Khamar Mayuri B, Soni Shruti R, Mehta Siddharth V, Srivastava Samaresh, Vasavada Viraj A
Glaucoma Centre, Raghudeep Eye Hospital, Ahmedabad, India.
Indian J Ophthalmol. 2014 Jun;62(6):711-4. doi: 10.4103/0301-4738.136227.
To image trabeculectomy blebs using anterior segment optical coherence tomography (AS-OCT), and to correlate the bleb morphologic features at one month postoperatively with bleb function at six months.
This prospective, observational study included 56 eyes undergoing trabeculectomy with MMC, followed up for minimum of six months. Postoperatively, bleb imaging was done using AS-OCT at one and six month. Bleb morphology was assessed for bleb wall reflectivity, bleb pattern in multiform reflectivity, visibility of drainage route and presence of hyper-reflectivity area. Bleb function was considered successful if IOP was <18 mmHg without medication at six month. Bleb morphology one month postoperatively was correlated with bleb function at six months.
At six months successful bleb function was noted in 44 (81.5%) eyes. Morphology of bleb at one month showed uniform bleb wall reflectivity in 6 eyes (11%) and multiform wall reflectivity in 48 eyes (89%). In eyes with multiform wall reflectivity, microcysts with multiple layers was seen in 26 eyes (48%), microcysts with subconjunctival separation in 12 eyes (22%) and only microcyst in 10 eyes (19%). When bleb features at one month were correlated with the bleb function at six months, logistic regression analysis revealed that blebs with multiform reflectivity with multiple internal layers with microcysts were associated with higher chances of success (P < 0.001).
AS-OCT demonstrated early bleb morphological features that may be used to predict the functioning of a bleb. Multiform bleb wall reflectivity with a pattern of multiple internal layers and microcysts was associated with increased chances of success of a bleb.
使用眼前节光学相干断层扫描（AS-OCT）对小梁切除术后的滤过泡进行成像，并将术后1个月时的滤过泡形态特征与6个月时的滤过泡功能相关联。
这项前瞻性观察性研究纳入了56例行丝裂霉素C小梁切除术的患眼，随访至少6个月。术后，分别在1个月和6个月时使用AS-OCT对滤过泡进行成像。评估滤过泡形态，包括滤过泡壁反射率、多种反射率下的滤过泡模式、引流途径的可见性以及高反射区的存在情况。如果6个月时眼压在未使用药物的情况下<18 mmHg，则认为滤过泡功能成功。将术后1个月时的滤过泡形态与6个月时的滤过泡功能进行相关性分析。
6个月时，44只（81.5%）患眼的滤过泡功能成功。1个月时滤过泡形态显示，6只眼（11%）的滤过泡壁反射率均匀，48只眼（89%）的滤过泡壁反射率多样。在滤过泡壁反射率多样的眼中，26只眼（48%）可见多层微囊肿，12只眼（22%）可见伴有结膜下分离的微囊肿，10只眼（19%）仅见微囊肿。当将1个月时的滤过泡特征与6个月时的滤过泡功能进行相关性分析时，逻辑回归分析显示，具有多层内部微囊肿的多样反射率滤过泡成功的机会更高（P < 0.001）。
AS-OCT可显示早期滤过泡形态特征，这些特征可用于预测滤过泡的功能。具有多层内部结构和微囊肿模式的多样滤过泡壁反射率与滤过泡成功的机会增加相关。
