The functional changes of aqueous outflow pump after a new type of trabeculotome tunnelling trabeculoplasty

doi:10.3877/cma.j.issn.2095-2007.2022.06.002

Abstract

Abstract:

Objective

To investigate the changes of aqueous outflow pump function after a new trabeculotome tunnelling trabeculoplasty (3T) using phase sensitive optical coherence tomography (PHS-OCT).

Methods

From March 2022 to September 2022, 10 patients (10 eyes) with primary open-angle glaucoma (POAG) who had no previous history of anti-glaucoma surgery were collected from the Beijing Tongren Eye Center, Beijing Tongren Hospital affiliated to Capital Medical University for a prospective study. Among them, 7 males (7 eyes) and 3 females (3 eyes) with an average age of (45.3±10.5) years who were ranged from 30 to 64 years. All POAG patients were treated with new 3T surgery. The intraocular pressure (IOP) of POAG patients before and after operation for 3 months was recorded, and described by the interval and average IOP value. The movement speed of TM external area, amplitude of TM external area, diameter of the major axis of the cross section of Schlemm′s tube and the change amplitude of the cross section area of Schlemm′s tube were measured and recorded at a total of 30 points of the patient′s trabecular meshwork (TM) before and after surgery. All data was tested for normality, and described by (±s), and compared with the paired substance t test if those that conformed to the normal distribution.

Results

All 10 patients (10 eyes) had the average visual field defect value of the affected eye before operation was (13.5±5.0) dB. The IOP of the affected eye was 25.3 to 48.5 mmHg (1 mmHg=0.133 kPa), and the average IOP was(32.9±8.7) mmHg without the use of IOP lowering drugs before operation. The IOP was 15.6 to 25.0 mmHg with the average IOP of (20.9±3.4) mmHg under using of IOP lowering drugs before operation. After operation for 3 months, the IOP was 14.2 to 20.5 mmHg with the average IOP of (16.4±1.7) mmHg. The movement velocity of TM external region, amplitude of TM external region, diameter of major axis of Schlemm′s tube cross section and the change amplitude of Schlemm′s tube cross section area at 30 points of TM 3 detection points before and after operation were (22.7±5.6) μm/s and (17.3±3.3)μm/s, (0.21±0.06)μm and (0.17±0.04)μm, (180.0±9.1)μm and (370.5±18.6) μm and (37.7±7.6) μm² and (62.0 ± 11.6) μm². After operation, the movement speed and the amplitude of of TM external area both decreased, while the diameter of the major axis of the cross section of Schlemm′s tube increased, and the change range of the cross section area of Schlemm′s tube increased at the 30 testing points of TM. There were statistically significant differences in the movement speed and the amplitude of of TM external area, the diameter of the major axis of the cross section and the change range of the cross section area of Schlemm′s tube befor and after operation through t test (t=3.51, 2.09, -18.35, -3.93; P<0.05).

Conclusions

PHS-OCT can be used to evaluate the function of aqueous outflow pump after a new type of 3T surgery, and the function of aqueous outflow pump after surgery is enhanced.

Key words: Outflow pump function, Primary open-angle glaucoma, Minimally invasive glaucoma surgery

Qing Sang, Chen Xin, Jin Wang, Yingyan Mao, Diya Yang, Dapeng Mu, Ye Zhang, Huaizhou Wang, Ningli Wang. The functional changes of aqueous outflow pump after a new type of trabeculotome tunnelling trabeculoplasty[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(06): 326-331.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhykyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2007.2022.06.002

https://zhykyxzz.cma-cmc.com.cn/EN/Y2022/V12/I06/326

Figures/Tables 2

References 30

[1]	晏兴云，贺平，刘静. 基层眼科小梁切除术405例并发症分析[J]. 国际眼科杂志，2015，15(4)：2.
[2]	辛晨，汪军，刘广峰，等. 青光眼微创手术进展[J]. 眼科新进展，2015，35(1)：6.
[3]	中华医学会眼科学分会青光眼学组，中国医师协会眼科医师分会青光眼学组. 中国青光眼指南(2020年)[J]. 中华眼科杂志，2020，56(8)：14.
[4]	Tham YC, Li X, Wong TY, et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta－analysis[J]. Ophthalmology, 2014, 121(11): 2081－2090.
[5]	Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020[J]. Br J Ophthalmol, 2006, 90(3): 262－267.
[6]	Casson RJ, Chidlow G, Wood JP, et al. Definition of glaucoma: clinical and experimental concepts[J]. Clin Exp Ophthalmol, 2012, 40(4): 341－349.
[7]	Goel M, Picciani RG, Lee RK, et al. Aqueous Humor Dynamics: A Review[J]. Open Ophthalmol J, 2010, 4(1): 52－59.
[8]	Wong D. Non－penetrating glaucoma surgery for advanced open－angle glaucoma[J]. Graefes Arch Clin Exp Ophthalmol, 2018, 256(8): 1479.
[9]	Tektas OY, Lütjen－Drecoll E. Structural changes of the trabecular meshwork in different kinds of glaucoma[J]. Exp Eye Res, 2009, 88(4): 769－775.
[10]	Ellingsen BA, Grant WM. The relationship of pressure and aqueous outflow in enucleated human eyes[J]. Invest Ophthalmol, 1971, 10 (6): 430－437.
[11]	Buskirk E. Anatomic correlates of changing aqueous outflow facility in excised human eyes[J]. Investigative Ophthalmology & Visual Science, 1982, 22(5): 625－632.
[12]	Andrew NH, Akkach S, Casson RJ. A review of aqueous outflow resistance and its relevance to micro－invasive glaucoma surgery[J]. Surv Ophthalmol, 2020, 65(1): 18－31.
[13]	Gillmann K, Mansouri K. Minimally Invasive Glaucoma Surgery: Where Is the Evidence？[J] Asia Pac J Ophthalmol (Phila), 2020, 9(3): 203－214.
[14]	Hann CR, Bentley MD, Vercnocke A, et al. Imaging the aqueous humor outflflow pathway in human eyes by three－dimensional micro－computed tomography (3D micro－CT)[J]. Exp Eye Res, 2011, 92(2): 104－111.
[15]	Huang AS, Camp A, Xu BY, et al. Aqueous Angiography: Aqueous Humor Outflow Imaging in Live Human Subjects[J]. Ophthalmology, 2017, 124(8): 1249－1251.
[16]	Li P, Reif R, Zhi Z, et al. Phase－sensitive optical coherence tomography characterization of pulse－induced trabecular meshwork displacement in ex vivo nonhuman primate eyes[J]. J Biomed Opt, 2012, 17(7): 076026.
[17]	Ramos RF, Sumida GM, Stamer WD. Cyclic mechanical stress and trabecular meshwork cell contractility[J]. Invest Ophthalmol Vis Sci, 2009, 50(8): 3826－3832.
[18]	Luna C, Li G, Qiu J, et al. Extracellular release of ATP mediated by cyclic mechanical stress leads to mobilization of AA in trabecular meshwork cells[J]. Invest Ophthalmol Vis Sci, 2009, 50(12): 5805－5810.
[19]	Du R, Xin C, Xu J, et al. Pulsatile Trabecular Meshwork Motion: An Indicator of Intraocular Pressure Control in Primary Open－Angle Glaucoma[J]. J Clin Med, 2022, 11(10): 2696.
[20]	Stamer WD, Clark AF. The many faces of the trabecular meshwork cell[J]. Exp Eye Res, 2017, 158: 112－123.
[21]	Last JA, Pan T, Ding Y, et al. Elastic Modulus Determination of Normal and Glaucomatous Human Trabecular Meshwork[J]. Invest Ophthalmol Vis, 2011, 52(5): 2147－2152.
[22]	Johnstone M, Xin C, Tan J, et al. Aqueous outflow regulation － 21st century concepts[J]. Prog Retin Eye Res, 2021, 83: 100917.
[23]	Shuman MA, Polansky JR, Merkel C, et al. Tissue plasminogen activator in cultured human trabecular meshwork cells. Predominance of enzyme over plasminogen activator inhibitor[J]. Invest Ophthalmol Vis Sci, 1988, 29(3): 401－405.
[24]	Peotter JL, Phillips J, Tong T, et al. Involvement of Tiam1, RhoG and ELMO2/ILK in Rac1－mediated phagocytosis in human trabecular meshwork cells[J]. Exp Cell Res, 2016, 347(2): 301－311.
[25]	Xin C, Tian N, Li M, et al.Mechanism of the reconstruction of aqueous outflow drainage[J]. Sci China Life Sci, 2018, 61(5): 534－540.
[26]	Li P, Shen TT, Johnstone M, et al. Pulsatile motion of the trabecular meshwork in healthy human subjects quantified by phase－sensitive optical coherence tomography[J]. Biomed Opt Express, 2013, 4(10): 2051－2065.
[27]	Xin C, Song S, Johnstone M, et al. Quantification of Pulse－Dependent Trabecular Meshwork Motion in Normal Humans Using Phase－Sensitive OCT[J]. Invest Ophthalmol Vis Sci, 2018, 59(8): 3675－3681.
[28]	Hamada M, Ohkoshi K, Inagaki K, et al. Visualization of microaneurysms using optical coherence tomography angiography: comparison of OCTA en face, OCT B－scan, OCT en face, FA, and IA images[J]. Jpn J Ophthalmol, 2018, 62(2): 168－175.
[29]	Gao K, Song S, Johnstone MA, et al. Reduced Pulsatile Trabecular Meshwork Motion in Eyes With Primary Open Angle Glaucoma Using Phase－Sensitive Optical Coherence Tomography[J]. Invest Ophthalmol Vis Sci, 2020, 61(14): 21.
[30]	Li P, Shen TT, Johnstone M, et al. Pulsatile motion of the trabecular meshwork in healthy human subjects quantified by phase－sensitive optical coherence tomography[J]. Biomed Opt Express, 2013, 4(10): 2051－2065.

检测时间	检测点位(点)	小梁网外部区域运动速度(μm/s)	小梁网外部区域振幅(μm)	Schlemm′s管横截面长轴的直径(μm)	Schlemm′s管横截面面积变化幅度(μm²)	眼压(mmHg)
术前	30	22.7±5.6	0.21±0.06	180.0± 9.1	37.7± 7.6	20.9±3.4
术后	30	17.3±3.3	0.17±0.04	370.5±18.6	62.0±11.6	16.4±1.7
t值		3.51	2.09	－18.35	－3.93	3.94
P值		<0.05	<0.05	<0.05	<0.05	<0.05

检测时间	检测点位(点)	小梁网外部区域运动速度(μm/s)	小梁网外部区域振幅(μm)	Schlemm′s管横截面长轴的直径(μm)	Schlemm′s管横截面面积变化幅度(μm²)	眼压(mmHg)
术前	30	22.7±5.6	0.21±0.06	180.0± 9.1	37.7± 7.6	20.9±3.4
术后	30	17.3±3.3	0.17±0.04	370.5±18.6	62.0±11.6	16.4±1.7
t值		3.51	2.09	－18.35	－3.93	3.94
P值		<0.05	<0.05	<0.05	<0.05	<0.05

Please choose a citation manager

Content to export