Marchini G, Marraffa M, Brunelli C, Morbio R, Bonomi L
The Eye Clinic, Department of Neurological and Vision Sciences, University of Verona, Verona, Italy.
J Cataract Refract Surg. 2001 Apr;27(4):507-17. doi: 10.1016/s0886-3350(00)00857-9.
To evaluate the anatomic characteristics and intraocular pressure (IOP) lowering mechanisms of deep sclerectomy with reticulated hyaluronic acid implant (DS with RHAI) using ultrasound biomicroscopy (UBM).
Eye Clinic, Department of Neurological and Vision Sciences, University of Verona, Verona, Italy.
Thirty patients with primary open-angle glaucoma not controlled by medical therapy had DS with RHAI in 1 eye. A complete ocular examination and UBM study were performed 1, 3, 6, and 12 months postoperatively and thereafter at 6 month intervals. Eleven parameters were evaluated, the most important of which were IOP, surgical success in lowering IOP to 21 mm Hg or less with or without additional medical therapy, UBM appearance of the site of DS with RHAI, size of the decompression space, presence of a filtering bleb and supraciliary hypoechoic area, and scleral reflectivity around the decompression space.
After a mean follow-up of 11.4 months +/- 4.7 (SD), the mean percentage reduction in IOP compared to preoperatively was 38% (from 26 +/- 4.5 mm Hg to 16.2 +/- 3.8 mm Hg; P =.0001). Twenty-four patients (80%) had an IOP less than 21 mm Hg; however, 7 of these eyes (23%) required additional IOP-lowering medical therapy. The operation failed in 6 patients (20%) despite additional therapy. Ultrasound biomicroscopy revealed a reduction in the size of the decompression space from 6 months postoperatively and its disappearance in 2 cases. The difference in size at the last follow-up and at 1 month postoperatively (maximum length 2.41 +/- 1.02 mm versus 3.53 +/- 0.51 mm) was significant (P =.0001). At the last examination, a filtering bleb was present in 18 patients (60%), a supraciliary hypoechoic area in 18 (60%), and hyporeflectivity of the scleral tissue around the decompression space in 14 (47%). These 3 UBM characteristics were detected singly and in various combinations. The simultaneous presence of all 3 characteristics in the same eye correlated significantly with a higher surgical success rate (P =.004).
Ultrasound biomicroscopy showed that filtering bleb formation was frequent in eyes having DS with RHAI but that it was not the only surgically induced IOP-lowering mechanism. Increased uveoscleral and transscleral filtration may be equally important.
使用超声生物显微镜（UBM）评估带网状透明质酸植入物的深层巩膜切除术（DS联合RHAI）的解剖学特征及降低眼压（IOP）的机制。
意大利维罗纳大学神经与视觉科学系眼科诊所。
30例药物治疗无法控制的原发性开角型青光眼患者的1只眼睛接受了DS联合RHAI手术。术后1、3、6和12个月以及之后每隔6个月进行一次全面的眼部检查和UBM研究。评估了11项参数，其中最重要的是眼压、在使用或不使用额外药物治疗的情况下将眼压降低至21 mmHg或更低的手术成功率、DS联合RHAI部位的UBM表现、减压空间的大小、滤过泡和睫状体上低回声区的存在情况以及减压空间周围巩膜的反射率。
平均随访11.4个月±4.7（标准差）后，与术前相比，眼压平均降低百分比为38%（从26±4.5 mmHg降至16.2±3.8 mmHg；P = 0.0001）。24例患者（80%）的眼压低于21 mmHg；然而，其中7只眼睛（23%）需要额外的降眼压药物治疗。尽管进行了额外治疗，仍有6例患者（20%）手术失败。超声生物显微镜显示，术后6个月减压空间大小减小，2例减压空间消失。最后一次随访时与术后1个月时的大小差异（最大长度2.41±1.02 mm对3.53±0.51 mm）具有显著性（P = 0.0001）。在最后一次检查时，18例患者（60%）有滤过泡，18例（60%）有睫状体上低回声区，14例（47%）减压空间周围巩膜组织反射率降低。这3项UBM特征单独或多种组合出现。同一只眼睛中同时出现这3项特征与较高的手术成功率显著相关（P = 0.004）。
超声生物显微镜显示，DS联合RHAI手术的眼睛中滤过泡形成很常见，但它不是唯一的手术诱导性降眼压机制。葡萄膜巩膜和经巩膜滤过增加可能同样重要。
