原发性闭角型青光眼小梁切除早期滤过泡形态与24h眼压关系

Correlation between the bleb morphology and the 24-hour following trabeculectomy in the early postoperative outcomes glaucoma （PACG） intraocular pressure （IOP） of primary angle-closure

目的观察原发性闭角型青光眼小梁切除术后1个月时结膜滤过泡形态与术后24h眼压（IOP）的关系。方法对46例施行小梁切除术的原发性闭角型青光眼患者进行随访观察。采用IBAGS滤过泡分级系统（Indiana Bleb Grading Scale，IBAGS）对术后1个月的滤过泡进行记录，应用Gold．mann压平眼压计进行眼压测量。采用线性回归分析方法检验滤过泡与24h眼压的关系，采用t检验的方法对有无微囊结构滤过泡的24h眼压进行比较。结果线性回归分析显示滤过泡高度（H）每增加1分术后24h眼压波动值将降低0．60mmHg（95％可信区间为-1．183-0．024），滤过泡范围（E）每增加1分术后24h眼压波动值将降低0．66mmHg（95％可信区间为-1．193-0．122），滤过泡面积（即大小H＋E）每增加1分术后24h眼压波动值将降低0．43mmHg（95％可信区间为-0．756-0．109），术后具有微囊结构的滤过泡其眼压波动范围较无微囊结构者平均降低1．02mmHg（95％可信区间为-1．876-0．156）。具有微囊特征滤过泡的患者上午10点的IOP、24hIOP平均值、波动值、24hIOP最大值及最小值均较无微囊者为理想（P值分别为0．0058、0．0039、0．0019、0．0014、0．0211。），差异有统计学意义。所有患者中仅有一例发生滤过泡渗漏。结论滤过泡形态与术后24h眼压具有一定的相关性。滤过泡的高度，范围及面积对术后24h眼压的影响最明显。同时具有微囊结构滤过泡的病例术后24h眼压控制良好。

Objective To observe the correlation of the morphologic appearance of blebs after trabeculectomy in the first postoperative month with the outcome of 24-hour IOP among patients with PACG after trabeculectomy. Methods A total of 46 patients of PACG were included for the analysis after trabeculectomy. The bleb morphology in the first month after trabeculectomy was grad- ed with the Indian Bleb Appearance Grading Scale based on standard photos. IOP were measured by Goldmann applanation tonometer. The correlation between postoperative different filtering bleb characteristics and 24-hour IOP were tested by linear regression analysis. The 24-hour lOP with or without microcysts were compared by t test. Results On the linear regression analysis an increase in IBAGS height score by 1U resulted in a reduction in 24-hour IOP fluctuation of 0.60mmHg [95% confidence interval （CI）=-1.183-0.024]. An increase in IBAGS extent score by 1U resulted in a reduction in 24-hour IOP flucfiaation of 0.66mmHg [95% CI=-1.193-0.122]. An increase in IBAGS size （H＋E） score by 1U resulted in a reduction in 24-hour lOP fluctuation of 0.43mmHg [95% CI=-0.756-0.109]. In the model, bleb with microcysts had 1.02mmHg lower of 24-hour IOP fluctuation value [95% CI=-1.876-0.156] than those without microcysts in the third postoperativemonth. The lOP during regular office hours, the mean lOP, fluctuation value, the maximum and the minimum of 24-hour IOP with microcysts were lower than those without microcysts （P value were 0.0058, 0.0039, 0.0019, 0.0014, and 0.0211 respectively）. This difference was statistically significant. There were only one bleb leak in this series. Conclusions The bleb morphology and 24-hour IOP has a certain correlation. Bleb heigh, extent, size and microcysts are the most important factors to in- fluence 24-hour IOE