眼前节扫频OCT对大直径穿透性角膜移植术后早期高眼压治疗的指导意义

Evaluation of Anterior Segment Swept-Frequency OCT Used for Guidance in Early High Intraocular Pressure Therapy after Large Diameter Penetrating Keratoplasty

目的:使用眼前节扫频OCT(SS-OCT)观察行大直径穿透性角膜移植术(LDPK)后早期高眼压房角图像特点,评估眼前节SS-OCT对角膜移植术后高眼压治疗的指导意义。方法:回顾性观察性研究。选择2017年1-6月间在山东省眼科医院行LDPK术后早期出现高眼压患者15例(15眼),术后使用眼前节SS-OCT采集患眼房角粘连情况及范围,记录各患者治疗方案,分析其与术前病因、术前眼压、术中植片大小、治疗方案之间的关系。数据采用Mann-Whitney U检验和Kruskal-Wallis H检验进行分析。结果:所有LDPK术后早期高眼压患者均获得清晰眼前节SS-OCT房角图像,存在房角粘连10例(10/15),未存在房角粘连5例(5/15),平均粘连范围42°(0°~183°)。不同术前病因的房角粘连范围差异无统计学意义(Z=-0.072,P=0.943),移植术前高眼压较正常眼压者的房角粘连范围大,差异有统计学意义(Z=-1.935,P=0.043)。术中角膜植片较大的房角粘连范围大,差异有统计学意义(Z=-2.506,P=0.012)。术后高眼压联合手术治疗较单纯药物治疗者房角粘连范围大,差异有统计学意义(Z=-3.133,P=0.002),房角粘连范围>180°全部联合手术治疗。结论:大直径穿透性角膜移植术后早期高眼压患者行眼前节SS-OCT检查有助于发现不同程度的房角粘连,术前眼压、术中植片大小影响术后房角粘连范围,对于SS-OCT观察术后房角粘连范围>180°的药物治疗无效,宜及早行滤过手术治疗。

Objective: To observe the characteristics of an early high intraocular pressure angle adhesion after large-diameter penetrating keratoplasty (LDPK) using anterior segment swept-source optical coherence tomography (SS-OCT) and to evaluate the anterior segment SS-OCT forguiding the treatment of high intraocular pressureafter penetrating keratoplasty. Methods: This was a retrospective observational study. Fifteen patients (15 eyes) with high intraocular pressure (IOP) in the early stage after LDPK in the Eye Hospital of Shandong Province were selectedfrom January to June 2017. Postoperative anterior segment SS-OCT was used to record the adhesion and extent of peripheral anterior synechia. Treatment plans were then developed for the patients. The relationships between preoperative etiology, preoperative intraocular pressure, intraoperative graft size, treatment plans and adhesion angle rangewerecompared and data were analyzed using the Mann-Whitney U test and the Kruskal-Wallis H test. Results: Clear images of the chamber angle were obtained with SS-OCT from allpatients with early high intraocular pressure after LDPK. There were 10 cases of anterior chamber angle adhesion (10/15), 5 cases of nocturnal adhesion (5/15), and the average adhesion range was 42°(0~183°). There was no significant difference in the range of adhesion angle between different preoperative causes (Z=-0.072, P=0.943). Preoperative high intraocular pressure was compared with preoperative normal intraocular pressure and there was a larger angle adhesion range. The difference was statistically significant (Z=-1.935, P=0.043). Alarge area of the implant had an extended range of adhesion, and the difference was statistically significant (Z=-2.506, P=0.012). All patients were followed up until normal intraocular pressure was obtained. The range of the adhesion angle in the combined surgery group was larger than that in the drug-only group. The difference was statistically significant (Z=-3.133, P=0.002), and all of the adhesion angle ranges>180° were treated with surgery. Conclusions: Anterior segment SS-OCT examination can help to find peripheral anterior synechiain patients with early high intraocular pressure after large-diameter penetrating keratoplasty. Preoperative intraocular pressure and intraoperative graft size affects the range of peripheral anterior synechia. For peripheral anterior synechia range of more than 180°, patients should have early filtering surgery if drugs are ineffective.