Shokoohi-Rad Saeed, Ansar Amir-Reza, Vatandoost Abbas, Firoozi Javad
Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Eye Research Center, The Five Senses Research Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
J Ophthalmic Vis Res. 2024 Jun 21;19(2):161-171. doi: 10.18502/jovr.v19i2.13228. eCollection 2024 Apr-Jun.
This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary open-angle glaucoma (POAG).
In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup-disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up.
A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 8.73 years, and the majority of the cases were male ( = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 7.22 mmHg on 2.47 1.1 medications, and the mean postoperative IOP reduced to 11.11 2.58 mmHg on 0.11 medications, which was statistically significant ( 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant.
This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP.
本研究旨在对原发性开角型青光眼（POAG）患者进行为期六个月的随访，调查白内障超声乳化吸除联合小梁切开术（phaco-VC）的效果，以及使用眼前节光学相干断层扫描（AS-OCT）观察其与巩膜内湖（IL）的关系。
本前瞻性观察研究共纳入36例适合phaco-VC手术的POAG患者的眼睛。所有患者在手术前以及手术后1个月、3个月和6个月均接受了AS-OCT评估和眼科检查，包括Goldmann眼压测量、杯盘比评估、最佳矫正视力（BCVA）测量以及抗青光眼药物使用情况。每次随访时均使用AS-OCT评估IL的宽度、长度、面积和周长。
本研究共调查了34例POAG患者的36只眼睛。结果显示，患者的平均年龄为70.09±8.73岁，大多数病例为男性（n = 23；63.9%）。术前平均眼压（IOP）为20.11±7.22 mmHg，使用2.47±1.1种药物，术后平均眼压降至11.11±2.58 mmHg，使用0.11种药物，差异具有统计学意义（P < 0.001）。所有病例均能检测到IL，成功率达100%。在六个月的随访期间，IL的宽度、面积和周长均有显著减小。AS-OCT上的眼压变化与IL参数之间的关系不显著。
本研究评估了phaco-VC术后IL变化与眼压降低之间的关联。六个月的随访显示IL有显著减小，但出乎意料的是，眼压控制并未下降。在眼压得到充分控制的情况下，IL直径减小表明除了IL直径外，小梁切开术可能还存在多种降低眼压的机制。有必要进一步评估小梁切开术，重点关注IL和施莱姆管直径的长期变化，以解释降低眼压的确切机制。
