前节OCT在青光眼穿透性小梁手术术后滤过泡观察中的应用效果
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摘要
目的探讨前节光学相干断层扫描技术(OCT)对青光眼穿透性小梁手术后滤过泡观察的应用效果,为临床诊治提供客观证据。方法选择2015—2018年间在我院行青光眼穿透性小梁手术的126例患者(126只患眼),在术后1 d～6个月分别进行前节OCT检查,分析所见滤过泡的变化。结果术后1 d～6个月通过前节OCT检查可见本组患者术后滤过泡总体高度无显著性变化(P>0.05);囊壁厚度呈逐渐变薄趋势,囊壁的反射逐渐增强,微囊泡逐渐减少(滤过泡高度:0.84±0.41 vs 0.96±0.40 vs 0.94±0.36 vs 0.95±0.29 vs 0.96±0.43,F=2.25;囊壁厚度:0.26±0.18 vs0.28±0.20 vs 0.16±0.11 vs 0.15±0.16 vs 0.21±0.17,F=15.27;出现微囊泡:126/(100.0%) vs 108/(85.7%) vs 89/(70.6%)vs 58/(46.0%) vs 61/(48.4%),F=131.661 9;囊壁反射增强:0/(0.0%) vs 18/(14.3%) vs 37/(29.4%) vs 71/(56.3%) vs 64/(50.8%),F=136.022 7;均P<0.01)。结论前节OCT能够探明术后滤过泡外观、内部结构的变化,通过分析这些变化与其功能之间的关系,可为滤过泡的功能维护提供参考依据,是对青光眼术后滤过泡形态进行评价的一种有效工具。
Objective To investigate the application effect of anterior segment optical coherence tomography(OCT) on the observation of filtering bleb after glaucoma penetrating trabecular surgery, and provide objective evidence for clinical diagnosis and treatment. Methods A total of 126 patients(126 eyes) who underwent glaucoma penetrating trabecular surgery in our hospital between 2015 and 2018 were enrolled. The anterior segment OCT was performed 1 to 6 months after surgery. The change of filtering bleb were analyzed. Results From the 1 st day to 6 th postoperative period, the anterior segment OCT examination showed that there was no significant change in the total height of postoperative filtration blebs in this group(P>0.05). The wall thickness of the capsules gradually became thinner and the reflection of the wall gradually increased. Microvesicles gradually decreased(filter bleb height: 0.84±0.41 vs 0.96±0.40 vs 0.94±0.36 vs 0.95±0.29 vs 0.96±0.43, F=2.25; wall thickness: 0.26±0.18 vs 0.28±0.20 vs 0.16±0.11 vs 0.15±0.16 vs 0.21±0.17, F=15.27; microvesicles appear: 126/(100.0%) vs 108/(85.7%) vs 89/(70.6%) vs 58/(46.0%) vs 61/(48.4%), F=131.661 9; enhanced wall reflection:0/(0.0%) vs 18/(14.3%) vs 37/(29.4%) vs 71/(56.3%) vs 64/(50.8%), F=136.022 7; both P<0.01). Conclusion The anterior segment OCT can detect the appearance of postoperative filtration bleb and the change of internal structure. By analyzing the relationship between these changes and its function, it can provide a reference for the functional maintenance of filtration bleb, which is filtered after glaucoma surgery and an effective tool for evaluating bubble morphology.
Objective To investigate the application effect of anterior segment optical coherence tomography(OCT) on the observation of filtering bleb after glaucoma penetrating trabecular surgery, and provide objective evidence for clinical diagnosis and treatment. Methods A total of 126 patients(126 eyes) who underwent glaucoma penetrating trabecular surgery in our hospital between 2015 and 2018 were enrolled. The anterior segment OCT was performed 1 to 6 months after surgery. The change of filtering bleb were analyzed. Results From the 1 st day to 6 th postoperative period, the anterior segment OCT examination showed that there was no significant change in the total height of postoperative filtration blebs in this group(P>0.05). The wall thickness of the capsules gradually became thinner and the reflection of the wall gradually increased. Microvesicles gradually decreased(filter bleb height: 0.84±0.41 vs 0.96±0.40 vs 0.94±0.36 vs 0.95±0.29 vs 0.96±0.43, F=2.25; wall thickness: 0.26±0.18 vs 0.28±0.20 vs 0.16±0.11 vs 0.15±0.16 vs 0.21±0.17, F=15.27; microvesicles appear: 126/(100.0%) vs 108/(85.7%) vs 89/(70.6%) vs 58/(46.0%) vs 61/(48.4%), F=131.661 9; enhanced wall reflection:0/(0.0%) vs 18/(14.3%) vs 37/(29.4%) vs 71/(56.3%) vs 64/(50.8%), F=136.022 7; both P<0.01). Conclusion The anterior segment OCT can detect the appearance of postoperative filtration bleb and the change of internal structure. By analyzing the relationship between these changes and its function, it can provide a reference for the functional maintenance of filtration bleb, which is filtered after glaucoma surgery and an effective tool for evaluating bubble morphology.
引文
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[2]梁沛,杨瑾,林锦镛.贝伐单抗结膜下注射对青光眼滤过术后滤过泡瘢痕化的抑制作用[J].中华实验眼科杂志2016,34(7):591-596.
[3]朱丹,马晓昀,刘林,等.频域眼前节光学相干断层扫描仪(AS-OCT)对激光周边虹膜切开术后患者前房角结构定量检测[J].眼科新进展,2017,37(7):667-670.
[4]高松哲,杨新怀,全婵娟,等.眼前节OCT观察超声乳化白内障吸除术后早期前房角变化[J].海南医学,2016,27(4)648-649.
[5]边俊杰,戴惟葭,刘大川.应用OCT评价激光周边虹膜成形联合切除术治疗临床前期原发性闭角型青光眼的有效性[J].国际眼科杂志,2015,16(12):2107-2109.
[6]蒋顺,凌家文,张志才,等.应用OCT评价激光周边虹膜成形联合切除术治疗原发性闭角型青光眼80例的效果观察[J].中外医疗,2016,35(12):196-198.
[7]莫锦全.AS-OCT对联合MMC与单纯小梁切除术后滤过泡的短期随访研究[D].汕头:汕头大学,2016,8-41.
[8]张宏光,沙爱娟,叶丹,等.前节光学相干断层扫描仪观察原发性急性闭角型青光眼超声乳化联合房角分离术后前房形态的变化[J].山西医药杂志,2016,45(17):2029-2031.
[9]吴若欣,李金瑛,柯瑞莉.前节OCT观察明暗光线下眼前节静态参数及其动态变化的研究[J].眼科,2017,26(4)238-243.
[10]王良海,陈辉,王洪涛,等.微小切口白内障超声乳化手术联合房角分离术治疗急性闭角型青光眼的疗效观察[J].当代医学,2017,23(18):14-18.