目的：应用眼前段相干光断层成像（ AS-OCT）检测改良黏小管切开术（ VCO）术后手术区域组织结构及滤道，以讨论改良黏小管切开术降眼压的机制。方法横断面研究。研究对象为术后从3～72个月的38例（55只眼）开角型青光眼，均为术前药物控制不良的开角型青光眼。11只眼（20％）因眼压高行Nd：YAG激光房角穿孔术。同时进行视力、眼压、裂隙灯、眼底和AS-OCT检查。 AS-OCT的检测指标为：①滤过泡形态，②巩膜池的长、宽、高，③脉络膜上腔，④泪河高度。结果患者术后眼压（15.4±4.9） mm Hg较术前（31.0±10．9） mm Hg明显下降，42只眼有弥散的滤泡。 AS-OCT证明了结膜瓣下腔隙的存在，39只眼（70．9％）检测到巩膜池，巩膜池的平均体积为1.09 mm3（0.04～0．203 mm3）。结论 AS-OCT检查证明了改良VCO房水引流的可能机制。扁平弥散的结膜下腔隙证明了持续的滤过，为眼外引流；39只眼（70．9％）存在巩膜池。巩膜池的体积与眼压无关，提示脉络膜上腔可能是主要的房水眼内引流途径。%Objective The aim of this study was to reveal structural and mechanical changes of outflow pathways after modified viscocanalostomy (modified VCO) using anterior segment optical coherence tomography (AS-OCT).Meth-ods Fifty-five eyes of 38 patients with medically uncontrolled open-angle glaucoma received modified VCO .Eleven eyes (20%) also received Nd:YAG laser goniopuncture to further control intraocular pressure ( IOP) .Postoperative follow-up included complete ophthalmic examinations and AS-OCT scan of the filtering site .The following assessments were done with AS-OCT:1) dimensions of subconjunctival filtering bleb;2) volume of intrascleral cavity;3) volume of suprachoroidal space;4) height of tear meniscus .Results Intraocular pressure decreased significantly from 31.0 ±10.9 mmHg to 15.4 ±4.9mmHg.AS-OCT demonstrated a subconjunctival space in forty-two eyes.In 39 eyes (70.9%) an intrascleral cavity was observed.The mean volume of this cavity was 1.09 mm3(0.04-0.203 mm3).Conclusion AS-OCT revealed several possible pathways for aqueous humour drainage after modified VCO .A flat, diffuse subconjunctival space indicated persis-tent drainage.Thirty-nine eyes (70.9%) exhibited a remaining intrascleral cavity , whose volume was unrelated to IOP , suggesting that suprachoroidal outflow may be the main outflow pathway after modified VCO .
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