Valve-Like Outflow System Behavior With Motion Slowing in Glaucoma Eyes: Findings Using a Minimally Invasive Glaucoma Surgery-MIGS-Like Platform and Optical Coherence Tomography Imaging.
Valve-Like Outflow System Behavior With Motion Slowing in Glaucoma Eyes: Findings Using a Minimally Invasive Glaucoma Surgery-MIGS-Like Platform and Optical Coherence Tomography Imaging.
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DOI：
10.3389/fmed.2022.815866
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发表时间：
2022
影响因子：
3.9
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中科院分区：
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本研究旨在利用高分辨率光学相干断层扫描（HR-OCT）研究正常眼和青光眼眼中压力依赖性小梁网和远端瓣膜样结构变形的解剖关系和生物力学。我们在使用 HR-OCT 对三只正常 (NL) 和五只青光眼 (GL) 离体眼睛的片段进行成像期间控制了施累姆氏管 (SC) 压力。从 15 个位置（5 个 NL 和 10 个 GL）对解剖的角膜缘楔进行研究。将类似于微创青光眼手术 (MIGS) 的插管插入 SC 腔中，而另一端连接到两个储液器之间的开关，一个为 0，另一个为 30 mm Hg。在 3D 体积成像过程中，维持 30 mm Hg 的稳态压力以扩张 SC 和收集通道 (CC)。使用排除 SC 和 CC 周围组织的图像掩模，将所得 3D 管腔表面关系与内部结构特征相关联。使用 HR-OCT 成像时，通过将压力从 0 毫米汞柱切换到 30 毫米汞柱或从 30 毫米汞柱切换到 0 毫米汞柱，捕获 SC 和 CC 区域的实时运动响应。比较了 NL 与 GL 运动差异。管腔表面和内部关系已成功成像。我们确定了 SC 入口和出口阀状结构。在 NL 和 GL 中，在 0 和 30 mm Hg 稳态下测量的平均 SC 面积均存在显着差异 (p < 0.0001)。 SC 和 CC 流明面积的同步变化发生在 <200 ms 内。 NL 眼在稳态 0 和 30 mmHg 时测得的 SC 面积差异分别大于 GL 眼 (p < 0.0001)。 GL 中的 SC 运动曲线上升速度明显慢于 NL (p < 0.001)。压力波从插管端沿着 SC 腔传播到 CC 和深层巩膜内通道。 HR-OCT 可同时测量流出通道管腔表面、内部结构以及实时压力相关尺寸变化的生物力学。我们确定了 SC 入口和出口阀状结构。 GL 组织比 NL 经历更少的运动并且响应更慢，这与组织刚度的增加一致。类似于 MIGS 的 SC 分流允许脉冲波沿着 SC 腔向远端行进并进入 CC。
This study aimed to investigate anatomic relationships and biomechanics of pressure-dependent trabecular meshwork and distal valve-like structure deformation in normal and glaucoma eyes using high-resolution optical coherence tomography (HR-OCT). We controlled Schlemm’s canal (SC) pressure during imaging with HR-OCT in segments of three normal (NL) and five glaucomatous (GL) ex vivo eyes. The dissected limbal wedges were studied from 15 locations (5 NL and 10 GL). A minimally invasive glaucoma surgery (MIGS)-like cannula was inserted into the SC lumen, whereas the other end was attached to a switch between two reservoirs, one at 0, the other at 30 mm Hg. A steady-state pressure of 30 mm Hg was maintained to dilate SC and collector channels (CC) during 3D volume imaging. The resulting 3D lumen surface relationships were correlated with internal structural features using an image mask that excluded tissues surrounding SC and CC. While imaging with HR-OCT, real-time motion responses in SC and CC areas were captured by switching pressure from 0 to 30 or 30 to 0 mm Hg. NL vs. GL motion differences were compared. Lumen surface and internal relationships were successfully imaged. We identified SC inlet and outlet valve-like structures. In NL and GL, the mean SC areas measured at the steady-state of 0 and 30 mm Hg were each significantly different (p < 0.0001). Synchronous changes in SC and CC lumen areas occurred in <200 ms. Measured SC area differences at the steady-state 0 and 30 mmHg, respectively, were larger in NL than GL eyes (p < 0.0001). The SC motion curves rose significantly more slowly in GL than NL (p < 0.001). Pressure waves traveled from the cannula end along the SC lumen to CC and deep intrascleral channels. HR-OCT provided simultaneous measurements of outflow pathway lumen surfaces, internal structures, and biomechanics of real-time pressure-dependent dimension changes. We identified SC inlet and outlet valve-like structures. GL tissues underwent less motion and responded more slowly than NL, consistent with increased tissue stiffness. A MIGS-like shunt to SC permitted pulse waves to travel distally along SC lumen and into CC.