悬垂滤过泡的手术治疗及组织病理学特征

Surgical management and histopathological features of symptomatic overhanging filtering blebs

目的 探讨小梁切除手术后并发症悬垂滤过泡的形态学和组织病理学特点,并探讨悬垂滤过泡无缝线部分切除术的方法和疗效.方法 回顾性病例研究.分析小梁切除术后出现悬垂滤过泡的病例,共9例（10眼）,均施行了无缝线部分切除术,分析其年龄、性别、症状、青光眼类型、既往滤过性手术方式、术前术后最佳矫正视力、眼压、滤过泡形态及术前超声生物显微镜检查、角膜表面情况、手术并发症等,以及切除物的组织病理学检查.所有患者随访4个月至5年.手术前后眼压测量值及视力比较采用配对t检验.结果 随访（28.8±19.8）个月.所有患眼术前超声生物显微镜检查均显示悬垂的滤过泡组织与结膜滤过泡不相通,与角膜上皮融合,与角膜前弹力层有明显分界.所有病例均成功施行无缝线部分滤过泡切除术,术后眼压控制良好,滤过泡功能正常,角膜保持透明.在随访期内,未见悬垂滤过泡复发.未见滤过泡渗漏、低眼压及眼内炎.组织病理学检查显示,被切除的组织主要为增生和变性的纤维结缔组织,被覆上皮或有上皮嵌入.结论 无缝线的悬垂滤过泡部分切除术是一种简单而安全的滤过泡重建方法,有助于缓解眼表不适,同时不影响眼压控制.

Objective To described methods and outcomes of a sutureless technique for partial excision of symptomatic overhanging bleb and reported the histopathological findings. Methods A retrospective case series of 10 eyes of 9 patients who underwent trabeculectomy. A sutureless partial excision procedure was offered to 10 eyes with overhanging blebs. Data on age, sex, presenting symptoms, glaucoma types, type of prior filtration surgery, pre- and post- best corrected visual acuity, pre- and post- excision intraocular pressure （IOP）, bleb morphology, corneal surface, complications of excision, ultrasonic biomicroscopy images and histopathologieal imaging were collected. The length of follow up ranged from 4 months to 5 years. Data were analyzed using paired t test. Results The length of follow up was （28.8＋_19.8） months. Before the surgical excision, Ultrasonic biomicroscopy imagings showed that the bleb tissues were tightly attached to the cornea and some parts of the blebs were fluid-filled. Successful excision of the overhanging bleb was achieved for all the cases. There was satisfactory control of IOP and the cornea remained clear. No case of recurrent overhanging bleb was found in the period of follow-up. This surgical technique did not lead to leakage, hypotony, and endophthalmitis during the period of follow up. Histopathological examination showed that the excised tissues mainly consisted of fibrous connective tissue and corneal epithelial tissue embedded with cyst-like structures. Conclusion Sutureless partial excision of the overhanging blebs seems to be a simple and safe means that helps in revising the blebs, relieving discomfort, and ensuing IOP control.