Zhang Yang, Zhou Qi, Zhang Shun-Hua, Li Lüe, Bian Ai-Ling, Liu Li-Ying, Jiang Ru-Xin, Cheng Gang-Wei
Department of Ophthalmology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2021 Oct;43(5):749-754. doi: 10.3881/j.issn.1000-503X.13615.
Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO laser-assisted sclerectomy surgery(CLASS).Methods This was a case series study.A combination of modified CLASS and preoperative laser iris management was administered to 28 eyes.Visual acuity,intraocular pressure(IOP),and slit-lamp examinations,visual field testing,and gonioscopy were carried out at baseline and until 24 months postoperatively.UBM examination was performed at 1,3,12 and 24 months postoperatively.Results Compared with the mean preoperative IOP [(30.61±10.59)mmHg],the IOP at each time point after operation was significantly lowered [(15.15±5.87),(12.56±3.24),(13.15±2.73),(13.75±2.55)and(13.75±2.46)mmHg at 1,3,6,12 and 24 months,respectively;all <0.001].Complete success rates and qualified success rates at 12 months and 24 months were 60.71%,89.29% and 53.57%,85.71%,respectively.UBM images can present "dolphin head sign" after successful CLASS.The thickness of trabeculo-Descemet's window was(0.13±0.03)mm,which had no significant correlation with postoperative IOP at 12(=-0.278,=0.144)and 24 months(=0.026,=0.895).UBM examination revealed a severe scleral lake diminution(a change > 50%)in 1 eye(3.57%)at 12 months and 3 eyes(10.71%)at 24 months.There was no statistical significance detected between the size of the scleral lake and IOP after CLASS.Non-founctional blebs were found in 16 eyes(57.14%)at 12 months and 25 eyes(89.28%)at 24 months.Two eyes(7.14%)demonstrated severe peripheral anterior synechiae at 24 months,requiring surgical intervention.Conclusions UBM can effectively observe the morphology of the scleral lake,anterior chamber angle and filtering blebs in post-operative follow-up after modified CLASS,and give early warning of complications.It plays an important role in ensuring the success of CLASS.
目的 观察超声生物显微镜（UBM）在原发性开角型青光眼改良CO2激光辅助巩膜切除术（CLASS）术后2年随访中的作用。方法 这是一项病例系列研究。对28只眼实施改良CLASS联合术前激光虹膜处理。在基线时以及术后直至24个月进行视力、眼压（IOP）、裂隙灯检查、视野检测和前房角镜检查。在术后1、3、12和24个月进行UBM检查。结果 与术前平均IOP[（30.61±10.59）mmHg]相比，术后各时间点的IOP均显著降低[术后1、3、6、12和24个月分别为（15.15±5.87）、（12.56±3.24）、（13.15±2.73）、（13.75±2.55）和（13.75±2.46）mmHg；均P<0.001]。12个月和24个月时的完全成功率和合格成功率分别为60.71%、89.29%和53.57%、85.71%。改良CLASS成功后UBM图像可呈现“海豚头征”。小梁-Descemet窗厚度为（0.13±0.03）mm，与术后12个月（r=-0.278，P=0.144）和24个月（r=0.026，P=0.895）的IOP无显著相关性。UBM检查显示，12个月时1只眼（3.57%）和24个月时3只眼（10.71%）出现严重的巩膜湖缩小（变化>50%）。CLASS术后巩膜湖大小与IOP之间未检测到统计学意义。12个月时16只眼（57.14%）和24个月时25只眼（89.28%）发现无功能滤过泡。24个月时2只眼（7.14%）出现严重周边前粘连，需要手术干预。结论 UBM可有效观察改良CLASS术后随访中巩膜湖、前房角和滤过泡的形态，并对并发症发出早期预警。它在确保CLASS手术成功方面发挥着重要作用。
