CAJ | 학술논문

目的：应用眼前段相干光断层成像（ AS-OCT）检测改良黏小管切开术（ VCO）术后手术区域组织结构及滤道，以讨论改良黏小管切开术降眼压的机制。方法横断面研究。研究对象为术后从3～72个月的38例（55只眼）开角型青光眼，均为术前药物控制不良的开角型青光眼。11只眼（20％）因眼压高行Nd：YAG激光房角穿孔术。同时进行视力、眼压、裂隙灯、眼底和AS-OCT检查。 AS-OCT的检测指标为：①滤过泡形态，②巩膜池的长、宽、高，③脉络膜上腔，④泪河高度。结果患者术后眼压（15.4±4.9） mm Hg较术前（31.0±10．9） mm Hg明显下降，42只眼有弥散的滤泡。 AS-OCT证明了结膜瓣下腔隙的存在，39只眼（70．9％）检测到巩膜池，巩膜池的平均体积为1.09 mm3（0.04～0．203 mm3）。结论 AS-OCT检查证明了改良VCO房水引流的可能机制。扁平弥散的结膜下腔隙证明了持续的滤过，为眼外引流；39只眼（70．9％）存在巩膜池。巩膜池的体积与眼压无关，提示脉络膜上腔可能是主要的房水眼内引流途径。
목적：응용안전단상간광단층성상（ AS-OCT）검측개량점소관절개술（ VCO）술후수술구역조직결구급려도，이토론개량점소관절개술강안압적궤제。방법횡단면연구。연구대상위술후종3～72개월적38례（55지안）개각형청광안，균위술전약물공제불량적개각형청광안。11지안（20％）인안압고행Nd：YAG격광방각천공술。동시진행시력、안압、렬극등、안저화AS-OCT검사。 AS-OCT적검측지표위：①려과포형태，②공막지적장、관、고，③맥락막상강，④루하고도。결과환자술후안압（15.4±4.9） mm Hg교술전（31.0±10．9） mm Hg명현하강，42지안유미산적려포。 AS-OCT증명료결막판하강극적존재，39지안（70．9％）검측도공막지，공막지적평균체적위1.09 mm3（0.04～0．203 mm3）。결론 AS-OCT검사증명료개량VCO방수인류적가능궤제。편평미산적결막하강극증명료지속적려과，위안외인류；39지안（70．9％）존재공막지。공막지적체적여안압무관，제시맥락막상강가능시주요적방수안내인류도경。
Objective The aim of this study was to reveal structural and mechanical changes of outflow pathways after modified viscocanalostomy (modified VCO) using anterior segment optical coherence tomography (AS-OCT).Meth-ods Fifty-five eyes of 38 patients with medically uncontrolled open-angle glaucoma received modified VCO .Eleven eyes (20%) also received Nd:YAG laser goniopuncture to further control intraocular pressure ( IOP) .Postoperative follow-up included complete ophthalmic examinations and AS-OCT scan of the filtering site .The following assessments were done with AS-OCT:1) dimensions of subconjunctival filtering bleb;2) volume of intrascleral cavity;3) volume of suprachoroidal space;4) height of tear meniscus .Results Intraocular pressure decreased significantly from 31.0 ±10.9 mmHg to 15.4 ±4.9mmHg.AS-OCT demonstrated a subconjunctival space in forty-two eyes.In 39 eyes (70.9%) an intrascleral cavity was observed.The mean volume of this cavity was 1.09 mm3(0.04-0.203 mm3).Conclusion AS-OCT revealed several possible pathways for aqueous humour drainage after modified VCO .A flat, diffuse subconjunctival space indicated persis-tent drainage.Thirty-nine eyes (70.9%) exhibited a remaining intrascleral cavity , whose volume was unrelated to IOP , suggesting that suprachoroidal outflow may be the main outflow pathway after modified VCO .