Taheri Nazli, Mostafaie Ali, Niyousha Mohamad Reza, Fallahi Motlagh Behzad, Ghorbanpour Amir Ali, Arasteh Amin
Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, , Iran.
Department of Ophthalmology, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, , Iran; Kidney Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Photodiagnosis Photodyn Ther. 2025 Aug;54:104686. doi: 10.1016/j.pdpdt.2025.104686. Epub 2025 Jun 17.
To explore the short-term effects of Mitomycin C-augmented non-penetrating deep sclerectomy (NPDS) procedure on the retinal microvasculature and visual field function of eyes with primary open-angle glaucoma (POAG).
Single-arm, non-randomized, interventional prospective study METHODS: 22 POAG eyes of 22 patients without previous surgical interventions for glaucoma, whose disease was progressing and/or the intraocular pressure was not at the target level with full topical medications, were allocated to this prospective interventional study. All the patients underwent the NPDS procedure and were followed up for a month. The IOP, Humphrey visual field (HVF) 30-2 (as mean deviation (MD) and pattern standard deviation (PSD)), retinal nerve fiber layer (RNFL), and the vessel density (VD) of the optic nerve head (ONH) and macula (by RTVue XR Avanti OCTA) were evaluated one day before the surgery and one month after the NPDS procedure.
At the one-month post-op follow-up, the IOP was significantly lower than the pre-op visit (8 mmHg vs. 23.5 mmHg, p: <0.001). The visual field MD was significantly better one month after the NPDS procedure (-13.06 dB vs. -15.44 dB, p:0.038), although the PSD did not indicate any significant change. Neither the peripapillary nor the macular VD significantly changed in our follow-up. However, the post-op MD was significantly and positively correlated to the ONH whole image, peripapillary, perifoveal, and parafoveal VD.
The deep sclerectomy procedure is a compelling choice of POAG treatment, which could significantly decrease the IOP. However, this procedure may not alter the retinal microvasculature in a short period. Nevertheless, the positive correlation between retinal VD and the visual field MD proposes a possible vascular mechanism for the visual field defect in glaucomatous eyes.
探讨丝裂霉素C增强的非穿透性深层巩膜切除术（NPDS）对原发性开角型青光眼（POAG）患者视网膜微血管和视野功能的短期影响。
单臂、非随机、前瞻性干预研究
22例未经青光眼手术干预且病情进展和/或使用足量局部药物后眼压未达目标水平的POAG患者的22只眼睛被纳入该前瞻性干预研究。所有患者均接受NPDS手术，并随访1个月。在手术前一天和NPDS手术后1个月评估眼压、Humphrey视野（HVF）30-2（以平均偏差（MD）和模式标准偏差（PSD）表示）、视网膜神经纤维层（RNFL）以及视神经乳头（ONH）和黄斑的血管密度（VD）（通过RTVue XR Avanti OCTA）。
术后1个月随访时，眼压显著低于术前（8 mmHg对23.5 mmHg，p：<0.001）。NPDS手术后1个月视野MD显著改善（-13.06 dB对-15.44 dB，p：0.038），尽管PSD无显著变化。在我们的随访中，视乳头周围和黄斑的VD均无显著变化。然而，术后MD与ONH全图、视乳头周围、中心凹周围和中心凹旁VD显著正相关。
深层巩膜切除术是POAG治疗的一个有吸引力的选择，可显著降低眼压。然而，该手术短期内可能不会改变视网膜微血管。尽管如此，视网膜VD与视野MD之间的正相关提出了青光眼性视野缺损可能的血管机制。
