Kadziauskienė Aistė, Strelkauskaitė Ernesta, Mockevičiūtė Eglė, Ašoklis Rimvydas, Lesinskas Eugenijus, Schmetterer Leopold
Clinic of Ear, Nose, Throat, and Eye Diseases, Vilnius University, Vilnius, Lithuania.
Santaros Klinikos, Vilnius University Hospital, Vilnius, Lithuania.
Acta Med Litu. 2017;24(2):93-100. doi: 10.6001/actamedica.v24i2.3489.
None of the authors have any conflict of interest to declare, financial or otherwise. No financial or other support was received for the study.
The aim of the study was to assess changes in macular thickness after trabeculectomy in respect to the use of 5-fluorouracil (5-FU) as well as to analyse possible associations between the postoperative changes in macular thickness and intraocular pressure (IOP).
The prospective observational study included 106 eyes (100 patients) with glaucoma who underwent trabeculectomy with or without 5-FU. Subsequently 5-FU needling was performed if failure of the filtrating bleb occurred. Macular thickness and the IOP were evaluated before, one week, and six months after the surgery. The mean and sectoral macular thickness was assessed using spectral domain optical coherence tomography.
The mean (±SD) IOP reduced from 27.71 (±6.88) mmHg at baseline to 18.3 (±8.1) mmHg one week ( < 0.001) and 15.1 (±7.6) mmHg six months ( < 0.001) after trabeculectomy. One week postoperatively, the mean macular thickness increased from 285.19 (±15.98) μm to 288.9 (±16.31) μm ( < 0.001); macular thickening was significant in all subfields ( < 0.001) and correlated positively with IOP reduction ( = 0.312, = 0.001 for central subfield). After six months, macula remained thicker only at the central and inner nasal subfields ( < 0.05). The changes in macular thickness were not affected by the use of 5-fluorouracil.
Trabeculectomy may induce a slight macular thickening which is more pronounced in the early postoperative period. The IOP reduction plays an important role in this process and is associated with thicker postoperative macula. However, the use of adjunctive 5-FU has no influence on macular thickness after glaucoma surgery despite its potential hypotonic, inflammatory and cytotoxic effects.
所有作者均无任何利益冲突需要声明，无论是财务方面还是其他方面。该研究未获得任何财务或其他支持。
本研究的目的是评估小梁切除术中使用5-氟尿嘧啶（5-FU）后黄斑厚度的变化，并分析黄斑厚度术后变化与眼压（IOP）之间可能存在的关联。
这项前瞻性观察性研究纳入了106只眼（100例患者）青光眼患者，他们接受了小梁切除术，术中有的使用了5-FU，有的未使用。如果滤过泡失败，则随后进行5-FU针刺。在手术前、术后1周和6个月评估黄斑厚度和眼压。使用光谱域光学相干断层扫描评估黄斑的平均厚度和扇形厚度。
小梁切除术后，平均眼压（±标准差）从基线时的27.71（±6.88）mmHg降至术后1周的18.3（±8.1）mmHg（<0.001）和6个月时的15.1（±7.6）mmHg（<0.001）。术后1周，黄斑平均厚度从285.19（±15.98）μm增加至288.9（±16.31）μm（<0.001）；所有子区域的黄斑均显著增厚（<0.001），且与眼压降低呈正相关（中央子区域：r = 0.312，P = 0.001）。6个月后，仅中央和鼻内侧子区域的黄斑仍较厚（<0.05）。黄斑厚度的变化不受5-氟尿嘧啶使用的影响。
小梁切除术可能会导致黄斑轻度增厚，这在术后早期更为明显。眼压降低在这一过程中起重要作用，且与术后黄斑增厚有关。然而，尽管辅助使用5-FU具有潜在的低渗、炎症和细胞毒性作用，但对青光眼手术后的黄斑厚度没有影响。
