Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph
Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph
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DOI：
10.1016/s0161-6420(99)00526-6
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发表时间：
1999-05-01
期刊：
影响因子：
13.7
通讯作者：
Schmidt, CM
中科院分区：
文献类型：
--
作者：
Lesk, MR;Spaeth, GL;Schmidt, CM
目的：使用海德堡视网膜断层扫描仪（HRT，海德堡仪器公司，海德堡，德国）检测和定量青光眼手术后视神经形态的变化。设计：非连续观察病例系列。参与者和干预：作者前瞻性招募了 21 名因进行性青光眼损伤而接受青光眼切开手术的成年患者。通过扫描激光断层扫描和自动视野检查对青光眼手术前后的视神经乳头进行定量分析。主要指标：视神经参数的变化与术后眼压（IOP）降低百分比以及年龄、屈光度、术前杯盘比和视野变化进行线性回归分析 结果：17 名患者的术前和术后图像适合分析，术前图像采集时的平均 IOP 为 30.5 +/- 12 mmHg，术后为 11.8 +/- 5.2 mmHg（平均随访时间，26 +/- 7 周）。 13 名眼压降低超过 40% 的患者中，有 11 名 (85%) 表现出视盘参数有所改善。所有 4 名 IOP 下降幅度小于 25% 的患者均表现出大多数参数的恶化。视盘参数的变化与眼压降低百分比和年龄高度相关。与眼压变化百分比变化最密切相关的参数是视杯面积、边缘面积、视杯：视盘比率和平均值（向上深度教导，P < 0.005）。患者年龄与最大视杯深度的变化高度相关（P < 0.005）。屈光度和临床确定的视杯：视盘比率与测量的视盘参数的变化相关性较差。视野的临床改善与杯盘比的改善程度相关（P = 0.025）。结论：大多数青光眼手术后眼压降低 40% 的患者通过 HRT 测量显示视神经形态有所改善。改善量与眼压降低百分比高度相关。
Objective: To detect and quantitate changes in optic nerve morphology after glaucoma surgery using the Heidelberg Retina Tomograph (HRT, Heidelberg Instruments, Heidelberg, Germany).Design: Nonconsecutive observational case series.Participants and Intervention: The authors prospectively enrolled 21 adult patients undergoing incisional glaucoma surgery for progressive glaucoma damage. Quantitative analysis of the optic nerve head by scanning laser tomography and automated perimetry were performed before and after glaucoma surgery.Main Outcome Measures: Changes in optic nerve parameters were subjected to linear regression analysis with respect to percent of postoperative reduction of intraocular pressure (IOP), as well as with respect to age, refraction, preoperative cup,disc ratio, and change in visual field parameters.Results: Seventeen patients had pre- and postoperative images suitable for analysis, Mean IOP at the time of image acquisition before surgery was 30.5 +/- 12 mmHg, and after surgery 11.8 +/- 5.2 mmHg (mean follow-up, 26 +/- 7 weeks). Eleven of 13 (85%) patients having IOP reduction of greater than 40% showed improvement in optic disc parameters. All four patients with less than 25% reduction in IOP showed worsening of most parameters. Changes in optic disc parameters were highly correlated with percent IOP reduction and with age. The parameters in which change most strongly correlated with percent change of IOP were cup area, rim area, cup:disc ratio, and mean (up depth teach, P < 0.005), The age of the patient correlated highly with change in maximum cup depth (P < 0.005), Refraction and clinically determined cup:disc ratio correlated poorly with changes in measured optic disc parameters. Clinical improvement in visual fields was correlated with the degree of improvement of cup:disc ratio (P = 0.025),Conclusion: Most patients showing a 40% lowering of IOP after glaucoma surgery show improved optic nerve morphology as measured by the HRT. The amount of improvement correlated highly with the percent reduction of IOP.