Legacy Devers Eye Institute, Portland, OR, United States.
Ophthalmol Glaucoma. 2020 Jan-Feb;3(1):32-39. doi: 10.1016/j.ogla.2019.09.003. Epub 2019 Oct 4.
Ophthalmologists commonly perform glaucoma surgery to treat progressive glaucoma. Few studies have examined the stability of OCT neuroretinal rim parameters after glaucoma surgery for ongoing detection of glaucoma progression.
Longitudinal cohort study.
20 eyes (16 subjects) with primary open angle glaucoma who had undergone a trabeculectomy.
We calculated the change in OCT parameters (minimum rim area (MRA), minimum rim width (MRW), Bruch's membrane opening (BMO) area, mean cup depth (MCD), anterior lamina cribrosa surface depth (ALCSD), prelaminar tissue thickness (PLTT), retinal nerve fiber layer thickness (RFNLT) during an interval from the visit before the surgery to the visit after the surgery, a span of approximately 6-months. We also calculated changes in the same eyes over two separate 6-month intervals that did not contain trabeculectomy to serve as control. We compared these intervals using a generalized linear model (with compound symmetry correlation structure), accounting for the correlation between time intervals for the same eye.
MRW, MRA, angle above the reference plane for MRW and MRA, BMO area, MCD, mean ALCSD, PLTT, RNFLT and visual field parameters (mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI)).
The intervals containing trabeculectomy showed a significant decrease in intraocular pressure (-9.2 mmHg, p<.001) when compared to control intervals. Likewise, the following neuroretinal rim parameters showed significant changes with trabeculectomy: increased MRW (+6.04μm, p=.001), increased MRA (+0.014mm, p=.024), increased angle above reference plane of MRW (+2.64°, p<.001), decreased MCD (-11.6μm, p=.007), and decreased mean ALCSD (-18.91μm, p=.006). This is consistent with an increase in rim tissue thickness and a more anterior position of the ILM and ALCS relative to the BMO plane. Conversely, RNFLT change was not significantly different between trabeculectomy and control intervals (p=.37).
Trabeculectomy resulted in anatomical changes to the ONH rim associated with reduced glaucomatous cupping. The RNFL thickness may be a more stable measure of disease progression that clinicians can use to monitor across time intervals containing glaucoma surgery.
眼科医生通常会进行青光眼手术来治疗进展性青光眼。很少有研究检查青光眼手术后 OCT 神经视网膜边缘参数的稳定性，以持续检测青光眼的进展。
纵向队列研究。
20 只眼（16 例）患有原发性开角型青光眼，行小梁切除术。
我们计算了 OCT 参数（最小边缘面积（MRA）、最小边缘宽度（MRW）、Bruch 膜开口（BMO）面积、平均杯深度（MCD）、前层状筛板表面深度（ALCSD）、前层组织厚度（PLTT）、视网膜神经纤维层厚度（RFNLT））在手术前就诊到手术后就诊期间的变化，间隔约 6 个月。我们还计算了在不包含小梁切除术的两个单独的 6 个月间隔内同一眼睛的变化，作为对照。我们使用广义线性模型（具有复合对称相关结构）比较了这些间隔，考虑了同一眼睛时间间隔之间的相关性。
MRW、MRA、MRW 和 MRA 参考平面上方的角度、BMO 面积、MCD、平均 ALCSD、PLTT、RNFLT 和视野参数（平均偏差（MD）、模式标准差（PSD）和视野指数（VFI））。
与对照间隔相比，包含小梁切除术的间隔眼内压明显下降（-9.2mmHg，p<.001）。同样，以下神经视网膜边缘参数在小梁切除术后发生显著变化：MRW 增加（+6.04μm，p=.001）、MRA 增加（+0.014mm，p=.024）、MRW 参考平面上方角度增加（+2.64°，p<.001）、MCD 减少（-11.6μm，p=.007）和平均 ALCSD 减少（-18.91μm，p=.006）。这与 ILM 和 ALCS 相对于 BMO 平面的 rim 组织厚度增加和更靠前的位置相对应。相反，小梁切除术与对照间隔之间的 RNFLT 变化无显著差异（p=.37）。
小梁切除术导致 ONH 边缘的解剖结构发生变化，与青光眼杯状凹陷减少相关。RNFL 厚度可能是疾病进展更稳定的测量指标，临床医生可以用于监测包含青光眼手术的时间间隔。
