CAJ | 학술논문

目的观察原发性闭角型青光眼小梁切除术后1个月时结膜滤过泡形态与术后24h眼压(IOP)的关系.方法对46例施行小梁切除术的原发性闭角型青光眼患者进行随访观察.采用IBAGS滤过泡分级系统(Indiana Bleb Grading Scale,IBAGS)对术后1个月的滤过泡进行记录,应用Goldmann压平眼压计进行眼压测量.采用线性回归分析方法检验滤过泡与24 h眼压的关系,采用t检验的方法对有无微囊结构滤过泡的24 h眼压进行比较.结果线性回归分析显示滤过泡高度(H)每增加1分术后24 h眼压波动值将降低0.60 mm Hg(95％可信区间为-1.183～-0.024),滤过泡范围(E)每增加1分术后24 h眼压波动值将降低0.66 mm Hg(95％可信区间为-1.193～-0.122),滤过泡面积(即大小H+E)每增加1分术后24 h眼压波动值将降低0.43 mm Hg(95％可信区间为-0.756～-0.109),术后具有微囊结构的滤过泡其眼压波动范围较无微囊结构者平均降低1.02 mm Hg(95％可信区间为-1.876～-0.156).具有微囊特征滤过泡的患者上午10点的IOP、24h IOP平均值、波动值、24 h IOP 最大值及最小值均较无微囊者为理想(P值分别为0.0058、0.0039、0.0019、0.0014、0.0211.),差异有统计学意义.所有患者中仅有一例发生滤过泡渗漏.结论滤过泡形态与术后24 h眼压具有一定的相关性.滤过泡的高度,范围及面积对术后24 h眼压的影响最明显.同时具有微囊结构滤过泡的病例术后24 h眼压控制良好.
목적 관찰원발성폐각형청광안소량절제술후1개월시결막려과포형태여술후24h안압(IOP)적관계.방법 대46례시행소량절제술적원발성폐각형청광안환자진행수방관찰.채용IBAGS려과포분급계통(Indiana Bleb Grading Scale,IBAGS)대술후1개월적려과포진행기록,응용Goldmann압평안압계진행안압측량.채용선성회귀분석방법검험려과포여24 h안압적관계,채용t검험적방법대유무미낭결구려과포적24 h안압진행비교.결과 선성회귀분석현시려과포고도(H)매증가1분술후24 h안압파동치장강저0.60 mm Hg(95％가신구간위-1.183～-0.024),려과포범위(E)매증가1분술후24 h안압파동치장강저0.66 mm Hg(95％가신구간위-1.193～-0.122),려과포면적(즉대소H+E)매증가1분술후24 h안압파동치장강저0.43 mm Hg(95％가신구간위-0.756～-0.109),술후구유미낭결구적려과포기안압파동범위교무미낭결구자평균강저1.02 mm Hg(95％가신구간위-1.876～-0.156).구유미낭특정려과포적환자상오10점적IOP、24h IOP평균치、파동치、24 h IOP 최대치급최소치균교무미낭자위이상(P치분별위0.0058、0.0039、0.0019、0.0014、0.0211.),차이유통계학의의.소유환자중부유일례발생려과포삼루.결론 려과포형태여술후24 h안압구유일정적상관성.려과포적고도,범위급면적대술후24 h안압적영향최명현.동시구유미낭결구려과포적병례술후24 h안압공제량호.
Objective To observe the correlation of the morphologic appearance of blebs after trabeculectomy in the first postoperative month with the outcome of 24-hour IOP among patients with PACG after trabeculectomy.Methods A total of 46 patients of PACG were included for the analysis after trabeculectomy.The bleb morphology in the first month after trabeculectomy was graded with the Indian Bleb Appearance Grading Scale based on standard photos.IOP were measured by Goldmann applanation tonometer.The correlation between postoperative different filtering bleb characteristics and 24-hour IOP were tested by linear regression analysis.The 24-hour IOP with or without microcysts were compared by t test.Results On the linear regression analysis an increase in IBAGS height score by 1U resulted in a reduction in 24-hour IOP fluctuation of 0.60mmHg [95％ confidence interval (CI)=-1.183～-0.024].An increase in IBAGS extent score by 1U resulted in a reduction in 24-hour IOP fluctuation of 0.66mmHg [95％ CI=-1.193～-0.122].An increase in IBAGS size (H+E) score by 1U resulted in a reduction in 24-hour IOP fluctuation of 0.43mmHg [95％ CI=-0.756～-0.109].In the model,bleb with microcysts had 1.02mmHg lower of 24-hour IOP fluctuation value [95％ CI=-1.876～-0.156] than those without microcysts in the third postoperative month.The IOP during regular office hours,the mean IOP,fluctuation value,the maximum and the minimum of 24-hour IOP with microcysts were lower than those without microcysts (P valuc were 0.0058,0.0039,0.0019,0.0014,and 0.0211 respectively).This difference was statistically significant.There were only one bleb leak in this series.Conclusions The bleb morphology and 24-hour IOP has a certain correlation.Bleb heigh,extent,size and microcysts are the most important factors to influence 24-hour IOP.