Department of Surgical Sciences and Odontostomatology, Eye Clinic, University of Cagliari, Cagliari, Italy.
Department of Surgical Sciences and Odontostomatology, Eye Clinic, University of Cagliari, Cagliari, Italy.
Can J Ophthalmol. 2014 Apr;49(2):210-6. doi: 10.1016/j.jcjo.2013.10.003.
To provide a qualitative and quantitative analysis of filtering blebs with optical coherence tomography (OCT) in patients after primary trabeculectomy.
Evaluation of diagnostic technology.
We retrospectively studied 20 eyes of 20 patients who had a fornix-based flap in primary trabeculectomy: 14 with mitomycin C (MMC) and 6 without MMC.
Filtering blebs were examined using 2 types of OCTs working at a wavelength of 840 and 1310 nm. In this study, we analyzed both the OCT morphologic pattern and the internal structures of blebs, including bleb wall thickness, scleral flap thickness, and the route under the scleral flap, and quantified the reflectivity of the intrableb area.
Blebs were classified according to the Hirooka scheme in 3 OCT morphologic patterns: cystoid, diffuse, and layer type. The MMC was associated with the surgical success (100%). A significant association was found between good functionality and cystoid type with both devices: 840-nm OCT (p = 0.02) and 1310-nm OCT (p = 0.04). A significant difference in morphologic patterns was found using the 2 OCTs. There were no significant differences between successful and unsuccessful filtering surgery for intrableb structures. The reflectivity of filtering blebs correlated very well to the postoperative intraocular pressure (IOP; R(2) = 0.90; p < 0.001) and to the reduction of IOP (R(2) = 0.58; p = 0.001). Our method to quantify the reflectivity showed a significant degree of intergrader consensus (intraclass correlation coefficient = 0.99; p < 0.001).
Although 840-nm OCT was not developed to assess the anterior segment, it may be considered a useful tool to evaluate the functionality of blebs in the postoperative period.
利用光学相干断层扫描（OCT）对原发性小梁切除术后患者的滤过泡进行定性和定量分析。
诊断技术评估。
我们回顾性研究了 20 例 20 只眼，这些患者均在原发性小梁切除术中行穹窿部结膜瓣：14 例使用丝裂霉素 C（MMC），6 例未使用 MMC。
使用两种工作波长为 840nm 和 1310nm 的 OCT 检查滤过泡。在这项研究中，我们同时分析了 OCT 形态和滤过泡的内部结构，包括滤过泡壁厚度、巩膜瓣厚度和巩膜瓣下的路径，并对滤过泡内区域的反射率进行了量化。
滤过泡根据 Hirooka 方案分为 3 种 OCT 形态类型：囊样型、弥漫型和层状型。MMC 与手术成功（100%）相关。两种 OCT 均发现功能良好与囊样型之间存在显著相关性：840nm OCT（p=0.02）和 1310nm OCT（p=0.04）。两种 OCT 均发现形态类型存在显著差异。滤过泡内结构在手术成功和失败之间没有显著差异。滤过泡的反射率与术后眼压（IOP；R²=0.90；p<0.001）和 IOP 降低（R²=0.58；p=0.001）密切相关。我们用于量化反射率的方法显示出显著的评分者间一致性（组内相关系数=0.99；p<0.001）。
尽管 840nm OCT 不是为评估眼前节而开发的，但它可以被认为是评估术后滤过泡功能的有用工具。
