Seo Je Hyun, Lee Young, Shin Jong Hoon, Kim Ye An, Park Keun Heung
Veterans Medical Research Institute, Veterans Health Service Medical Center, Jinhwangdo-ro 61-gil 53, Gangdong-gu, Seoul, 05368, South Korea.
Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Graefes Arch Clin Exp Ophthalmol. 2019 Oct;257(10):2239-2255. doi: 10.1007/s00417-019-04412-0. Epub 2019 Jul 10.
To compare bleb vascularity changes using optical coherence tomography angiography (OCT-A) between mitomycin-C (MMC)-augmented trabeculectomy and phacotrabeculectomy and to determine whether bleb vascularity measurements during preoperative and early postoperative periods could act as surrogate parameters to predict surgical outcomes.
We retrospectively reviewed data for 72 eyes from 72 glaucoma patients who underwent MMC-augmented trabeculectomy with/without cataract surgery. Bleb area scans were obtained using OCT-A during the preoperative period; 1, 2, 4, and 6 weeks postoperatively; and 2, 4, and 6 months postoperatively. For conjunctival vascularity analysis, a semi-automated program was used to calculate color and brightness densities of the selected area.
Color and brightness densities were decreased in the trabeculectomy group during all periods but not in the phacotrabeculectomy group at 4 and 6 weeks, as well as 2, 4, and 6 months postoperatively. Color and brightness densities were significantly higher in the phacotrabeculectomy group than in the trabeculectomy group after 6 weeks and 2, 4, and 6 months postoperatively. A Kaplan-Meier survival graph indicated that intraocular pressure differed according to glaucoma type but not surgery type. Logistic regression analysis revealed that brightness density 1 week postoperatively was correlated with reoperation.
Changes in conjunctival vascularity density measured by OCT-A differed according to the surgical method. Following trabeculectomy with MMC, brightness density 1 week postoperatively may be a predictive index for surgical outcomes.
使用光学相干断层扫描血管造影（OCT-A）比较丝裂霉素C（MMC）辅助小梁切除术和晶状体切除联合小梁切除术的滤过泡血管变化，并确定术前和术后早期的滤过泡血管测量是否可作为预测手术结果的替代参数。
我们回顾性分析了72例青光眼患者72只眼的数据，这些患者接受了有或无白内障手术的MMC辅助小梁切除术。在术前、术后1周、2周、4周和6周以及术后2个月、4个月和6个月使用OCT-A进行滤过泡区域扫描。对于结膜血管分析，使用半自动程序计算选定区域的颜色和亮度密度。
小梁切除术组在所有时期的颜色和亮度密度均降低，但晶状体切除联合小梁切除术组在术后4周和6周以及术后2个月、4个月和6个月时未降低。术后6周以及术后2个月、4个月和6个月时，晶状体切除联合小梁切除术组的颜色和亮度密度显著高于小梁切除术组。Kaplan-Meier生存曲线表明，眼压因青光眼类型而异，而非手术类型。逻辑回归分析显示，术后1周的亮度密度与再次手术相关。
OCT-A测量的结膜血管密度变化因手术方法而异。MMC辅助小梁切除术后，术后1周的亮度密度可能是手术结果的预测指标。
