Filtering Bleb Structure Associated with Long-Term Intraocular Pressure Control after Amniotic Membrane-Assisted Trabeculectomy
Filtering Bleb Structure Associated with Long-Term Intraocular Pressure Control after Amniotic Membrane-Assisted Trabeculectomy
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DOI：
10.3109/02713683.2011.635403
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发表时间：
2012-03-01
影响因子：
2
通讯作者：
Negi, Akira
中科院分区：
文献类型：
--
作者：
Nakamura, Makoto;Naka, Maiko;Negi, Akira
目的/目标：目的：探讨小梁切除术中羊膜移植（AMT）对滤过泡内结构的影响，以及滤过泡内参数与长期眼压控制的相关性。材料与方法：选择青光眼患者56例（64只眼），均行小梁切除术，其中羊膜移植组36只眼，羊膜移植组28只眼。术后至少1年通过超声生物显微镜（UBM）评价滤过泡结构。当术前IOP下降超过30%时，IOP控制被定义为良好，如果术前IOP高于21 mmHg，则IOP值< 18 mmHg。Logistic回归分析，以确定与IOP control.Results显着相关的因素：手术和UBM检查的时间间隔（中位数; 2.5年）和良好的IOP控制的总体频率（28/36在没有AMT和17/28在那些与AMT;卡方检验，P = 0.2276）在两组相似。与无AMT的眼相比，有AMT的眼的H型（高反射）或L型（低反射）滤过泡的数量显著减少，而E型（包裹性）滤过泡的数量显著增加（P < 0.0001）。在年龄、性别、青光眼类型、透镜状态、降眼压药数量和既往眼内手术等独立变量中，仅F型无AMT的眼中（扁平）水泡（P = 0.0008，比值比[ OR] = 0.0256）和无或有限的滤过泡内液体填充空间与AMT眼的IOP控制不良显著相关结论：单纯小梁切除术与AMT辅助小梁切除术后滤过泡内结构有明显差异。前者的滤过泡壁反射率和后者的结膜下液体填充空间的范围是与长期IOP控制相关的因素。
Purpose/Aim: To determine whether amniotic membrane transplantation (AMT) at trabeculectomy affects intrableb structures and which intrableb parameters are significantly correlated with the long-term intraocular pressure (IOP) control.Materials and Methods: Enrolled were 64 eyes of 56 glaucoma patients who underwent trabeculectomy without (36 eyes) or with (28 eyes) AMT. Bleb structure was evaluated by ultrasound biomicroscopy (UBM) at least one year after surgery. IOP control was defined as good when the eyes had a more than 30% decrease in the preoperative IOP and an IOP value < 18 mmHg if the preoperative IOP was higher than 21 mmHg. Logistic regression analyses were conducted to identify factors significantly associated with IOP control.Results: Intervals between surgery and the timing of the UBM examinations (median; 2.5 years) and the overall frequency of good IOP control (28/36 in the eyes without AMT and 17/28 in those with AMT; chi-square test, P = 0.2276) were similar in the two groups. The eyes with AMT had a significantly lower number of type H (high reflective) or L (low reflective) blebs and a higher number of type E (encapsulated) blebs compared to those without AMT (P < 0.0001). Among independent variables, which included age, sex, glaucoma type, lens status, the number of ocular hypotensives, and previous intraocular surgeries, only type F (flattened) bleb in eyes without AMT (P = 0.0008, odds ratio [ OR] = 0.0256) and no or limited intrableb fluid-filled space in eyes with AMT were significantly associated with poor IOP control (P = 0.0026, OR = 0.0111, and 0.0071, 0.0167, respectively).Conclusions: Intrableb structures after trabeculectomy alone versus AMT-assisted trabeculectomy were distinct. The bleb wall reflectivity in the former and the extent of the subconjunctival fluid-filled space in the latter were factors associated with long-term IOP control.