活体人眼前节巩膜静脉流体波毗邻微侵袭青光眼手术（MIGS）支持实验室研究：房水外流呈圆周局限性、远段保存性和下鼻侧优势性。
Episcleral Venous Fluid Wave in the Living Human Eye Adjacent to Microinvasive Glaucoma Surgery (MIGS) Supports Laboratory Research: Outflow is Limited Circumferentially, Conserved Distally, and Favored Inferonasally.
机构信息
Attending Surgeon and Clinician Glaucoma Associates of Texas Dallas, Texas.
出版信息
J Glaucoma. 2019 Feb;28(2):139-145. doi: 10.1097/IJG.0000000000001126.
PURPOSE
The purpose of this study was to describe downstream patterns of outflow with the episcleral venous fluid wave (EVFW) in the living human eye adjacent to microinvasive glaucoma surgery (MIGS) and determine if the EVFW supports existing ex-vivo laboratory outflow research.
DESIGN
Retrospective, noncomparative case series.
PATIENTS
A total of 10 eyes of 10 patients who underwent phaco-Trabectome and 10 eyes of 10 patients who underwent phaco-iStent consecutively at Glaucoma Associates of Texas for cataract and uncontrolled glaucoma who demonstrated an episcleral wave.
METHODS
The EVFW was visualized and recorded during irrigation and aspiration. To describe the hydrodynamic properties of the fluid wave, its degrees, extent, and characteristics were measured with a protractor in Photoshop.
RESULTS
The incised Trabectome arc produced adjacent episcleral blanching of 134±11 degrees (range, 112 to 150 degrees) with an additional 54 degrees of marginal recruitment (41 degrees inferonasal plus 13 degrees superonasal) adjacent to the ends of the Trabectome incision. The mean episcleral blanch for the iStent was 51±19 degrees (range, 19 to 90 degrees), comprised of 29 degrees inferonasal plus 22 degrees superonasal.
CONCLUSIONS
Downstream episcleral flow in the living human eye adjacent to the iStent is variable and mainly confined to 2 clock hours indicating a lack of significant circumferential flow in glaucomatous eyes. Flow distal to the Trabectome site encompasses the Trabectome incisional arc with an additional 2 clock hours of lateral fluid wave favoring the inferonasal over superonasal quadrant 3 to 1. These in-vivo findings made visible with MIGS, corroborate recent in-vivo and long-standing ex-vivo laboratory research that outflow is largely segmented, favored inferonasally and conserved distally.
目的
本研究旨在描述活体人眼前部紧邻微创青光眼手术（MIGS）时巩膜静脉液波（EVFW）的下游流动模式，并确定 EVFW 是否支持现有的离体实验室流出研究。
设计
回顾性、非对照病例系列。
患者
共纳入 10 例连续接受白内障超声乳化联合 Trabectome 手术和白内障超声乳化联合 iStent 手术的患者，每例患者各 10 只眼，这些患者均因白内障和未控制的青光眼在德克萨斯州青光眼协会就诊，术区均可见巩膜波。
方法
在冲洗和抽吸过程中观察和记录 EVFW。为了描述液波的流体动力学特性，使用 Photoshop 中的量角器测量其角度、范围和特征。
结果
切开的 Trabectome 弧形产生 134±11 度（范围 112 度至 150 度）的相邻巩膜苍白，另外还有 54 度的边缘募集（41 度鼻下象限加 13 度鼻上象限）紧邻 Trabectome 切口的末端。iStent 的平均巩膜苍白为 51±19 度（范围 19 度至 90 度），包括 29 度鼻下象限加 22 度鼻上象限。
结论
活体人眼紧邻 iStent 的巩膜下游流动是可变的，主要局限于 2 个时钟小时，表明青光眼眼中没有明显的周向流动。Trabectome 部位远端的流动包括 Trabectome 切口弧形，外加 2 个时钟小时的侧向液波，有利于鼻下象限至 3 到 1 象限。这些 MIGS 下可见的活体发现与最近的活体和长期的离体实验室研究相吻合，表明流出主要是分段的，有利于鼻下象限，并在远端保留。
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