应用小梁网分析软件定量评价正常张力性青光眼小梁网。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-03 DOI:10.1016/j.ajo.2025.03.049

Teruhiko Hamanaka , Tetsuro Sakurai , Takuji Kato , Nobuo Ishida , Toshinari Funaki

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引用次数: 0

摘要

目的研究正常张力性青光眼（NTG）患者小梁网（TM）的组织学变化，探讨NTG患者小梁切除术（TRAB）标本是否可以作为正常对照，应用基于光镜（LM）的TM分析软件（TMAS）分析其他类型的高张力性青光眼。方法：回顾性分析23例NTG患者（65.4±9.2岁）的TRAB标本，包括相关临床资料，以及12只尸检眼（66±11.2岁，P=0.8637）。捕获TRAB标本的LM图像，并使用TMAS评估TM空间，TM细胞结构和色素颗粒（PG）在TM中的积累。TMAS1通过将关节旁组织（JCT）、角膜巩膜网（CSM）和葡萄膜网（UVM）划分为前、中、后节段来评估这些区域的差异，而TMAS2测量JCT、CSM和UVM的总面积。主要观察指标眼压、流出设施、眼轴长度、局部青光眼用药时间、眼管旁组织间隙、角膜巩膜网、小梁网细胞结构、色素颗粒堆积等。结果：NTG患者表现为近视（-5.5±4.7 D）、眼轴长（26±2.5 mm）、视野缺损晚期(Aulhorn-Greve分级：4.6±0.9期)，长期使用局部青光眼药物（13.0±5.0 Y），流出液设施低于正常水平（0.24±0.09µl/min/mmHg）。NTG眼的TMAS1和TMAS2空间测量结果无显著差异。然而，与尸检眼睛相比，TMAS2检测到NTG标本中TM间隙的显著减少（JCT: P=0.000, CSM: P=0.000）和TM细胞计数的降低（JCT: P=0.0285, UVM: P=0.0006）。结论ntg不应被视为正常变异，尽管眼压正常，但仍存在结构异常。这些异常可能是由于TM的细微不规则引起的，与高张力原发性开角型青光眼、长期使用局部青光眼药物或其他因素（如眼轴长度增加）相比，这些异常可能不那么明显。TMAS2已被证明不仅是评估NTG的有用工具，而且是通过分析TRAB标本识别不同类型高张力性青光眼的潜在手段。

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Quantitative Evaluation of Trabecular Meshwork in Normal Tension Glaucoma Using Trabecular Meshwork Analyzing Software

PURPOSE

This study aimed to investigate histologic changes of trabecular meshwork (TM) in normal-tension glaucoma (NTG) and determine whether trabeculectomy specimens from NTG patients can serve as normal controls for analyzing other types of high-tension glaucoma using TM analysis software (TMAS) based on light microscopy.

DESIGN

Prospective comparative case series.

METHODS

Trabeculectomy specimens from 23 NTG patients (65.4±9.2 years old), including associated clinical data, as well as 12 autopsy eyes (66±11.2 years old, P = .86), were retrospectively analyzed. Light microscopy images of trabeculectomy specimens were captured, and TM spaces, TM cellularity, and pigment granule accumulation in TM were evaluated using TMAS. TMAS1 assessed regional variations in the juxtacanalicular tissue (JCT), corneoscleral meshwork (CSM), and uveal meshwork (UVM) by dividing these regions into anterior, middle, and posterior segments, whereas TMAS2 measured the total areas of JCT, CSM, and UVM.

MAIN OUTCOME MEASURES

Intraocular pressure, outflow facility, axial length, periods of topical glaucoma medication, spaces in JCT, corneoscleral and uveal meshwork, trabecular meshwork cellularity, and pigment granule accumulation were measured.

RESULTS

NTG patients exhibited features such as myopia (–5.5±4.7 D), long axial length (26±2.5 mm), advanced stage of visual field defect (Aulhorn-Greve classification: stage 4.6±0.9), prolonged use of topical glaucoma medications (13.0±5.0 years), and subnormal outflow facility (0.24±0.09 µL/min/mm Hg). TM space measurements showed no notable differences between TMAS1 and TMAS2 in NTG eyes. However, TMAS2 detected a significantly greater reduction in TM spaces (JCT: P < .001, CSM: P < .001) and a lower TM cell count (JCT: P = .029, UVM: P < .001) in NTG specimens compared with autopsy eyes.

CONCLUSIONS

NTG should not be regarded as a normal variant, as structural abnormalities are present despite normal intraocular pressure. These abnormalities may arise from subtle irregularities in the TM, which may be less pronounced than those in high-tension primary open-angle glaucoma, prolonged use of topical glaucoma medications, or other contributing factors such as increased axial length. TMAS2 has proven to be a useful instrument for assessing not only NTG but also a potential means of identifying different types of high-tension glaucoma through the analysis of trabeculectomy specimens.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.