Mansouri Kaweh, Mendrinos Efstratios, Shaarawy Tarek, Dosso Andre A
Glaucoma Sector, Department of Ophthalmology, University of Geneva, Geneva, Switzerland.
Arch Ophthalmol. 2011 Oct;129(10):1305-10. doi: 10.1001/archophthalmol.2011.275.
To evaluate the morphologic characteristics of the trabeculo-Descemet membrane (TDM) by in vivo confocal microscopy (IVCM) after deep sclerectomy with collagen implant and to correlate the findings with the intraocular pressure (IOP)-lowering effect of goniopuncture.
Twenty eyes of 19 patients were evaluated in a prospective, observational case series. Examination using IVCM and measurement of IOP were performed 15 minutes before and 15 minutes after Nd:YAG goniopuncture.
Two groups could be distinguished on the basis of morphologic characteristics of the TDM before goniopuncture. In group 1 (13 eyes), the TDM was characterized by the presence of an area of epithelial cells in the deep stromal level. After goniopuncture, an opening at the TDM with dispersed epithelial cells was visible. In group 2 (7 eyes), fibrotic tissue overlying the TDM was observed in all cases, and no openings were visible after goniopuncture. Group 1 had a statistically significant decrease in mean (SD) IOP after goniopuncture (21.6 [4.8] mm Hg before and 13.5 [4.6] mm Hg after, P = .008); there was no significant change in group 2 (19.2 [4.3] mm Hg before and 20.8 [7.5] mm Hg after, P = .30). There was a strong correlation between the presence of fibrous tissue and percentage of IOP lowering after goniopuncture (ρ = -0.89, P < .001).
The presence of fibrotic tissue covering the TDM is associated with failure of goniopuncture. Use of IVCM may be valuable in predicting the efficacy of goniopuncture in patients with elevated IOP after deep sclerectomy with collagen implant.
通过体内共焦显微镜（IVCM）评估胶原植入物深层巩膜切除术后小梁-Descemet膜（TDM）的形态学特征，并将结果与前房穿刺降低眼压（IOP）的效果相关联。
在一项前瞻性观察性病例系列研究中对19例患者的20只眼进行了评估。在Nd:YAG前房穿刺前15分钟和穿刺后15分钟使用IVCM进行检查并测量眼压。
根据前房穿刺前TDM的形态学特征可区分出两组。在第1组（13只眼）中，TDM的特征是在深层基质水平存在上皮细胞区域。前房穿刺后，可见TDM处有开口且上皮细胞分散。在第2组（7只眼）中，所有病例均观察到覆盖TDM的纤维化组织，前房穿刺后未见开口。第1组前房穿刺后平均（标准差）眼压有统计学意义的下降（穿刺前为21.6 [4.8] mmHg，穿刺后为13.5 [4.6] mmHg，P = 0.008）；第2组无显著变化（穿刺前为19.2 [4.3] mmHg，穿刺后为20.8 [7.5] mmHg，P = 0.30）。纤维化组织的存在与前房穿刺后眼压降低百分比之间存在强相关性（ρ = -0.89，P < 0.001）。
覆盖TDM的纤维化组织的存在与前房穿刺失败相关。IVCM的应用可能有助于预测胶原植入物深层巩膜切除术后眼压升高患者前房穿刺的疗效。
