原发性开角型青光眼和剥脱性青光眼小梁切除联合丝裂霉素C术后的角膜生物力学变化

Corneal biomechanical changes after trabeculectomy with mitomycin C in primary open-angle glaucoma and pseudoexfoliation glaucoma.

作者信息

Sorkhabi Rana, Najafzadeh Farhad, Sadeghi Ali, Ahoor Mohamadhosein, Mahdavifard Ali

机构信息

Nikookari Hospital (Eye Center), Tabriz University of Medical Sciences, Tabriz, Iran.

Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

出版信息

Int Ophthalmol. 2019 Dec;39(12):2741-2748. doi: 10.1007/s10792-019-01118-4. Epub 2019 May 27.

DOI:10.1007/s10792-019-01118-4

PMID:31134423

Abstract

PURPOSE

This study aimed to examine the effect of trabeculectomy with mitomycin C on corneal biomechanical characteristics in PEXG and POAG patients.

METHODS

In this prospective comparative case series study, 32 glaucoma patients of whom 17 patients were suffering from PEXG and 15 patients from POAG were enrolled. All patients underwent complete ocular examination, CCT using ultrasound pachymetry and corneal biomechanical study using ORA. The patients were hospitalized, and trabeculectomy surgery with mitomycin was done. Three months after surgery, patients were examined and ORA was obtained again.

RESULTS

The mean CH in patients with PEXG was lower compared to patients with POAG (5.66 ± 1.13, 7.49 ± 0.88, respectively) before surgery, which had a statistically significant difference (P < 0.001). CRF in patients with PEXG was significantly lower compared to patients with POAG (8.19 ± 1.48 vs. 9.35 ± 1.60, respectively) before surgery, with P = 0.049. CH remarkably increased and reached 6.69 ± 0.78 (P < 0.001) in the PEXG group after TBX + MMC surgery. CH increased in the POAG group after TBX + MIC surgery and reached 8.23 ± 1.09, which was statistically significant (P = 0.001). There was a significant relationship between CH and IOP changes in both PEXG and POAG groups (P < 0.001 and P = 0.01, respectively). Although TBX + MMC surgery changed the amount of CH in PEXG and POAG groups, no significant difference was shown in the parameters between the two groups comparing the CH changes (P = 0.33).

CONCLUSION

According to the results of this study, the biomechanical characteristics of cornea, particularly CH, shows certain changes following surgery and is increased, reflecting the dynamic nature of these parameters. Our knowledge of the biomechanical changes after glaucoma surgery can help us better understand the pathophysiology of glaucoma diseases and make the right decisions for follow-up of the patients.

摘要

目的

本研究旨在探讨丝裂霉素C小梁切除术对剥脱性青光眼（PEXG）和原发性开角型青光眼（POAG）患者角膜生物力学特征的影响。

方法

在这项前瞻性比较病例系列研究中，纳入了32例青光眼患者，其中17例为PEXG患者，15例为POAG患者。所有患者均接受了全面的眼部检查，使用超声测厚仪测量中央角膜厚度（CCT），并使用ORA进行角膜生物力学研究。患者入院后，进行了丝裂霉素小梁切除术。术后3个月，对患者进行检查并再次获取ORA数据。

结果

术前，PEXG患者的平均角膜滞后（CH）低于POAG患者（分别为5.66±1.13和7.49±0.88），差异具有统计学意义（P<0.001）。术前，PEXG患者的角膜阻力因子（CRF）显著低于POAG患者（分别为8.19±1.48和9.35±1.60），P=0.049。在PEXG组，小梁切除术联合丝裂霉素C（TBX+MMC）术后CH显著增加，达到6.69±0.78（P<0.001）。在POAG组，小梁切除术联合丝裂霉素I（TBX+MIC）术后CH增加，达到8.23±1.09，差异具有统计学意义（P=0.001）。在PEXG和POAG组中，CH与眼压变化之间均存在显著相关性（分别为P<0.001和P=0.01）。虽然TBX+MMC手术改变了PEXG和POAG组的CH量，但两组之间CH变化参数的比较无显著差异（P=0.33）。