Glaucoma

青光眼
  • 文章类型: Journal Article
    糖皮质激素诱导的青光眼(GIG)是与糖皮质激素(GC)相关的常见并发症,导致不可逆转的失明。GIG的特征是细胞外基质(ECM)在小梁网(TM)中的异常沉积,眼内压(IOP)升高,和视网膜神经节细胞(RGC)的损失。本研究的目的是研究烟酰胺核苷(NR)对GIG中TM的影响。
    利用对GC有反应的原代人TM细胞(pHTMs)和C57BL/6J小鼠建立体外和体内GIG模型,分别。该研究评估了TM中ECM相关蛋白的表达以及pHTMs的功能,以反映NR的作用。还在GIG细胞模型中检查了线粒体形态和功能。通过IOP监测GIG进展,RGC,和线粒体形态。酶促测定pHTM的细胞内烟酰胺腺嘌呤二核苷酸(NAD)水平。
    NR在地塞米松治疗后显著阻止ECM相关蛋白的表达并减轻pHTM的功能障碍。重要的是,NR保护受损的ATP合成,防止线粒体活性氧(ROS)的过度表达,并且还可以防止体外GCs诱导的线粒体膜电位降低。在GIG小鼠模型中,NR部分防止了IOP的升高和RGC的损失。此外,NR有效抑制ECM相关蛋白的过度表达,减轻体内线粒体损伤。
    根据结果,NR有效增强细胞内NAD+水平,从而通过减弱由GC诱导的线粒体损伤来减轻GIG中的异常ECM沉积和TM功能障碍。因此,NR作为GIG治疗的治疗候选物具有有希望的潜力。
    UNASSIGNED: Glucocorticoid-induced glaucoma (GIG) is a prevalent complication associated with glucocorticoids (GCs), resulting in irreversible blindness. GIG is characterized by the abnormal deposition of extracellular matrix (ECM) in the trabecular meshwork (TM), elevation of intraocular pressure (IOP), and loss of retinal ganglion cells (RGCs). The objective of this study is to investigate the effects of nicotinamide riboside (NR) on TM in GIG.
    UNASSIGNED: Primary human TM cells (pHTMs) and C57BL/6J mice responsive to GCs were utilized to establish in vitro and in vivo GIG models, respectively. The study assessed the expression of ECM-related proteins in TM and the functions of pHTMs to reflect the effects of NR. Mitochondrial morphology and function were also examined in the GIG cell model. GIG progression was monitored through IOP, RGCs, and mitochondrial morphology. Intracellular nicotinamide adenine dinucleotide (NAD+) levels of pHTMs were enzymatically assayed.
    UNASSIGNED: NR significantly prevented the expression of ECM-related proteins and alleviated dysfunction in pHTMs after dexamethasone treatment. Importantly, NR protected damaged ATP synthesis, preventing overexpression of mitochondrial reactive oxygen species (ROS), and also protect against decreased mitochondrial membrane potential induced by GCs in vitro. In the GIG mouse model, NR partially prevented the elevation of IOP and the loss of RGCs. Furthermore, NR effectively suppressed the excessive expression of ECM-associated proteins and mitigated mitochondrial damage in vivo.
    UNASSIGNED: Based on the results, NR effectively enhances intracellular levels of NAD+, thereby mitigating abnormal ECM deposition and TM dysfunction in GIG by attenuating mitochondrial damage induced by GCs. Thus, NR has promising potential as a therapeutic candidate for GIG treatment.
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  • 文章类型: Journal Article
    探讨激光小梁成形术(LTP)对开角型青光眼或高眼压患者行超声乳化/Kahook双刀切开术(phaco-KDB)的后续手术的影响。
    在2019年至2021年期间接受phaco-KDB的患者分为以前接受LTP治疗的患者和以前接受非LTP治疗的患者。LTP治疗包括氩激光小梁成形术(ALT)和选择性激光小梁成形术(SLT)。主要目标是调查以前的LTP是否影响phaco-KDB的术后结果。次要目标是调查LTP的结果是否可以预测随后的phaco-KDB的结果。我们还比较了LTP和非LTP治疗患者的IOP和药物减少。
    将总共111名LTP治疗的患者与139名非LTP治疗的患者进行比较。在接受LTP治疗的患者中,phaco-KDB手术成功率为82.9%,相比之下,非LTP治疗患者为88.5%(P=0.20)。组间IOP和药物的降低相似。此外,在LTP组中,LTP治疗成功的患者随后接受phaco-KDB的手术成功率为80.7%,LTP治疗失败的患者为83.0%(P=0.765)。
    先前的LTP治疗不能预测phaco-KDB的结果。此外,LTP效应与phaco-KDB手术后的成功没有相关性.
    UNASSIGNED: To investigate the influence of laser trabeculoplasty (LTP) on subsequent surgery with combined phacoemulsification/Kahook Dual Blade goniotomy (phaco-KDB) in patients with open-angle glaucoma or intraocular hypertension.
    UNASSIGNED: Patients undergoing phaco-KDB between 2019 and 2021 were divided into previously LTP treated and previously non-LTP treated, and LTP-treatment included argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). The primary goal was to investigate if previous LTP influenced later surgical outcome of phaco-KDB. The secondary goal was to investigate if the outcome of LTP could be predictive of the outcome of subsequent phaco-KDB. We also compared IOP- and medication reductions between LTP and non-LTP treated patients.
    UNASSIGNED: A total of 111 LTP treated patients were compared to 139 non-LTP treated patients. In LTP treated patients, surgical success of phaco-KDB was 82.9%, compared to 88.5% in non-LTP treated patients (P=0.20). Reductions in IOP and medications were similar between groups. Furthermore, within the LTP group, patients with successful LTP-treatment had a subsequent surgical success of phaco-KDB in 80.7%, compared to 83.0% in patients with unsuccessful LTP-treatment (P=0.765).
    UNASSIGNED: Previous LTP treatment does not predict the outcome of phaco-KDB. Furthermore, no correlation was found between the LTP effect and a later surgical success of phaco-KDB.
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    文章类型: English Abstract
    It is widely known that in economically developed countries there is an increase in the proportion of older people. However, the problem of the influence of territorial features of economic development on the rate of population aging is not sufficiently covered. The goal was to study the impact of economic development indicators (EDI) on the processes of premature aging of the population. The materials were statistical collections of the Ministry of Health of Russia and Russian Statistics Service for 2011-2019. The highest incidence was characteristic of cataracts and glaucoma. A direct correlation has been established between the EDI and the age-specific incidence index (ASII) of cataracts (r=0,31; p=0,00436). A group of regions with a high level of economic development was characterized by a higher value of ASII, which, as a rule, corresponds to the later development of the disease.
    Широко известно, что в экономически развитых странах наблюдается увеличение доли лиц старшего возраста. Однако проблема влияния территориальных особенностей экономического развития на темпы старения населения недостаточно освещена. Цель работы — изучение влияния показателей экономического развития (ПЭР) на процессы преждевременного старения населения. В качестве материалов взяты статистические сборники Минздрава России и Росстата за 2011–2019 гг. Наиболее высокая инцидентность была характерна для катаракты и глаукомы. Установлена прямая корреляционная связь ПЭР и возрастного индекса заболеваемости (ВИЗ) катарактой (r=0,31; p=0,00436). Для группы регионов с высоким уровнем экономического развития было характерно более высокое значение ВИЗ, что, как правило, соответствует более позднему развитию заболевания.
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  • 文章类型: Journal Article
    背景:青光眼是一种世界性的眼病,可导致不可逆的视力丧失。早期发现青光眼对减少视力丧失很重要,而视网膜眼底图像检查由于其成本低,是青光眼诊断最常用的解决方案之一。临床上,眼底图像的杯盘比是青光眼诊断的重要指标。近年来,已经有越来越多的算法用于分割和识别视盘(OD)和视杯(OC),但是这些算法的普适性一般较差,分割性能,和分割精度。
    方法:通过改进YOLOv8算法对OD和OC进行分割。首先,设计了一组算法,使REFUGE数据集的结果图像适应YOLOv8算法的输入格式。其次,为了提高分割性能,改进了YOLOV8的网络结构,包括添加ROI(感兴趣区域)模块,将边界框回归损失函数从CIOU修改为Focal-EIoU。最后,通过训练和测试REFUGE数据集,对改进的YOLOv8算法进行了评价。
    结果:实验结果表明,改进的YOLOv8算法在REFUGE数据集上实现了良好的分割性能。在OD和OC分割测试中,F1得分为0.999。
    结论:我们改进了YOLOv8算法,并将改进的模型应用于眼底图像中OD和OC的分割任务。结果表明,改进后的模型在训练速度上远远优于主流的U-Net模型,分割性能,和分割精度。
    BACKGROUND: Glaucoma is a worldwide eye disease that can cause irreversible vision loss. Early detection of glaucoma is important to reduce vision loss, and retinal fundus image examination is one of the most commonly used solutions for glaucoma diagnosis due to its low cost. Clinically, the cup-disc ratio of fundus images is an important indicator for glaucoma diagnosis. In recent years, there have been an increasing number of algorithms for segmentation and recognition of the optic disc (OD) and optic cup (OC), but these algorithms generally have poor universality, segmentation performance, and segmentation accuracy.
    METHODS: By improving the YOLOv8 algorithm for segmentation of OD and OC. Firstly, a set of algorithms was designed to adapt the REFUGE dataset\'s result images to the input format of the YOLOv8 algorithm. Secondly, in order to improve segmentation performance, the network structure of YOLOv8 was improved, including adding a ROI (Region of Interest) module, modifying the bounding box regression loss function from CIOU to Focal-EIoU. Finally, by training and testing the REFUGE dataset, the improved YOLOv8 algorithm was evaluated.
    RESULTS: The experimental results show that the improved YOLOv8 algorithm achieves good segmentation performance on the REFUGE dataset. In the OD and OC segmentation tests, the F1 score is 0.999.
    CONCLUSIONS: We improved the YOLOv8 algorithm and applied the improved model to the segmentation task of OD and OC in fundus images. The results show that our improved model is far superior to the mainstream U-Net model in terms of training speed, segmentation performance, and segmentation accuracy.
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  • 文章类型: Journal Article
    通过研究没食子酸对视网膜神经节细胞氧化应激的抑制作用,评价没食子酸对视神经的保护作用。100只雄性SD大鼠随机分为4组:正常对照组,单纯高眼压组,0.5%没食子酸实验组,1%没食子酸实验组。HE染色,免疫荧光,DHE染色,蛋白质印迹,采用q-PCR方法观察没食子酸对急性高眼压大鼠视网膜的抗氧化作用。SD大鼠视网膜HE染色证实RGCs细胞核清晰,正常对照组的RNFL厚度是规则的,单纯高眼压(IOP)组和没食子酸组的RGC核破裂和溶解,RNFL的厚度明显增厚,与单纯高眼压组相比,没食子酸组RNFL厚度显著降低(p<0.05)。DHE染色显示单纯高眼压组ROS含量较正常对照组显著升高,施用没食子酸后ROS含量明显下降(p<0.05)。用Brn-3a抗体免疫荧光染色证实,与正常对照组相比,单纯高眼压组的RGCs数量明显减少,而在施用没食子酸后,没食子酸组RGC数量明显多于单纯高眼压组(p<0.05)。WesternBlot和q-PCR证实单纯高眼压组视网膜组织中缺氧诱导因子1α(HIF-1α)蛋白含量和转录水平显著升高,没食子酸能抑制HIF-1α蛋白含量(p<0.05),降低转录因子水平(p<0.05)。没食子酸通过抑制急性眼压升高大鼠的氧化应激对RGC具有保护作用。
    To evaluate the protective effect of gallic acid on the optic nerve by studying the inhibitory effect of gallic acid on oxidative stress in retinal ganglion cells. 100 male SD rats were randomly divided into four groups: normal control group, simple high IOP group, 0.5% gallic acid experimental group, and 1% gallic acid experimental group. HE staining, immunofluorescence, DHE staining, Western blot, and q-PCR were used to observe the antioxidant effect of gallic acid on the retina of acute ocular hypertension rats. HE staining of the retina of SD rats confirmed that the nucleus of RGCs was clear, the thickness of the RNFL was regular in the normal control group, and the nucleus of RGCs was ruptured and lysed in the simple high intraocular pressure (IOP) group and the gallic acid group, and the thickness of the RNFL was significantly thickened, but the thickness of the RNFL in the gallic acid group was significantly reduced compared with that in the simple high IOP group (p < 0.05). DHE staining showed that ROS content in the simple high IOP group was significantly increased compared with the normal control group, and ROS content was significantly decreased after the application of gallic acid (p < 0.05). Immunofluorescence staining with Brn-3a antibody confirmed that the number of RGCs was significantly reduced in the simple high IOP group compared with the normal control group, whereas after application of gallic acid, the number of RGCs was significantly more in the gallic acid group than in the simple high IOP group (p < 0.05). Western Blot and q-PCR confirmed that hypoxia-inducing factor 1α (HIF-1α) protein content and transcription level were significantly increased in the retinal tissue of the simple high IOP group, and gallic acid could inhibit HIF-1α protein content (p < 0.05) and reduce transcription factor level (p < 0.05). Gallic acid exerts a protective effect on RGC by inhibiting oxidative stress in rats with acute IOP elevation.
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  • 文章类型: Journal Article
    确定使用常规Goldmann压平眼压计(GA1,2T)和SUOERSW-500回弹眼压计的眼内压(IOP)测量值之间的一致性。
    这是一项回顾性观察性研究,其中106名青光眼患者的205只眼由2名受过研究训练的眼科医生测量了他们的IOP。使用Bland-Altman差异方法分析数据。使用皮尔逊系数测量相关性。
    我们的大多数患者为中国人(88.7%)和女性(51.9%)。平均年龄为66.9岁。通过GAT测量的IOP的范围为2至58mmHg。使用Bland-Altman方法比较GAT和SuOERSW-500回弹眼压计。眼压计高估了右眼的IOP0.5mmHg,而低估了左眼的IOP0.1mmHg。总的来说,眼压计高估了眼压0.2mmHg。眼压计眼压与GAT有很好的相关性,右眼的皮尔逊相关系数(r)为0.89(p<0.001),左眼为0.86(p<0.001),分别。在GATIOP≥21mmHg(n=25)的患者中,眼压计低估了眼压2.96mmHg。
    SUOERSW-500回弹眼压计的眼压测量值与常规GAT在正常眼压范围内的眼压测量值具有良好的相关性。SuoerSW-500回弹眼压计可能会使用,特别是如果感染传播的风险很高,考虑到探针是一次性的。它易于使用,体积小,便携性使其在无法在裂隙灯处检查患者的情况下很有用。
    UNASSIGNED: To determine the agreement between intraocular pressure (IOP) measurements using conventional Goldmann applanation tonometry (GA1,2T) and SUOER SW-500 Rebound Tonometer.
    UNASSIGNED: This was a retrospective observational study where 205 eyes of 106 glaucoma patients had their IOPs measured by 2 fellowship trained ophthalmologists. Data were analyzed using the Bland-Altman method of differences. Correlation was measured using the Pearson coefficient.
    UNASSIGNED: Most of our patients were Chinese (88.7%) and female (51.9%). The average age was 66.9 years. The range of IOPs as measured by GAT was 2 to 58 mm Hg. Using the Bland-Altman method to compare GAT and SUOER SW-500 Rebound Tonometer. The tonometer overestimated the IOP by 0.5 mm Hg in the right eye and underestimated it by 0.1 mm Hg in the left eye. Overall, the tonometer overestimated the IOP by 0.2 mmHg. The Tonometer IOP correlated well with GAT, with a Pearson coefficient of correlation(r) of 0.89 (p < 0.001) for the right eye and 0.86 (p < 0.001) for the left eye, respectively. In patients with GAT IOP ≥ 21 mm Hg (n = 25), the Tonometer underestimated the IOP by 2.96 mm Hg.
    UNASSIGNED: The IOP measurements from the SUOER SW-500 Rebound Tonometer correlates well with the conventional GAT in measuring the IOP within normal ranges of IOP. SUOER SW-500 Rebound Tonometer may be of use, especially if the risk of transmission of infection is high considering that the probes are disposable. It is easy to use and its small size and portability makes it useful in situations where the patient is unable to be examined at the slit lamp.
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  • 文章类型: Journal Article
    由于血液中含有所有主要的膳食类胡萝卜素,它是评估其含量的合适基质,在体内。在对开角型青光眼患者补充黄斑色素类胡萝卜素18个月后(叶黄素,玉米黄质和内消旋玉米黄质)在欧洲营养在青光眼管理试验中,进行了补充前后参与者血清类胡萝卜素含量的拉曼光谱分析,调查补充方案的系统性影响,并探索使用常规血液检查量化这种影响的更直接方法。使用532nm激光源进行最佳响应,在补充血清中观察到血清类胡萝卜素浓度的持续增加,初始高基线类胡萝卜素含量的患者最高。1519cm-1类胡萝卜素峰的偏移也揭示了两组的类胡萝卜素结构分布的差异。这些发现强调了拉曼光谱直接量化和区分血清中类胡萝卜素的潜力。
    As all major dietary carotenoids are contained in blood, it is a suitable substrate to evaluate their content, in vivo. Following 18-month supplementation of open-angle glaucoma patients with macula-pigment carotenoids (Lutein, Zeaxanthin and Meso-Zeaxanthin) in the European Nutrition in Glaucoma Management trial, Raman spectroscopic analysis of the carotenoid content of pre- and post-supplementation participant blood serum was carried out, to investigate the systemic impact of the supplementation regimen and explore a more direct way of quantifying this impact using routine blood tests. Using a 532 nm laser source for optimal response, a consistent increase in serum carotenoid concentration was observed in the supplemented serum, highest in patients with initial high baseline carotenoid content. A shift in the 1519 cm-1 carotenoid peak also revealed differences in the carotenoid structural profile of the two groups. The findings highlight the potential of Raman spectroscopy toquantify and differentiate carotenoids directly in blood serum.
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  • 文章类型: Journal Article
    目的:雌马酚被肠道细菌从大豆异黄酮中代谢出来,在化学上与雌激素相似。饮食习惯,比如豆制品的消费,影响雌马酚的生产。青光眼和雌激素之间的关系已经被确定;这里,我们调查了日本雌马酚产生状况与青光眼之间的关系.
    方法:我们从我院招募了68名正常眼压性青光眼(NTG)患者(男女比例26:42,平均年龄63.0±7.6岁)和31名对照(男女比例13:18,平均年龄66.0±6.3岁)。纳入的所有女性均为绝经后。用ELISA方法定量尿雌马酚浓度。MD是根据汉弗莱视野计算的。采用Spearman秩相关系数分析MD与雌马酚的相关性。Mann-WhitneyU检验用于比较雌马酚产生(>1μM)和不产生(<1μM)的受试者。我们还通过逻辑回归分析研究了雌马酚与青光眼之间的关系。
    结果:在NTG患者中,雌马酚与MD之间存在显着相关性(r=0.36,P<0.01)。青光眼,以MD为代表,与不产生雌马酚的受试者相比,产生雌马酚的受试者明显更温和(P=0.03)。多变量分析揭示了雌马酚的独立贡献,cpRNFLT,和IOP到MD(分别为P=0.03,P=0.04和P<0.01)。
    结论:我们的结果表明雌马酚,通过雌激素受体介导的神经保护作用,可能参与抑制NTG的进展。这一结果也增加了青光眼可能受生活方式影响的证据。
    OBJECTIVE: Equol is metabolized by intestinal bacteria from soy isoflavones and is chemically similar to estrogen. Dietary habits, such as consumption of soy products, influence equol production. A relationship between glaucoma and estrogen has been identified; here, we investigated the relationship between equol production status and glaucoma in Japan.
    METHODS: We recruited 68 normal-tension glaucoma (NTG) patients (male to female ratio 26:42, average age 63.0 ± 7.6 years) and 31 controls (male to female ratio 13:18, average age 66.0 ± 6.3 years) from our hospital. All women included were postmenopausal. Urinary equol concentration was quantified with the ELISA method. MD was calculated based on the Humphrey visual field. The association between MD and equol was analyzed with Spearman\'s rank correlation coefficient. The Mann-Whitney U test was used to compare the equol-producing (> 1 μM) and non-producing (< 1 μM) subjects. We also investigated the association between equol and glaucoma with a logistic regression analysis.
    RESULTS: There was a significant association between equol and MD (r = 0.36, P < 0.01) in the NTG patients. Glaucoma, represented by MD, was significantly milder in the equol-producing subjects than the non-equol producing subjects (P = 0.03). A multivariate analysis revealed the independent contributions of equol, cpRNFLT, and IOP to MD (P = 0.03, P = 0.04, and P < 0.01, respectively).
    CONCLUSIONS: Our results suggest that equol, acting through estrogen receptor-mediated neuroprotective effects, might be involved in suppressing the progression of NTG. This result also adds to evidence that glaucoma may be influenced by lifestyle.
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  • 文章类型: Journal Article
    眼睛的复杂结构对有效输送药物提出了挑战,这可以通过使用纳米技术来规避。本研究旨在使用简单的一步制造方法制备乙酰唑胺-loadedleciplex(ACZ-LP),然后采用32全因子设计进行优化。ACZ-LP具有很高的包封效率(93.25±2.32%),记录的平均直径约为171.03±3.32,单分散尺寸分布和zeta电位为41.33±2.10mV。制备的制剂的体外释放和离体渗透研究表明,与普通的乙酰唑胺溶液相比,在1小时内开始突释,然后是持续释放模式。此外,离体角膜药物保留(27.05±1.20%)和使用不同浓度粘蛋白的体外粘膜粘附研究表明,强静电结合证实了制剂的粘膜粘附特性。此外,组织病理学研究确保了制剂无刺激性和无毒,而HET-CAM确保了制剂的基本耐受性.在兔模型上进行的体内药效学研究表明,与普通乙酰唑胺溶液相比,用ACZ-LP治疗导致眼内压显著和延长的降低。乙酰唑胺口服片,和Brinzox®。总之,ACZ-LP是一种有效且通用的药物递送方法,在控制青光眼方面显示出显著的潜力.
    The complex structure of the eye poses challenges in delivering drugs effectively, which can be circumvented by employing nanotechnologies. The present study aimed to prepareacetazolamide-loadedleciplex (ACZ - LP) using a simple one-step fabrication approach followed byoptimization employing a 32 Full Factorial Design. The ACZ - LP demonstrated high entrapment efficiency (93.25 ± 2.32 %), average diameter was recorded around 171.03 ± 3.32 with monodisperse size distribution and zeta potential of 41.33 ± 2.10 mV. Invitro release and ex vivo permeation studies of prepared formulation demonstrated an initial burst release in 1 h followed by sustained release pattern as compared to plain acetazolamide solution. Moreover, an ex vivo corneal drug retention (27.05 ± 1.20 %) and in vitro mucoadhesive studies with different concentration of mucin indicated strong electrostatic bonding confirming the mucoadhesive characteristics of the formulation. Additionally, the histopathological studies ensured that the formulation was non-irritant and nontoxic while and HET-CAM ensured substantial tolerability of the formulation. The in vivo pharmacodynamic investigation carried out on a rabbit model demonstrated that treatment with ACZ - LP resulted in a significant and prolonged reduction in intraocular pressure as compared to plain acetazolamide solution, acetazolamide oral tablet, and Brinzox®. In summary, the ACZ - LP is anefficient and versatile drug delivery approach which demonstrates significant potential in controlling glaucoma.
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  • 文章类型: Journal Article
    目的:使用光学相干断层扫描(AS-OCT)评估房角镜辅助经腔小梁切开术(GATT)和微切口小梁切除术(MIT)后小梁网区的结构改变和愈合反应。
    方法:本前瞻性研究纳入MIT(n=41)或GATT(n=32)术后随访≥6个月的67例患者(M:F=45:22)的73只眼。评估手术后1、3、6个月在AS-OCT上看到的角度的结构改变,如外周前粘连(PAS),前房积血,和过度反射的疤痕反应。根据从小梁网(TM)槽中心到巩膜/角膜测量的线性程度将瘢痕分级为轻度(<250μ),中等(250-500μ),和严重(500μ),虽然疤痕的图案被分级为开碟/排水沟,封闭的排水沟,和沟槽图案。使用多元回归分析药物或手术结果的需要与临床变量和AS-OCT参数(包括瘢痕形成的模式和严重程度)之间的关联。
    结果:在平均8±32次随访时,所有眼睛均实现了IOP和药物数量的显着降低,最终IOP为15±3.2mmHg。月。虽然轻度疤痕在麻省理工学院更常见,在关贸总协定>65%的眼睛中看到严重的疤痕,而MIT的眼睛为31%,p<0.001。在麻省理工学院和关贸总协定中同样可以看到开碟,而在关贸总协定眼中更常见的是沟槽图案(>50%)。沟槽模式中的严重疤痕似乎预测了IOP控制药物的需要。尽管它们似乎独立地不影响最终的IOP或手术结果。
    结论:在AS-OCT上呈沟槽状的严重形式的瘢痕预示了MIGS手术后青光眼药物的需要。有必要通过AS-OCT和临床检查定期监测瘢痕形成反应,以确定MIGS后需要药物治疗的患者。
    OBJECTIVE: To evaluate structural alterations and healing responses in the trabecular meshwork region with optical coherence tomography (AS-OCT) following after gonioscopy assisted transluminal trabeculotomy (GATT) and microincisional trabeculectomy (MIT).
    METHODS: 73 eyes of 67 patients (M:F = 45:22) with ≥6 months of follow-up after MIT (n = 41) or GATT (n = 32) with or without combined cataract surgery were included for this prospective study. The angle as seen on AS-OCT at 1, 3, 6 months after surgery were evaluated for structural alterations like peripheral anterior synechiae (PAS), hyphema, and hyperreflective scarring responses. The scarring was graded according to the linear extent measured from the centre of the trabecular meshwork (TM) gutter to the sclera/cornea as mild (<250μ), moderate (250-500μ), and severe(˃500μ), while the pattern of scarring was graded as open saucer/gutter, closed gutter, and trench pattern. The association of the need for medication or surgical outcome and clinical variables and AS-OCT parameters including the pattern and severity of scarring were analysed using multivariate regression.
    RESULTS: All eyes achieved significant reduction of IOP and number of medications with a final IOP of 15±3.2mm Hg at a mean follow-up of 8±32. months. While mild scarring was seen more common in MIT, severe scarring was seen in >65% of GATT eyes compared to 31% of MIT eye, p<0.001. An open saucer was equally seen in MIT and GATT while the trench pattern was more commonly seen in GATT eyes (>50%). Severe scarring in a trench pattern seemed to predict the need for medications for IOP control, though they independently did not seem to influence the final IOP or surgical outcome.
    CONCLUSIONS: A severe form of scarring in a trench pattern on AS-OCT predicted the need for glaucoma medications after MIGS surgery. Regular monitoring of the scarring responses by AS-OCT and clinical examination are necessary to identify those at need for medications after MIGS.
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