Toptan Muslum, Yilmaz Omer Faruk
Department of Ophthalmology, Harran University Faculty of Medicine, Sanliurfa, Turkey.
Department of Ophthalmology, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey.
Med Hypothesis Discov Innov Ophthalmol. 2024 Aug 14;13(2):76-81. doi: 10.51329/mehdiophthal1497. eCollection 2024 Summer.
The effects of trabeculectomy on anterior segment parameters have been widely investigated. However, the stabilization time for various glaucoma types after trabeculectomy remains debatable. We investigated the effect of mitomycin C-augmented trabeculectomy on ocular anterior segment parameters in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) during short-term follow-up using the Pentacam HR.
In this retrospective observational study, consecutive patients diagnosed with medically uncontrolled POAG or PXG who underwent MMC-augmented trabeculectomy were recruited. All individuals underwent detailed ocular examinations. All trabeculectomies were performed by a single surgeon using the same technique. Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and central corneal thickness (CCT) were measured using the Pentacam HR, along with intraocular pressure (IOP) using a Goldmann applanation tonometer, pre-operatively and at 1-week, 1-month, and 3-month post-operative visits.
We included 80 patients with a median (range) age of 58.0 (41.0-86.0) years having a nearly similar sex ratio. The study groups were matched according to sex and age (both > 0.05). The group-by-time interaction was significant for CCT and ACV (both < 0.05) but not for IOP, ACD, and ACA (all > 0.05). The mean (standard deviation [SD]) IOP, ACD, and ACA were comparable between groups (all > 0.05) during the 3-month period; however, they changed significantly over time in both groups (all < 0.001). The mean CCT and ACV were comparable between groups at each time point (all > 0.05), except at the 1-month post-operative visit, at which the mean (SD) ACV was significantly lower in the PXG group ( < 0.05). We found a comparable mean (SD) CCT between paired visits in each group (all > 0.05), except for the mean (SD) CCT at 3 months, which was significantly lower than that at the 1-month post-operative visit in the PXG group ( < 0.05). We found a comparable mean (SD) ACV between paired visits in each group (all > 0.05); however, it was significantly lower at the 1-month post-operative versus the baseline visit in both groups and resumed a significantly higher value at the 1-month versus the 1-week visit and at the 3-month versus the 1-month visit in the PXG group (all < 0.05).
We observed significant changes in IOP, ACD, and ACA over 3 months after post-augmented trabeculectomy in eyes with POAG and PXG; however, the majority of anterior segment parameters were comparable between the two groups. Further large-scale studies with longer follow-up periods should be conducted to verify the post-operative fluctuations in these parameters in POAG and PXG.
小梁切除术对眼前节参数的影响已得到广泛研究。然而，小梁切除术后不同类型青光眼的参数稳定时间仍存在争议。我们使用Pentacam HR在短期随访期间研究了丝裂霉素C辅助小梁切除术对原发性开角型青光眼（POAG）和剥脱性青光眼（PXG）眼前节参数的影响。
在这项回顾性观察研究中，招募了连续诊断为药物治疗无法控制的POAG或PXG且接受丝裂霉素C辅助小梁切除术的患者。所有个体均接受了详细的眼部检查。所有小梁切除术均由同一位外科医生采用相同技术进行。使用Pentacam HR测量眼前节参数，包括前房深度（ACD）、前房容积（ACV）、前房角（ACA）和中央角膜厚度（CCT），并使用Goldmann压平眼压计测量眼压，在术前以及术后1周、1个月和3个月随访时进行测量。
我们纳入了80例患者，年龄中位数（范围）为58.0（41.0 - 86.0）岁，性别比例相近。研究组在性别和年龄方面匹配（均>0.05）。时间分组交互作用对CCT和ACV有显著影响（均<0.05），但对眼压、ACD和ACA无显著影响（均>0.05）。在3个月期间，两组间的平均（标准差[SD]）眼压、ACD和ACA具有可比性（均>0.05）；然而，两组这些参数均随时间发生显著变化（均<0.001）。除术后1个月时PXG组的平均（SD）ACV显著较低（<0.05）外，各时间点两组间的平均CCT和ACV具有可比性（均>0.05）。我们发现每组配对访视间的平均（SD）CCT具有可比性（均>0.05），但PXG组术后3个月的平均（SD）CCT显著低于术后1个月时（<0.05）。我们发现每组配对访视间的平均（SD）ACV具有可比性（均>0.05）；然而，两组术后1个月时的ACV均显著低于基线访视时，且PXG组术后1个月相对于术后1周以及术后3个月相对于术后1个月时ACV均显著升高（均<0.05）。
我们观察到POAG和PXG患者小梁切除术后3个月内眼压、ACD和ACA有显著变化；然而，两组间大多数眼前节参数具有可比性。应进行进一步的大规模、更长随访期研究以验证POAG和PXG患者这些参数的术后波动情况。
