Kuerten David, Fuest Matthias, Koch Eva C, Remky Andreas, Plange Niklas
Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
Ophthalmic Physiol Opt. 2015 Mar;35(2):194-200. doi: 10.1111/opo.12188. Epub 2014 Dec 20.
Previous reports showed increased flow velocities in retrobulbar vessels after glaucoma surgery in the first weeks. Colour Doppler imaging was performed to investigate the long-term effects of trabeculectomy on retrobulbar haemodynamics in patients with primary open-angle glaucoma (POAG).
In a prospective study 30 patients (mean age 63.2 ± 15.4 years) with POAG were included. Colour Doppler imaging was performed before 1-2 weeks, after 2 months, after 4-6 months, and up to 3 years after trabeculectomy to determine the peak systolic and end-diastolic velocities in the ophthalmic artery, central retinal artery, and the short nasal and temporal posterior ciliary arteries.
Mean follow-up was 416 ± 246 days. In the first postsurgical period mean intraocular pressure (IOP) decreased after trabeculectomy from 25 ± 6 mmHg to 9 ± 4 mm Hg (p < 0.0001) and then increased in the further follow-up to 13 ± 3 mmHg (p < 0.05) without any anti-glaucomatous medication. Colour Doppler imaging revealed a significant increase of the end-diastolic velocities of the central retinal artery at all postoperative visits compared to pre-surgery (p < 0.003) and of the end-diastolic velocities in the temporal posterior ciliary arteries (p < 0.003). The change of blood flow parameters that increased during follow-up was significantly correlated to the change in ocular perfusion pressure and IOP.
End-diastolic velocities of the central retinal artery and of the temporal posterior ciliary arteries increased after successful trabeculectomy and remained stable in a longer period - even if IOP rose significantly in the follow-up.
先前的报告显示，青光眼手术后最初几周球后血管的血流速度增加。进行彩色多普勒成像以研究小梁切除术对原发性开角型青光眼（POAG）患者球后血流动力学的长期影响。
在一项前瞻性研究中，纳入了30例POAG患者（平均年龄63.2±15.4岁）。在小梁切除术前1 - 2周、术后2个月、4 - 6个月以及术后长达3年进行彩色多普勒成像，以确定眼动脉、视网膜中央动脉以及鼻侧和颞侧睫状后短动脉的收缩期峰值速度和舒张末期速度。
平均随访时间为416±246天。在术后第一个阶段，小梁切除术后平均眼压（IOP）从25±6 mmHg降至9±4 mmHg（p < 0.0001），然后在进一步随访中升至13±3 mmHg（p < 0.05），且未使用任何抗青光眼药物。彩色多普勒成像显示，与术前相比，所有术后随访时视网膜中央动脉的舒张末期速度均显著增加（p < 0.003），颞侧睫状后动脉的舒张末期速度也显著增加（p < 0.003）。随访期间血流参数增加的变化与眼灌注压和IOP的变化显著相关。
成功的小梁切除术后，视网膜中央动脉和颞侧睫状后动脉的舒张末期速度增加，并在较长时间内保持稳定——即使随访中IOP显著升高。
