Theelen Thomas, Wesseling Pieter, Keunen Jan E E, Klevering B Jeroen
Department of Ophthalmology, Radboud University Nijmegen Medical Centre, Philips van Leydenlaan 15, 6525, Nijmegen, The Netherlands.
Graefes Arch Clin Exp Ophthalmol. 2007 Jun;245(6):877-82. doi: 10.1007/s00417-006-0476-2. Epub 2006 Nov 22.
Our study aims to identify anatomical characteristics of glaucoma filtering blebs by means of slit lamp-adapted optical coherence tomography (SL-OCT) and to identify new parameters for the functional prognosis of the filter in the early post-operative period.
Patients with primary open-angle glaucoma, aged 18 years and older, scheduled for primary trabeculectomy at the Department of Ophthalmology, Radboud University Nijmegen Medical Centre, were considered for our study. All patients underwent standardized trabeculectomy with intra-operative application of mitomycin C. The filtering blebs were evaluated clinically and with SL-OCT on day 1 and 1, 2, 4 and 12 weeks following surgery. The resulting data were analysed and weighed against surgical success. To better understand the SL-OCT data a small comparative histologic study was performed.
The study included 20 eyes of 20 patients. After completion of our study, 15 eyes of 15 patients (mean age+/-SD 67 +/- 16 years) were eligible for data analysis and 5 eyes missed at least one follow-up visit. Filtering surgery was considered successful (intraocular pressure < or = 21 mmHg without antiglaucomatous medication) in 11 of 15 eyes. SL-OCT frequently demonstrated multiple hypo-reflective layers within Tenon's capsule ("striping" phenomenon) in the first post-operative week. Presumably, these layers corresponded with drainage channels in the histological specimen. These channels were present in functional filters but not in the failures. In addition, the visualisation of the sclera below the filtering zone was better defined in failures compared with successful filtering blebs ("shading" phenomenon). We observed no differences in the volume and clinical aspect of the blebs in the successful group compared with the unsuccessful group.
Successful filtering blebs show characteristic optical properties on SL-OCT. These phenomena suggest a diffusely enhanced fluid content and the presence of intra-bleb drainage channels in functional filtering blebs.
我们的研究旨在通过裂隙灯适配光学相干断层扫描（SL-OCT）确定青光眼滤过泡的解剖特征，并确定滤过功能早期预后的新参数。
纳入奈梅亨拉德堡大学医学中心眼科计划进行原发性小梁切除术的18岁及以上原发性开角型青光眼患者。所有患者均接受标准化小梁切除术并术中应用丝裂霉素C。术后第1天以及术后1、2、4和12周对滤过泡进行临床评估和SL-OCT检查。对所得数据进行分析，并与手术成功率进行权衡。为更好地理解SL-OCT数据，进行了一项小型对比组织学研究。
该研究纳入了20例患者的20只眼。研究完成后，15例患者的15只眼（平均年龄±标准差67±16岁）符合数据分析条件，5只眼至少错过一次随访。15只眼中有11只眼的滤过手术被认为成功（眼压≤21 mmHg且未使用抗青光眼药物）。SL-OCT在术后第一周经常显示在Tenon囊内有多个低反射层（“条纹”现象）。据推测，这些层与组织学标本中的引流通道相对应。这些通道存在于功能性滤过泡中，而在失败的滤过泡中不存在。此外，与成功的滤过泡相比，失败的滤过泡中滤过区下方巩膜的可视化更清晰（“阴影”现象）。我们观察到成功组与失败组的滤过泡体积和临床外观无差异。
成功的滤过泡在SL-OCT上显示出特征性光学特性。这些现象表明功能性滤过泡中液体含量弥漫性增加且存在泡内引流通道。
