Chiou A G, Mermoud A, Underdahl J P, Schnyder C C
Hôpital Ophtalmique Jules Gonin, Department of Ophthalmology, University of Lausanne, Switzerland.
Ophthalmology. 1998 Apr;105(4):746-50. doi: 10.1016/S0161-6420(98)94033-7.
This study aimed to assess the natural history of eyes after deep sclerectomy with collagen implant (DSCI), a nonperforating glaucoma-filtering surgery.
The design was a prospective, longitudinal, observational, and nonrandomized study.
Forty-five eyes of 41 patients with medically uncontrolled open-angle glaucoma were studied.
Deep sclerectomy with collagen implant was performed.
Ultrasound biomicroscopy (UBM) of the sclerectomy site was performed 1, 2, 3, 6, 9, 12, and 18 months after surgery. The following parameters were assessed: length and height of the collagen implant, thickness of the residual trabeculodescemetic membrane, and bleb appearance.
Mean intraocular pressure decreased from a preoperative value of 26.3 +/- 3.5 mmHg (mean +/- standard deviation) to a postoperative value of 16.6 +/- 3.1 mmHg (mean +/- standard deviation) at 18 months (P < 0.001). The UBM findings showed a subconjunctival filtration with a nonperforated thin trabeculodescemetic membrane. In 23 eyes (51%), a hypoechoic area in the suprachoroidal space was observed. The thickness of the trabeculodescemetic membrane was stable throughout the study with a mean value of 0.13 mm +/- 0.02 (mean +/- standard deviation) at 18 months. The collagen implant dissolved slowly within 6 to 9 months, leaving a tunnel in the sclera.
The UBM findings are consistent with intraocular pressure lowering by aqueous filtration through the thin remaining trabeculodescemetic membrane to an area under the scleral flap, which was maintained open by the collagen implant. The authors speculate that aqueous humor then reached the subconjunctival space and, eventually, was filtered through the thin scleral wall into the suprachoroidal space. Complete resorption of the collagen implant occurred between 6 and 9 months after surgery.
本研究旨在评估采用胶原植入物的深层巩膜切除术（DSCI）这一非穿透性青光眼滤过手术后眼睛的自然病程。
本研究为前瞻性、纵向、观察性且非随机的研究。
对41例药物治疗无法控制的开角型青光眼患者的45只眼睛进行了研究。
实施了采用胶原植入物的深层巩膜切除术。
术后1、2、3、6、9、12和18个月对巩膜切除部位进行超声生物显微镜检查（UBM）。评估以下参数：胶原植入物的长度和高度、残余小梁-Descemet膜的厚度以及滤过泡外观。
平均眼压从术前的26.3±3.5 mmHg（平均值±标准差）降至术后18个月时的16.6±3.1 mmHg（平均值±标准差）（P<0.001）。UBM检查结果显示为结膜下滤过，伴有未穿孔的薄小梁-Descemet膜。在23只眼睛（51%）中，观察到脉络膜上腔有低回声区。在整个研究过程中，小梁-Descemet膜的厚度保持稳定，18个月时的平均值为0.13 mm±0.02（平均值±标准差）。胶原植入物在6至9个月内缓慢溶解，在巩膜内留下一个通道。
UBM检查结果与房水通过剩余的薄小梁-Descemet膜滤过至巩膜瓣下区域从而降低眼压相一致，该区域由胶原植入物维持开放。作者推测房水随后到达结膜下间隙，并最终通过薄的巩膜壁滤入脉络膜上腔。胶原植入物在术后6至9个月完全吸收。
