难治性青光眼早期功能不良滤过泡处理的临床观察

Clinical observation of treating earlier dysfunction filtering bleb of refractory glaucoma

目的:观察难治性青光眼小梁切除术后早期功能不良滤过泡的处理方法、治疗效果,探讨有效、安全的早期功能不良滤过泡处理方法。方法:收集我院2006-01/2012-01诊断为难治性青光眼且行小梁切除术后出现早期功能不良滤过泡(或倾向)者20例20眼于小梁切除术后3～8d进行治疗,治疗方法包括:眼球按摩、断(或拆除)巩膜缝线后再行眼球按摩、钝针头针拨分离滤过泡或联合结膜下注射5-氟尿嘧啶(5-FU)。所有患者术中曾用过抗代谢药丝裂霉素C(MMC,0.3g/L)。随访6mo。结果:经眼球按摩后有9眼获得功能滤过泡,联合钝针头针拨分离滤过泡治疗后有5眼为功能滤过泡,4眼经联合5-FU结膜下注射后为功能滤过泡,其综合成功率达90%。治疗前平均眼压24.61±5.4mmHg(1mmHg=0.133kPa),随访6mo结束时平均眼压为15.20±4.8mmHg,治疗前后眼压差异有显著统计学意义(P<0.01)。操作中和操作后未见任何并发症。结论:难治性青光眼病情复杂,小梁切除术后极易出现早期功能不良滤过泡(或倾向),我们提倡尽早处理,综合眼球按摩、断(或拆除)巩膜缝线、钝针头针拨分离滤过泡或联合结膜下注射5-FU更安全有效,可很大程度上挽救早期濒临失败的滤过泡,提高手术成功率。

AIM： To observe the treatment method and efficacy to the earlier dysfunctional filtering blebs of refractory glaucoma, and investigate safer and more effective treatment method.METHODS： Twenty eyes of 20 patients with refractory glaucoma were included in this study between January 2006 and January 2012, every eye had the failing filtering bleb（or failing tendency） after suffering trabeculectomy. The treatment methods included eyeball massage or after breaking suture of sclera, and bled needling with a blunt needle or 5-fluorouracil（5-FU） subconjunctival injection. All patients underwent the treatment of failing filtering blebs 3-8 days after trabeculectomy with mitomycin-C. All the patients were followed up for 6 months.RESULTS： After massage and revision with bled needling and 5-FU subconjunctival injection, the failing filtering blebs turned to be functional blebs in 18 eyes（90%）. The average intraocular pressures （IOPs） were 24.61±5.4mmHg （1mmHg=0.133KPa） before treatment and 15.20±4.8mmHg 6 months after treatment. There was significant difference in IOP between pre- and post treatment eyes（P0.001）. No any severe complications were found during and after surgery.CONCLUSION： Refractory glaucoma was more complicated, and the failing filtering bleb（or failing tendency） was more readily available after suffering trabeculectomy. Eyeball massage or after breaking suture of sclera, and bled needling with a blunt needle or 5-FU subconjunctival injection are a safer and more effective method to treat early dysfunctional filtering bleb after glaucoma trabeculectomy, and it can improve the success rate of surgery.