针拨联合球结膜下注射丝裂霉素C治疗功能不良滤过泡

Needle revision combined with subconjunctival injection of mitomycin C on dysfunctional filtering blebs

目的探讨针拨联合丝裂霉素C（mitomycin C，MMC）球结膜下注射治疗青光眼患者小梁切除术后早期功能不良滤过泡的疗效。方法对47例（50眼）小梁切除术后2～8周滤过泡功能不良青光眼患者行针拨联合MMC0．2mL（0．04mg）结膜下注射，术后所有患者随访3～6个月，观察患者眼压、滤过泡形态和并发症。结果小梁切除术后2—8周，低平、限局、肥厚、充血型滤过泡32眼、包囊型囊样滤过泡18眼。针拔联合MMC结膜下注射治疗后3～6个月，46眼的滤过泡转为功能性的，轻度膨隆弥散型31眼，多腔或薄壁型15眼，限局肥厚型或无滤过泡4眼。治疗前患眼的平均眼压为（28．5±6．5）mmHg（1kPa：7．5mmHg），随访3～6个月平均眼压为（16．3±2．9）mmHg，与注射前比较二者差异有统计学意义（P〈0．05）。46眼没有用抗青光眼药物或用一种抗青光眼药物眼压控制在21mmHg以下，成功率占92％。治疗后视物模糊10眼，结膜下出血6眼，角膜上皮点状脱落2眼，无低眼压、伤口渗漏和前房变浅等并发症。结论针拨联合MMC结膜下注射治疗小梁切除术后早期功能不良滤过泡是安全、有效、简单的方法。

Objeetive To discuss the therapeutic effects of needle revision comblued with subconjunetival injection of mitomycLu C （ MMC ） on early dysfunctional ill- tering blebs after trabeculectomy for glaucoma. Methods Needle revision combined with subconjunctival injection of MMC 0.2 mL （0.04 mg） was performed on 50 eyes of 47 patients with dysfunctional filtering blebs at 2 to 8 weeks after trabeculectomy for glaucoma. The IOP, shapes of filtering blebs and complications were observed, and all patients were followed up for 3 to 5 months. Results Two to eight weeks after trabeculectomy,there were 32 eyes with low and flat, thickened, focalized and congestive blebs,18 eyes with encapsulated blebs. Three to six months after needle revision with subconjunctival injection of MMC, blebs of 46 eyes turned into functional ones. The blebs were diffused and elevated in 31 eyes,multiloculated and thin walled in 15 eyes, and thickened and focalized or absent in 4 eyes. Mean IOP was significantly lowered from （28.5 ＋5.5） mmHg （1 kPa=7.5 mmHg） before treatment to （16.3 ＋2.9）mmHg at follow up time with 3 to 6 months （P 〈 0.05 ）. There were 45 eyes with IOP lower than 21 mmHg without using anti-glaucoma drug or using one anti-glaucoma drug with the success rate of 92%. Blurred vision occurred in 10 eyes during the needle revision. Subconjunctival hemorrhage occurred in 6 eyes. Corneal epithelium spotted exfoliation occurred in 2 eyes. No such compli- cation as ocular hypotension, wound leaks or shallow anterior chamber was observed during the follow up time. Conclusion Needle revision combined with subconjunctival injection of MMC is an effective, safe and simple method for early dysfunctional filtering blebs after trabeculectomy.