Kawana Keisuke, Kiuchi Takahiro, Yasuno Yoshiaki, Oshika Tetsuro
Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba,1-1-1 Tennoudai, Tsukuba, Ibaraki, Japan.
Ophthalmology. 2009 May;116(5):848-55. doi: 10.1016/j.ophtha.2008.11.019. Epub 2009 Mar 5.
To investigate the internal structures of trabeculectomy blebs using 3-dimensional cornea and anterior segment optical coherence tomography (3-D CAS OCT).
Observational case series.
Thirty-eight filtering blebs in 31 patients who had undergone trabeculectomy examined retrospectively.
Intrableb structures were examined using 3-D CAS OCT. The blebs were classified clinically as successful (intraocular pressure [IOP] <18 mmHg without glaucoma medication) or failed.
Bleb structures were assessed in terms of the visibility of the drainage route, scleral flap, and microcysts. The length and height of the internal fluid-filled cavity, maximum and minimum bleb wall thickness, total bleb height, volumes of the internal fluid-filled cavity and hyporeflective area, and number of microcysts were analyzed.
Intrableb drainage route, scleral flap, and microcysts were observed in 92.1%, 94.7%, and 86.8% eyes, respectively. The IOP showed a significant negative correlation with horizontal and vertical length of the fluid-filled cavity (Spearman correlation coefficient [r(s)] = -0.634; P<0.0001; and r(s) = -0.539; P = 0.0008, respectively), height of the fluid-filled cavity (r(s) = -0.334; P = 0.031), maximum bleb wall thickness (r(s) = -0.491; P = 0.0023), total bleb height (r(s) = -0.629; P<0.0001), volume of the internal fluid-filled cavity (r(s) = -0.480; P = 0.0029), volume of hyporeflective area (r(s) = -0.443; P = 0.0056), and number of microcysts (r(s) = -0.451; P = 0.0045). There were 26 successful (64.8%) and 12 failed (31.6%) blebs. Significant differences were observed between these groups in IOP (P<0.0001), horizontal and vertical length of the fluid-filled cavity (P<0.0001 and P = 0.0019, respectively), height of the fluid-filled cavity (P = 0.0046), maximum bleb wall thickness (P = 0.0029), total bleb height (P = 0.0003), volume of the internal fluid-filled cavity (P = 0.0006), volume of hyporeflective area (P = 0.0020), and number of microcysts (P = 0.0025).
The internal aqueous humor outflow channel and scleral flap could be visualized, and the 3-D volume of the intrableb cavity was calculated using 3-D CAS OCT. The successful blebs exhibited a large internal fluid-filled cavity, an extensive hyporeflective area, and thicker bleb walls with more microcysts.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
使用三维角膜和眼前节光学相干断层扫描（3-D CAS OCT）研究小梁切除术滤过泡的内部结构。
观察性病例系列。
回顾性检查31例行小梁切除术患者的38个滤过泡。
使用3-D CAS OCT检查滤过泡内结构。临床上将滤过泡分为成功（眼压[IOP]<18 mmHg且未使用青光眼药物）或失败。
根据引流途径、巩膜瓣和微囊肿的可见性评估滤过泡结构。分析内部液腔的长度和高度、滤过泡壁的最大和最小厚度、滤过泡总高度、内部液腔和低反射区的体积以及微囊肿数量。
分别在92.1%、94.7%和86.8%的眼中观察到滤过泡内引流途径、巩膜瓣和微囊肿。眼压与液腔的水平和垂直长度（Spearman相关系数[r(s)]=-0.634；P<0.0001；r(s)=-0.539；P = 0.0008）、液腔高度（r(s)=-0.334；P = 0.031）、滤过泡壁最大厚度（r(s)=-0.491；P = 0.0023）、滤过泡总高度（r(s)=-0.629；P<0.0001）、内部液腔体积（r(s)=-0.480；P = 0.0029）、低反射区体积（r(s)=-0.443；P = 0.0056）以及微囊肿数量（r(s)=-0.451；P = 0.0045）呈显著负相关。有26个成功（64.8%）和12个失败（31.6%）的滤过泡。这些组在眼压（P<0.0001）、液腔的水平和垂直长度（分别为P<0.0001和P = 0.0019）、液腔高度（P = 0.0046）、滤过泡壁最大厚度（P = 0.0029）、滤过泡总高度（P = 0.0003）、内部液腔体积（P = 0.0006）、低反射区体积（P = 0.0020）以及微囊肿数量（P = 0.0025）方面存在显著差异。
使用3-D CAS OCT可观察到房水流出的内部通道和巩膜瓣，并计算滤过泡内的三维体积。成功的滤过泡表现为较大的内部液腔、广泛的低反射区以及更厚的滤过泡壁和更多的微囊肿。
作者对本文讨论的任何材料均无所有权或商业利益。
