SL-OCT对青光眼滤过手术后滤过泡形态的观察

Morphological analysis on trabeculectomy blebs with slit lamp adapted optical coherence tomography

目的利用裂隙灯适配光学相干断层扫描成像术(SL-OCT),观察分析青光眼滤过手术后的结膜滤过泡,探讨其对滤过泡形态和功能评估的临床意义。方法对62例78眼青光眼患者滤过术后行SL-OCT检查,获取滤过泡内部结构图像,使用设备内置软件进行测量,根据所得图像对滤过泡进行分析。结果在功能性滤过泡组中35/45(77.8%)眼观察到滤泡壁肥厚伴或不伴结膜下微囊泡或腔隙存在,而在非功能性滤过泡组中只有4/24(16.7%)眼有此特征,两者差异有统计学意义(P<0.005)。在功能性滤过泡中26/45(57.8%)眼有巩膜瓣周围低反射区存在,而在非功能性滤过泡中只有5/24(20.8%)眼有巩膜瓣周围低反射区(P<0.005)。在功能性滤过泡中12/45(26.7%)眼有巩膜瓣上高反射区存在,而在非功能性滤过泡中有14/24(58.3%)眼有巩膜瓣上高反射区(P<0.01)。在功能性滤过泡中20/45(44.4%)眼巩膜瓣下滤过通道不见,而在非功能性滤过泡中有19/24(79.2%)眼巩膜瓣下滤过通道不见(P<0.01)。另内口闭塞5眼全部出现在无功能滤过泡组(P<0.005)。结论SL-OCT通过非接触检查,可在术后各个阶段获得较高分辨率的滤过泡内部形态图像,为滤过泡功能的评估及形态分级提供参考,是一种有价值的滤过泡评价工具。

Objective To make morphological analysis on the trabeculectomy blebs with slit lamp adapted optical coherence tomography （SL-OCT）. Methods Seventy-eight eyes of 62 patients, underwent glaucoma filtering surgery, had the blebs be examined by Heidelberg SL-OCT. The images were recorded automatically and analyzed by the accessorial software. Results In 35 of 45 （77.8%） successful blebs, bleb wall thickening was found. In contrast, bleb wall thickening was found in only 4 of 24 （ 16.7% ） failed blebs （P 〈 0. 005）. Hyporeflective area around scleral flap was found in 26 of 45 （57.8%） successful blebs, in contrast, it was found in only 5 of 24 （20.8%） failed blebs （P 〈 0. 005）. High signal reflectivity area supra scleral flap was found in 12 of 45 （26.7%） successful blebs, in contrast, it was found in 14 of 24 （58.3%） failed blebs （P 〈 0.01 ）. The route under scleral flap was not found in 20 of 45 （44.4%） successful blebs, in contrast, it was not found in 19 of 24 （79.2%） failed blebs （P 〈 0.01 ）. In addition, we found internal ostium occlusion in 5 eyes, all of them were filed blebs （P 〈 0. 005）. Conclusion SL-OCT was able to demonstrate features of bleb morphology not visible with the slit lamp in trabeculectomised eyes in each stage after the surgery with non-contact examination. This information may be useful to study the different surgical outcomes and typing the blebs. SL-OCT is a worthy tool to image trabeculectomy blebs.