的患者62例(68只眼),年龄从27 ～ 79岁,平均年龄(62.56±14.06)岁,其中男性26例(29只眼),女性36例(39只眼).在术后1d,1周,1个月,3个月,6个月分别行视力,眼压,裂隙灯显微镜和AS-OCT检查.结果 68只眼中有4只眼在术后6个月时眼压高于20 mm Hg,其余64只眼在随访期间眼压均在正常范围.术后1d至术后6个月,滤过泡的总体高度变化差异无统计学意义(P＞0.05),囊壁厚度逐渐增加(P＜0.05),囊壁回声逐渐增强(P＜0.05).AS-OCT能清晰显示滤过泡的内部结构；量化有效滤过泡的各项指标,包括滤过泡总体高度,囊壁的厚度,巩膜瓣下的滤过通道等；显示滤过手术后不同时期滤过泡的动态变化.结论 AS-OCT是评价青光眼术后滤过泡形态的有效工具.探明滤过泡外观、内部结构及其功能的相互关系,有助于为滤过泡的功能维护提供客观参考.
목적 통과응용안전절광학상간단층소묘(AS-OCT)대청광안려과술후불동시기려과포내부결구적관찰,료해각충류형려과포적내부결구특정화동태변화규률,이기심조불동형태려과포여기공능간관계,위림상진료제공객관의거.방법 전첨성분석연구.대2009년3월지2009년12월재북경대학안과중심행청광안려과수술적환자62례(68지안),년령종27 ～ 79세,평균년령(62.56±14.06)세,기중남성26례(29지안),녀성36례(39지안).재술후1d,1주,1개월,3개월,6개월분별행시력,안압,렬극등현미경화AS-OCT검사.결과 68지안중유4지안재술후6개월시안압고우20 mm Hg,기여64지안재수방기간안압균재정상범위.술후1d지술후6개월,려과포적총체고도변화차이무통계학의의(P＞0.05),낭벽후도축점증가(P＜0.05),낭벽회성축점증강(P＜0.05).AS-OCT능청석현시려과포적내부결구；양화유효려과포적각항지표,포괄려과포총체고도,낭벽적후도,공막판하적려과통도등；현시려과수술후불동시기려과포적동태변화.결론 AS-OCT시평개청광안술후려과포형태적유효공구.탐명려과포외관、내부결구급기공능적상호관계,유조우위려과포적공능유호제공객관삼고.
Objective To quantify changes in filtering bleb morphology after trabeculectomy using anterior segment optical coherence tomography (AS-OCT). Methods This was a prospective observational case series of patients who underwent trabeculectomy surgery with mitomycin-C.Sixty-two subjects (68 eyes) who fulfilled inclusion criteria were enrolled in this study.Mean age of the patients was (62.56±14.06) years (range,27-79 years).Subjects were assessed before and at 1 day,1 week,1 month,3 months and 6 months after the surgery.At each visit,a standardized cross-sectional AS-OCT image of the bleb was obtained,from which a masked observer measured bleb height,cavity height,wall thickness,and the internal reflectivity of the filtering passage using custom software. Results Average postoperative Intraocular pressures (IOP) at each visit was within normal limits.IOP in 4 eyes was above 20mmHg at 6 months in all 68 cases.During the 6 months follow-up duration,no significant changes on total height of filtering bleb were found (P ＞ 0.05).There was a significant increase in thickness of bleb wall (P ＜0.05) and the reflectivity of the bleb wall (P ＜0.05).The internal structure of filtering bleb was displayed clearly in the images of AS-OCT.AS-OCT also showed the dynamic changes of filtering bleb after the surgery. Conclusions AS-OCT is able to quantify changes in bleb morphology after trabeculectomy,and offer a basis for the evaluation of eventual outcome and function of the filtering bleb.