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Abstract：
To analyze in vivo scleral changes induced by MicroPulse transscleral laser therapy (MP-TLT) in refractory glaucoma using anterior segment-optical coherence tomography (AS-OCT). Forty-two candidate patients for MP-TLT were consecutively enrolled and underwent AS-OCT at baseline and after six months. MP-TLT success was defined as an intraocular pressure (IOP) reduction by one-third. The main outcome measures were the mean superior (S-), inferior (I-), and total (T-) intra-scleral hypo-reflective space area (MISHA: mm2) and scleral reflectivity (S-SR, I-SR, T-SR; arbitrary scale) as in vivo biomarkers of uveoscleral aqueous humor (AH) outflow. The IOP was the secondary outcome. The relations between the baseline-to-six months differences (D) of DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, DT-SR, and DIOP, were investigated. At 6 months, the median IOP reduction was 21% in the failures and 38% in the successes. The baseline S-MISHA, I-MISHA, and T-MISHA did not differ between the groups, while S-SR and T-SR were higher in the successes (p < 0.05). At six months, successful and failed MP-TLTs showed a 50% increase in S-MISHA (p < 0.001; p = 0.037), whereas I-SR and T-SR reduced only in the successes (p = 0.002; p = 0.001). When comparing DS-MISHA, DI-MISHA, and DT-MISHA and DS-SR, DI-SR, and DT-SR, there were no significant differences between the groups. In the successful procedures, DIOP was positively correlated with DT-MISHA and DI-MISHA (ρ = 0.438 and ρ = 0.490; p < 0.05). MP-TLT produced potentially advantageous modifications of the sclera in refractory glaucoma. Given the partial correlation between these modifications and post-treatment IOP reduction, our study confirmed that the activation of the uveoscleral AH outflow route could significantly contribute to the IOP lowering after MP-TLT.
摘要：
应用眼前节光学相干断层扫描（AS-OCT）分析经巩膜微脉冲激光（MP-TLT）治疗难治性青光眼的巩膜变化。连续纳入42例MP-TLT候选患者，并在基线和6个月后接受AS-OCT检查。MP-TLT成功定义为眼内压（IOP）降低三分之一。主要结果指标是平均优(S-)，劣等（I-），和巩膜内总（T-）低反射空间面积（MISHA：mm2）和巩膜反射率（S-SR，I-SR,T-SR；任意尺度）作为葡萄膜巩膜房水（AH）流出的体内生物标志物。IOP是次要结果。DS-MISHA的基线至六个月差异（D）之间的关系，DI-MISHA,DT-MISHA和DS-SR，DI-SR,DT-SR,和DIOP,被调查了。6个月时,失败组的中位眼压降低为21%,成功组的中位眼压降低为38%.基线S-MISHA,我-MISHA,T-MISHA在两组之间没有差异，而S-SR和T-SR的成功率较高(p<0.05)。六个月的时候，成功和失败的MP-TLTs显示S-MISHA增加50%(p<0.001;p=0.037),而I-SR和T-SR仅在成功中降低(p=0.002;p=0.001)。比较DS-MISHA时，DI-MISHA,DT-MISHA和DS-SR，DI-SR,和DT-SR，两组间无显著差异.在成功的程序中，DIOP与DT-MISHA和DI-MISHA呈正相关(ρ=0.438和ρ=0.490;p<0.05)。MP-TLT在难治性青光眼中产生潜在的有利的巩膜修饰。鉴于这些修饰与治疗后眼压降低之间存在部分相关性，我们的研究证实,葡萄膜巩膜AH流出途径的激活可显著促进MP-TLT后IOP的降低.
