Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho, Chuo-ku, Kobe, Japan.
Curr Eye Res. 2012 Mar;37(3):239-50. doi: 10.3109/02713683.2011.635403.
PURPOSE/AIM: To determine whether amniotic membrane transplantation (AMT) at trabeculectomy affects intrableb structures and which intrableb parameters are significantly correlated with the long-term intraocular pressure (IOP) control.
Enrolled were 64 eyes of 56 glaucoma patients who underwent trabeculectomy without (36 eyes) or with (28 eyes) AMT. Bleb structure was evaluated by ultrasound biomicroscopy (UBM) at least one year after surgery. IOP control was defined as good when the eyes had a more than 30% decrease in the preoperative IOP and an IOP value <18 mmHg if the preoperative IOP was higher than 21 mmHg. Logistic regression analyses were conducted to identify factors significantly associated with IOP control.
Intervals between surgery and the timing of the UBM examinations (median; 2.5 years) and the overall frequency of good IOP control (28/36 in the eyes without AMT and 17/28 in those with AMT; chi-square test, P = 0.2276) were similar in the two groups. The eyes with AMT had a significantly lower number of type H (high reflective) or L (low reflective) blebs and a higher number of type E (encapsulated) blebs compared to those without AMT (P < 0.0001). Among independent variables, which included age, sex, glaucoma type, lens status, the number of ocular hypotensives, and previous intraocular surgeries, only type F (flattened) bleb in eyes without AMT (P = 0.0008, odds ratio [OR] = 0.0256) and no or limited intrableb fluid-filled space in eyes with AMT were significantly associated with poor IOP control (P = 0.0026, OR = 0.0111, and 0.0071, 0.0167, respectively).
Intrableb structures after trabeculectomy alone versus AMT-assisted trabeculectomy were distinct. The bleb wall reflectivity in the former and the extent of the subconjunctival fluid-filled space in the latter were factors associated with long-term IOP control.
确定在小梁切除术时进行羊膜移植（AMT）是否会影响滤过泡结构，以及哪些滤过泡参数与长期眼压（IOP）控制显著相关。
纳入了 56 名青光眼患者的 64 只眼，这些患者均接受了小梁切除术，其中 36 只眼未进行 AMT，28 只眼进行了 AMT。术后至少一年通过超声生物显微镜（UBM）评估滤过泡结构。如果术后眼内压较术前降低超过 30%，或术前眼内压高于 21mmHg 时眼内压值低于 18mmHg，则将眼压控制定义为良好。采用逻辑回归分析来确定与眼压控制显著相关的因素。
手术与 UBM 检查时间（中位数；2.5 年）以及两组中良好眼压控制的总体频率（无 AMT 的眼为 28/36，有 AMT 的眼为 17/28；卡方检验，P=0.2276）相似。与无 AMT 的眼相比，有 AMT 的眼的 H 型（高反射）或 L 型（低反射）滤过泡数量明显较少，E 型（包裹）滤过泡数量较多（P<0.0001）。在包括年龄、性别、青光眼类型、晶状体状态、降眼压药物数量和既往眼内手术等独立变量中，仅无 AMT 的眼的 F 型（扁平）滤过泡（P=0.0008，优势比[OR]=0.0256）和有 AMT 的眼的无或有限的结膜下液充满空间与不良的眼压控制显著相关（P=0.0026，OR=0.0111，0.0071，0.0167，分别）。
单独行小梁切除术与 AMT 辅助小梁切除术的滤过泡结构不同。前者滤过泡壁的反射率和后者结膜下液充满空间的程度是与长期眼压控制相关的因素。
