小梁切除联合丝裂霉素术后晚期滤泡相关并发症的临床分析

Analysis of late-onset bleb-belated complications following trabeculectomy with mitomycin C

目的:探讨小梁切除联合丝裂霉素术后晚期滤泡相关并发症的发生率及处理。方法:1994-05/2000-05接受小梁切除手术联合丝裂霉素治疗青光眼65例65眼,采用Kaplan-Meier生存分析法估计晚期滤过泡渗漏、滤泡炎、眼内炎的发生概率。结果:随访2.5～7.1(平均5.6)a,发生滤过泡渗漏16眼(16/65,24.6%),出现滤泡炎5眼(5/65,7.7%),发生眼内炎1眼,出现复合性滤泡并发症1眼,出现持久性低眼压9眼(9/65,13.8%)。Kaplan-Meier生存分析法估计晚期滤泡并发症5a发生概率为40.0%。多数眼通过门诊处理获得成功,部分眼需手术治疗。结论:小梁切除联合丝裂霉素术后晚期滤泡相关并发症的发生率可高达40.0%,单纯滤过泡渗漏是一相对良性的状况,只要及时处理,可被修复,滤泡炎或眼内炎可以被控制,而获得正常眼内压。

AIM： To study the incidence and management of late-onset bleb-related complications following trabeculectomy with mitomycin C. METHODS： We performed a retrospective analysis on 65 eyes of 65 glaucoma patients who underwent trabeclectomy with mitomycin from May 1994 to May 2000. The Kaplan-Meier survival method was used to estimate the probability of a bleb leak, blebitis or endophthalmitis. RESULTS： The average follow-up was 5.6a （range, 2.5-7.1a） , 16 eyes （16/65, 24.6%） experienced a bleb leak; 5 eyes （5/65, 7.7%） had an episode of blebitis. Endophalmitis occurred in 1 eye; 1 eye had combined complicate; 9 eyes （9/65, 13.8%） experienced persistent hypotony. A Kaplan-Meier survival analysis estimated the 5a probability of developing a bleb leak, blebitis, endophthalmitis to be 40.0%. Most eyes were successfully treated with office-based measures, and some eyes ultimately underwent surgical revision. CONCLUSION： There is significant morbidity associated with trabeculectomy with mitomycin C, and 40.0% of these eyes might develop one of these complications. The inolated bleb leak seems to be a relatively benign condition. If we can manage the complications promptly and precisely, bleb leaks could be repaired; infected eyes were controlled after treatment, and normal IOP could be obtained.