针刺分离联合滤泡内5-氟尿嘧啶注射治疗青光眼阀术后的盘周包裹

Needle revision combined with injection 5-Fu into the blebs in reviving encapsulated filtering blebs after Ahmed glaucoma valve implantation

目的分析对Ahmed青光眼阀(AGV)植入术后盘周包裹致眼压升高的患者,采用针刺分离联合盘周滤泡内注射5-氟尿嘧啶(5-Fu)的治疗效果。方法对23例(25只眼)AGV植入术后1个月至1年眼压升高、滤泡包裹失败的患者,采用针刺分离滤泡周围纤维瘢痕,然后滤泡内注射5-Fu约10 mg,隔日1次共3～11次,分析治疗后眼压情况及治疗后的眼部并发症。结果治疗结束时,平均治疗(8.2±5.1)次。25只眼中有22只眼眼压<21 mm Hg;治疗后3个月时,当时治疗有效的22只眼中11只眼眼压<21 mm Hg,7只眼加用1～2种抗青光眼药物眼压<21 mm Hg;治疗后6个月时,7只眼眼压<21 mm Hg,8只眼加用1～2种抗青光眼药物眼压<21 mm Hg,另5只眼加用3种以上抗青光眼药物眼压仍>21 mm Hg。并发症:治疗后常见并发症有滤泡结膜出血、角膜上皮损伤、滤过泡损伤等,其中1只眼发生引流管脱出前房的严重并发症。结论 AGV植入术后盘周包裹致眼压升高的患者采用针刺分离联合滤泡内注射5-Fu治疗简单、安全、有效,在其他有创性治疗前以及某些病例加用药物治疗前,可首先考虑该方法。

Objective To observe the effect of needle revision combined with injection 5-Fu into the blebs in reviving encapsulated filtering blebs after Ahmed glaucoma valve（AGV） implantation.Methods 23 patients with 25 eyes of encapsulated filtering blebs after AGV implantation among 1 month to 1 year were treated by lysing subconjunctival fibrosis and episcleral scar tissue around the blebs,combined with injection 5-Fu into the filtering blebs every 2 days to total 3～11 times,then to analysis the intro-ocular pressures（IOP） and the complications.Results The mean times of needle revision were 8.2±5.1 and the IOP of 22 eyes were below 21 mm Hg at the end of the treatment;the IOP of 11 eyes were below 21 mm Hg,7 eyes were below 21 mm Hg addition with 1～2 kinds of anti-glaucoma drugs at 3 months after needle revision;the IOP of 7 eyes were below 21 mm Hg,8 eyes were below 21 mm Hg addition with 1～2 kinds of anti-glaucoma drugs,and 5 eyes greater than 21 mm Hg though addition with more than 3 kinds of anti-glaucoma drugs at 6 months after needle revision.The most common complications were bleeding into the bleb,corneal epithelium damaged,filtering bleb damaged,et al,even 1 drain pipe prolapse from anterior chamber.Conclusion It is easy,safe and effective that treating encapsulated filtering blebs after AGV implantation with needle revision combined with injection 5-Fu into the blebs.This Methods should be considered before more aggressive surgical intervention,and in some cases before additional medical therapy.