Ueda Toshihiko, Suzumura Hirotaka, Johnstone Murray, Uda Shigekazu, Yoshida Kazuhide
Nihonmatsu Eye Hospital, Tokyo, Japan.
Suzumura Eye Clinic, Tokyo, Japan.
Ophthalmol Ther. 2018 Jun;7(1):133-143. doi: 10.1007/s40123-018-0127-9. Epub 2018 Apr 10.
To develop a grading system that provides objective quantification of flow through the conventional aqueous humor outflow (AHO) system. The technique gives clinicians an additional assessment option in the evaluation of glaucoma treatment approaches.
This was a retrospective observational study. This study evaluated the eyes of all primary open-angle glaucoma patients who underwent a Trabectome (NeoMedix Corp., Tustin, CA, USA) procedure with or without cataract surgery in the interval between April and September 2016 (n = 73). The nasal hemisphere was divided into three regions. Utilizing a four-level grading system designed for this study, an aqueous humor outflow grade (G0-G3) was assigned to each region using a video taken during examinations. The individual grade levels of the three regions were combined to get a composite AHO score. The correlation between the composite AHO score and intraocular pressure (IOP) was then analyzed. Additionally, the speed of red blood cell (RBC) clusters in the episcleral veins (ESV) was calculated when made possible by the existence of pulsatile flow.
At 3 months following the Trabectome procedure, average IOP decreased from 26 to 15 mmHg. Assessment of the relationship between AHO grade and IOP demonstrated that a high composite AHO score was correlated with lowered IOP (Tukey-Kramer method p < 0.05). Additionally, it was found that if one of the three regions had an AHO grade of ≥ G2, an IOP of < 20 mmHg could be predicted. (Fischer's exact test p < 0.0001). Calculated speed was as follows: at G1, the speed was 0.68 ± 0.26 mm/s (n = 7), at G2, the speed was 1.8 ± 0.84 mm/s (n = 5), and at G3, the speed was 6.8 ± 3.3 mm/s (n = 6).
There was a significant correlation between an increase in the composite AHO score and a decrease in IOP. Additionally, the speed of RBC clusters as they traveled through the ESVs remained consistent for each of the grades, and the span of the speeds from lower to higher grades represented a significant range. These findings suggest that the grading system is a reliable measure of AHO.
UMIN 000031745.
开发一种分级系统，用于对通过传统房水流出（AHO）系统的流量进行客观量化。该技术为临床医生评估青光眼治疗方法提供了额外的评估选项。
这是一项回顾性观察研究。本研究评估了2016年4月至9月期间接受了Trabectome手术（美国加利福尼亚州图斯廷市NeoMedix公司）且伴有或不伴有白内障手术的所有原发性开角型青光眼患者的眼睛（n = 73）。鼻侧半球被分为三个区域。利用为本研究设计的四级分级系统，使用检查期间拍摄的视频为每个区域分配房水流出等级（G0 - G3）。将三个区域的各个等级水平合并以获得综合AHO评分。然后分析综合AHO评分与眼压（IOP）之间的相关性。此外，在存在搏动性血流的情况下，计算巩膜上静脉（ESV）中红细胞（RBC）簇的速度。
在Trabectome手术后3个月，平均眼压从26 mmHg降至15 mmHg。AHO等级与眼压之间的关系评估表明，高综合AHO评分与眼压降低相关（Tukey - Kramer方法p < 0.05）。此外，发现如果三个区域之一的AHO等级≥G2，则可预测眼压<20 mmHg（Fischer精确检验p < 0.0001）。计算出的速度如下：在G1级时，速度为0.68±0.26 mm/s（n = 7），在G2级时，速度为1.8±0.84 mm/s（n = 5），在G3级时，速度为6.8±3.3 mm/s（n = 6）。
综合AHO评分的增加与眼压的降低之间存在显著相关性。此外，RBC簇在ESV中流动的速度在每个等级中保持一致，并且从低等级到高等级的速度跨度代表了一个显著范围。这些发现表明该分级系统是AHO的可靠测量方法。
UMIN 000031745。
