Lamina Cribrosa Reversal after Trabeculectomy and the Rate of Progressive Retinal Nerve Fiber Layer Thinning
Lamina Cribrosa Reversal after Trabeculectomy and the Rate of Progressive Retinal Nerve Fiber Layer Thinning
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DOI：
10.1016/j.ophtha.2015.07.020
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发表时间：
2015-11-01
期刊：
影响因子：
13.7
通讯作者：
Kim, Tae-Woo
中科院分区：
文献类型：
--
作者：
Lee, Eun Ji;Kim, Tae-Woo
目的：确定小梁切除术后观察到的筛板 (LC) 移位逆转是否与原发性开角型青光眼 (POAG) 的进行性视网膜神经纤维层 (RNFL) 变薄率相关。设计：观察性病例系列。参与者：34 名接受小梁切除术并随访至少 2.5 年的 POAG 患者，在此期间通过系列谱域测量 RNFL 厚度(SD) 光学相干断层扫描 (OCT)。 方法：参与者在术前 (PREOP)、术后 6 个月随访 (FU1) 以及术后至少 2.5 年的后续随访 (FU2) 中使用 SD OCT 对视神经进行增强深度成像扫描，并在研究期间至少测量 5 次连续 RNFL 厚度。术前和术后 LC 深度 (LCD) 是根据每只眼睛的 7 个选定的 B 扫描图像确定的，取平均值以产生平均 LCD。 RNFL 变薄率由连续 OCT RNFL 厚度测量值随时间的线性回归确定。主要结果指标：与 OCT RNFL 变薄率相关的因素。结果：眼压 (IOP) 在 FU1 时从 23.8 +/- 7.9 mmHg（平均值 +/- 标准差）下降至 11.0 +/- 4.4 mmHg（P < 0.001），随后增加至总体随访 3.5 +/- 0.8 年时为 13.1 +/- 5.2 mmHg (P = 0.003)。 FU1 时 LCD 从 589.90 +/- 148.32 减少到 508.57 +/- 136.28 mm (P < 0.001)。随后在 FU2 处注意到 LCD 略有但不显着的增加（516.48 +/- 145.87 mm；P = 0.410）。 RNFL 变薄速度较快与较短的随访期 (P = 0.032)、PREOP (P = 0.011) 和 FU2 (P = 0.014) 时的 IOP 较高以及 LCD 从 FU1 到 FU2 的较大增加 (P < 0.001) 相关。 PREOP和FU1之间以及PREOP和FU2之间LCD的变化与RNFL变薄的速度无关。结论：长期持续LCD减少的眼睛在小梁切除术后RNFL进行性变薄的速度较慢。如果在随后的随访中没有维持，术后早期 LCD 的大幅降低与长期进展率无关。 (C) 2015 年由美国眼科学会颁发。
Purpose: To determine whether the reversal of lamina cribrosa (LC) displacement observed after trabeculectomy is associated with the rate of progressive retinal nerve fiber layer (RNFL) thinning in primary open-angle glaucoma (POAG).Design: Observational case series.Participants: Thirty-four patients with POAG who underwent trabeculectomy and were followed up for at least 2.5 years, during which the RNFL thickness was measured by serial spectral-domain (SD) optical coherence tomography (OCT).Methods: The participants underwent enhanced depth imaging scanning of the optic nerve using SD OCT before surgery (PREOP), at a 6-month postoperative follow-up (FU1), and at a subsequent follow-up that was performed at least 2.5 years postoperatively (FU2), and serial RNFL thickness was measured at least 5 times during the study period. Preoperative and postoperative LC depths (LCDs) as determined on 7 selected B-scan images from each eye were averaged to produce the mean LCD. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements over time.Main Outcome Measures: Factors associated with the rate of OCT RNFL thinning.Results: The intraocular pressure (IOP) decreased from 23.8 +/- 7.9 mmHg (mean +/- standard deviation) to 11.0 +/- 4.4 mmHg at FU1 (P < 0.001) and subsequently increased to 13.1 +/- 5.2 mmHg at an overall follow-up of 3.5 +/- 0.8 years (P = 0.003). The LCD was reduced from 589.90 +/- 148.32 to 508.57 +/- 136.28 mm at FU1 (P < 0.001). A subsequent slight but nonsignificant increase in the LCD was noted at FU2 (516.48 +/- 145.87 mm; P = 0.410). A faster rate of RNFL thinning was associated with a shorter follow-up period (P = 0.032), higher IOP at PREOP (P = 0.011) and FU2 (P = 0.014), and a larger increase in LCD from FU1 to FU2 (P < 0.001). The changes in LCD between PREOP and FU1 and between PREOP and FU2 were not associated with the rate of RNFL thinning.Conclusions: Eyes with sustained LCD reduction over a long period had a slow rate of progressive RNFL thinning after trabeculectomy. A large LCD reduction in the early postoperative period was not associated with the long-term rate of progression if it was not maintained during subsequent follow-up. (C) 2015 by the American Academy of Ophthalmology.