Gulati Vikas, Fan Shan, Gardner Bret J, Havens Shane J, Schaaf Marie T, Neely Donna G, Toris Carol B
Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, United States.
Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, United States 2Case Western Reserve University, Cleveland, Ohio, United States.
Invest Ophthalmol Vis Sci. 2017 Mar 1;58(3):1462-1468. doi: 10.1167/iovs.16-20710.
This study was designed to evaluate the changes in aqueous humor dynamics (AHD) produced by selective laser trabeculoplasty (SLT) and to explore if baseline AHD parameters are predictive of IOP response to SLT.
Thirty-one consecutive subjects diagnosed with ocular hypertension or primary open-angle glaucoma scheduled to undergo SLT as their primary IOP-lowering therapy were enrolled in this prospective observational study. Subjects underwent baseline assessment of AHD in both eyes. Variables assessed were IOPs at 9 AM and noon, aqueous humor flow rate (fluorophotometry), episcleral venous pressure (EVP, venomanometry), outflow facility (pneumatonography and fluorophotometry) and uveoscleral outflow (calculated using modified Goldmann equation). All subjects underwent 360 degrees SLT and AHD measurements were repeated 3 months later.
Compared with baseline, IOPs after SLT were significantly lower at 9 AM (22.9 ± 5.1 vs. 19.7 ± 3.0 mm Hg; P = 0.001) and noon (23.4 ± 4.6 vs. 20.0 ± 3.5 mm Hg; P < 0.001). Outflow facility by fluorophotometry was significantly increased from 0.17 ± 0.11 μL/min/mm Hg at baseline to 0.24 ± 0.14 μL/min/mm Hg at 3 months (P = 0.008). Outflow facility by tonography (baseline: 0.16 ± 0.07 μL/min/mm Hg vs. 3 months: 0.22 ± 0.16 μL/min/mm Hg; P = 0.046) was similarly increased. No change in aqueous flow or EVP was observed. There were no changes in IOP or AHD in the contralateral untreated eye. Using multiple linear regression models, higher baseline aqueous flow, lower baseline outflow facility, and possibly lower uvescleral outflow were associated with more IOP lowering with SLT.
The IOP-lowering effect of SLT is mediated through an increase in outflow facility. There is no contralateral effect. Higher aqueous flow and lower outflow facility may be predictive of better response to SLT.
本研究旨在评估选择性激光小梁成形术（SLT）所引起的房水动力学（AHD）变化，并探讨基线AHD参数是否可预测眼压对SLT的反应。
本前瞻性观察性研究纳入了31例连续诊断为高眼压症或原发性开角型青光眼且计划接受SLT作为主要降眼压治疗的患者。所有受试者均对双眼进行AHD基线评估。评估的变量包括上午9点和中午的眼压、房水流量（荧光光度法）、巩膜静脉压（EVP，静脉测压法）、房水流畅度（气动眼压描记法和荧光光度法）以及葡萄膜巩膜外流（使用改良的戈德曼方程计算）。所有受试者均接受360度SLT治疗，并在3个月后重复进行AHD测量。
与基线相比，SLT术后上午9点的眼压显著降低（22.9±5.1 vs. 19.7±3.0 mmHg；P = 0.001），中午的眼压也显著降低（23.4±4.6 vs. 20.0±3.5 mmHg；P < 0.001）。荧光光度法测量的房水流畅度从基线时的0.17±0.11 μL/min/mmHg显著增加至3个月时的0.24±0.14 μL/min/mmHg（P = 0.008）。气动眼压描记法测量的房水流畅度（基线：0.16±0.07 μL/min/mmHg vs. 3个月：0.22±0.16 μL/min/mmHg；P = 0.046）也有类似增加。未观察到房水流量或EVP的变化。对侧未治疗眼的眼压或AHD无变化。使用多元线性回归模型，较高的基线房水流量、较低的基线房水流畅度以及可能较低的葡萄膜巩膜外流与SLT更大的降眼压效果相关。
SLT的降眼压作用是通过房水流畅度增加介导的。无对侧效应。较高的房水流量和较低的房水流畅度可能预示着对SLT有更好的反应。
