Deep sclerectomy versus trabeculectomy: a morphological study with anterior segment optical coherence tomography

作者：Konstantopoulos Aris; Yadegarfar Mohammad E; Yadegarfar Ghasem; Stinghe Alina; Macleod Alex; Jacob Aby; Hossain Parwez^*

来源：British Journal of Ophthalmology, 2013, 97(6): 708-714.

DOI：10.1136/bjophthalmol-2012-301926

Purpose To investigate the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy (DS) with anterior segment optical coherence tomography (AS-OCT). %26lt;br%26gt;Methods In a prospective cross-sectional study, AS-OCT parameters were compared between DS, trabeculectomy and control cases. Association with IOP and success (IOP %26lt;= 16 mm Hg without medication) was investigated. %26lt;br%26gt;Results 18 DS (15 patients), 17 trabeculectomy (16 patients) and 15 controls (15 patients) were examined. Successful had a taller intrascleral lake (IL) and thicker conjunctival/Tenon%26apos;s layer (CTL) than non-successful cases (513.3 vs 361.1 mu m, p=0.027 and 586.7 vs 251.1 mu m, p%26lt;0.001, respectively). CTL thickness correlated with IOP (r=-0.6407, p=0.004). CTL thickness was significantly different between controls, DS and trabeculectomy (mean (SD): 203.3 (62.6) vs 418.9 (261.9) vs 604.1 (220.7) mu m, p%26lt;0.0001). Successful trabeculectomy cases had a taller bleb cavity (BC) than non-successful cases (607.5 vs 176.7 mu m, p=0.041). CTL microcysts were detected in 50% of DS and 52.9% of trabeculectomy cases (p=1). %26lt;br%26gt;Conclusions Trans-conjunctival aqueous percolation was identified as a novel DS drainage route. DS had a fluid reservoir below the scleral flap, the IL, in analogy to the trabeculectomy BC. A postoperative tall IL and a thick CTL were associated with good outcome.

• 出版日期2013-6