Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50924, Cologne, Germany.
Glaucoma Imaging Center University of Cologne (GICC), Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50924, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2022 Oct;260(10):3321-3329. doi: 10.1007/s00417-022-05644-3. Epub 2022 Apr 8.
To evaluate the dynamics of Bruch's membrane opening-based morphometrics of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT) during the first week after glaucoma surgery by trabeculectomy with mitomycin C.
Prospective, longitudinal analysis of 25 eyes of 25 patients treated by trabeculectomy. Twenty-four eyes had evaluable postoperative SD-OCT examinations. Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness were analyzed at baseline before surgery, 1 day, 2 to 3 days, and 1 week after surgery. Changes compared to baseline were correlated to intraocular pressure (IOP).
One day after surgery, the mean BMO-MRW changed by + 26.17 µm, p = 0.001 (mean IOP reduction by 17.01 mmHg). This increase persisted on day 2-3 with a mean increase of BMO-MRW of + 25.33 µm, p = 0.001 (mean IOP reduction by 20.46 mmHg) and by week 1 with a mean BMO-MRW increase of + 33.17 µm, p < 0.001 (mean IOP reduction by 22.55 mmHg). The increase in BMO-MRW correlated significantly with the reduction of IOP on day 1 (Spearman's rho ρ = 0.656, p = 0.003) and d2-3 (Spearman's rho ρ = 0.479, p = 0.038). There was no statistically significant correlation found between the IOP and the increase in BMO-MRW in week 1. RNFL thickness showed no significant changes at day 1 as well as days 2-3 (p ≥ 0.078, respectively). It showed a small but significant increase in week 1 by 3.94 µm, p = 0.015.
Structural reversal of disc cupping in BMO-MRW occurs as early as 1 day after trabeculectomy and correlates to the extent of the IOP reduction. During the whole first week after surgery, a strong increase in BMO-MRW can be noted. The changes in BMO-based parameters need to be considered when evaluating patients' longitudinal follow-up.
利用频域光学相干断层扫描（SD-OCT）评估青光眼手术后第 1 周内，应用丝裂霉素 C 的小梁切除术对神经眼（ONH）的 Bruch 膜开口形态测量的动力学。
对 25 例 25 眼接受小梁切除术的患者进行前瞻性、纵向分析。24 只眼可进行术后 SD-OCT 检查。在手术前、手术后第 1 天、第 2-3 天和第 1 周，分析 Bruch 膜开口最小边缘宽度（BMO-MRW）和视盘周围视网膜神经纤维层（RNFL）厚度。与基线相比，将变化与眼内压（IOP）相关联。
术后第 1 天，BMO-MRW 平均增加 26.17µm，p=0.001（平均 IOP 降低 17.01mmHg）。第 2-3 天，这种增加持续存在，BMO-MRW 平均增加 25.33µm，p=0.001（平均 IOP 降低 20.46mmHg），第 1 周，BMO-MRW 平均增加 33.17µm，p<0.001（平均 IOP 降低 22.55mmHg）。BMO-MRW 的增加与第 1 天（Spearman 的 rho ρ=0.656，p=0.003）和第 2-3 天（Spearman 的 rho ρ=0.479，p=0.038）IOP 的降低显著相关。在第 1 周，未发现 IOP 与 BMO-MRW 增加之间存在统计学显著相关性。RNFL 厚度在第 1 天以及第 2-3 天均无明显变化（分别为 p≥0.078）。第 1 周，它的厚度增加了 3.94µm，p=0.015，有统计学意义。
小梁切除术后第 1 天即可出现 Bruch 膜开口最小边缘宽度的盘凹陷结构反转，与 IOP 降低程度相关。术后第 1 周，BMO-MRW 明显增加。在评估患者的纵向随访时，需要考虑基于 Bruch 膜的参数变化。
