原发性慢性闭角型青光眼术后早期滤过泡形态与远期眼压的相关性研究

目的 探讨原发性慢性闭角型青光眼小梁切除术后结膜滤过泡形态与眼压的相关性.方法 多中心临床病例系列研究.对176例(176只眼)40岁以上的原发性慢性闭角型青光眼患者,实施单纯小梁切除术88例(88只眼)或小梁切除联合可拆除缝线术88例(88只眼).术后3个月,按照Indiana bleb appearance grading scale滤过泡分级系统,对患者术后滤过泡形态进行分级,应用Goldmann压平眼压计测量眼压.术后滤过泡形态与眼压的相关性采用线性回归分析法.结果 150例(85.7％)患者完成18个月的随访观察.术后18个月平均眼压(15.6±5.4)mm Hg(1 mm Hg=0.133 kPa),其中10只眼的眼压≥21 mm Hg,5只眼在用药后眼压＜21 mm Hg,其余135只眼的眼压＜21 mm Hg.142只眼记录了术后3个月滤过泡形态:扁平无隆起(H0级)3只眼,低度隆起(H1级)45只眼,中度隆起(H2级)90只眼,高度隆起(H3级)4只眼;滤过泡未血管化66只眼,滤过泡血管化76只跟.单因素线性回归分析,显示有微囊结构滤过泡者的眼压较无微囊结构滤过泡者的眼压低2.77 mm Hg(β=-2.77,95％CI:-0.46～-5.08);滤过泡未血管化者的眼压较滤过泡血管化者的眼压低2.077 mm Hg(β=-2.07,95％ CI:-0.15～- 3.98);患者年龄每增加10岁,术后眼压降低1.2 mm Hg(β=-1.20,95％ CI:-0.00～-2.40);患者年龄、滤过泡微血管化及微囊结构滤过泡的存在与术后18个月的眼压有相关性(P＜0.05).结论 患者术后早期滤过泡形态对预测远期眼压水平具有一定意义,患者术后滤过泡形态、滤过泡血管化程度及年龄是影响远期眼压的主要因素.

Assess correlation between bleb morphology at long-term intraocular pressure effect in primary angle-closure glaucoma following trabeculectomy

Objective To evaluate the correlation between morphologic appearance of blebs at 3 month and long-term intraocular pressure (IOP) effect in patients with primary angle-closure glaucoma (PACG) after trabeculectomy.Methods Multi-centered cases series.Data were collected from 176 patients aged ≥40 years with PACG who were participated in a randomized clinical trial that aimed at addressing the efficacy of augmented releasable sutures after trabeculectomy.The bleb morphology was graded using the Modified Indian Bleb Appearance Grading Scale (IBAGS) based on standard photos at 3 month after trabeculectomy.IOPs were measured with Goldmann applanation tonometer.The correlation between bleb components and other selected testing influencing factors and long-term IOP was tested by linear Logistic regression analysis.Results 150 patients (85.7％ ) completed 18 months of follow up.IOP was (15.6 ± 5.4) mm Hg at 18 month of post-operation.135 eyes had an IOP ≤ 21 mm Hg without additional medications,10 eyes≥21 mm Hg,and the remaining 5 eyes required one or two medications to maintain normal IOP.Using IBAGS system,bleb was graded in 142 eyes as follows:H0 in 3 eyes,H1 in 45 eyes,H2 in 90 eyes,and H3 in 4 eyes,while V0 was observed in 66 eyes,V1-3 in 76 eyes.IOP at 18 months in bleb with microcysts was 2.77 mm Hg lower( β =- 2.77,95％ CI =- 0.46 to - 5.08 ) than those without microcysts and in bleb with non-vascular was 2.07 mm Hg lower( β =-2.07,95％ CI =-0.15 to -3.98)than those with vascular at 3 months after surgery.IOP was significantly ( β =- 1.20,95％ CI:-0.00 to -2.40) decrensed by 1.2 mm Hg with 10 years of age increase(P ＜ 0.05).Conclusions Early filtering bleb with microcysts,vascular,and age are identified as important factors to predict long-term IOP effect in patients with PACG after trabeculectomy but not early morphological appearance of filtering bleb.