Evaluating subconjunctival bleb function after trabeculectomy using slit-lamp optical coherence tomography and ultrasound biomicroscopy.
Evaluating subconjunctival bleb function after trabeculectomy using slit-lamp optical coherence tomography and ultrasound biomicroscopy.
复制标题
使用裂隙灯光学相干断层扫描和超声生物显微镜评估小梁切除术后的结膜下滤泡功能。
DOI：
10.1097/00029330-200807020-00005
复制
发表时间：
2008
影响因子：
6.1
通讯作者：
Bin Lu
中科院分区：
文献类型：
--
作者：
Yi Zhang;Qiang Wu;Min Zhang;Bei;Xin;Bin Lu
背景
现有的青光眼滤过泡分类主要依赖于滤过泡的外部特征和术后眼压控制。未仔细观察内部水泡结构。本研究旨在使用裂隙灯适应光学相干断层扫描（SL-OCT）和超声生物显微镜（UBM）分析和比较青光眼滤过泡形态，并根据结果和眼压对滤过泡进行分类。
方法
对2002年至2006年在上海市第六人民医院行青光眼滤过手术的男性21例29眼和女性32例40眼进行随访。使用SL-OCT和UBM对滤过泡进行成像，并根据滤过泡内形态和术后IOP控制情况进行分类。Fisher精确检验用于比较SL-OCT和UBM之间预测功能性滤过泡的灵敏度差异显著。基于SL-OCT，还使用Fisher精确检验对小梁切除术滤过泡进行形态分析。
结果
功能性滤过泡45眼（65.2%），无功能性滤过泡24眼（34.8%）。我们根据SL-OCT图像将水泡分为四类：弥漫性、囊性、包裹性和扁平性。弥漫性和囊性滤过泡是典型的功能性滤过泡，而其他两种类型的滤过泡总是无功能的。SL-OCT预测功能性滤过泡的敏感性为92.7%（38/41眼），预测非功能性滤过泡的特异性为83.3%（20/24眼）。UBM诊断青光眼的敏感性为66.7%（30/45眼），特异性为75.0%（18/24眼）。两种技术预测功能性滤过泡的灵敏度差异显著（P = 0.003）。
结论
SL-OCT可提供眼前节结构的高轴向分辨率图像。SL-OCT的非接触方法可以在手术后随时可视化滤过泡内结构。SL-OCT在评价滤过泡功能方面的敏感性和特异性均高于UBM。形态学分类支持滤过泡功能的评估，并可为评估抗青光眼手术的结果或是否需要二次手术提供客观数据。
BACKGROUND
The existing classifications for evaluating glaucoma filtering blebs rely mostly on external bleb characteristics and the postoperative control of intraocular pressure (IOP). Internal bleb structures are not carefully observed. This study aimed to analyze and compare glaucoma filtering bleb morphology using slit-lamp-adapted optical coherence tomography (SL-OCT) and ultrasound biomicroscopy (UBM), and to classify blebs according to results and intraocular pressure.
METHODS
We followed 29 eyes of 21 male patients and 40 eyes of 32 female patients who underwent glaucoma filtering surgery in Sixth People's Hospital of Shanghai, between 2002 and 2006. The blebs were imaged using SL-OCT and UBM and classified according to the intrableb morphology and control of IOP after surgery. A Fisher's exact test was used to compare the sensitivity for predicting a functioning bleb differed significantly between SL-OCT and UBM. A Fisher's exact test was also used for morphological analysis of the trabeculectomy blebs based on SL-OCT.
RESULTS
In the 69 eyes, there were 45 (65.2%) functioning blebs and 24 (34.8%) non-functioning blebs. We classified the blebs into four categories on the basis of SL-OCT images: diffuse, cystic, encapsulated and flat. Diffuse and cystic blebs were typically functional, whereas the other two types were always non-functional. The sensitivity of SL-OCT for predicting a functioning bleb was 92.7% (38/41 eyes) and specificity of predicting a non-functioning bleb was 83.3% (20/24 eyes). By contrast, sensitivity of UBM was 66.7% (30/45 eyes) and specificity was 75.0% (18/24 eyes). The sensitivity for predicting a functioning bleb differed significantly between the two techniques (P = 0.003).
CONCLUSIONS
SL-OCT provides high-axial-resolution images of anterior segment structures. The non-contact approach of SL-OCT enables visualization of intrableb structures at any time after surgery. SL-OCT has greater sensitivity and specificity than UBM in evaluating filtering bleb function. The morphological classification supported the assessment of bleb function and could provide objective data for evaluating the outcome of antiglaucoma surgery or the need for a second procedure.