针刺分离联合巩膜通道重建术治疗青光眼术后远期失败滤过泡

Needle revision combined with sclera filtering channel reconstruction for late failure bleb

目的探讨初次针刺分离联合巩膜通道重建治疗青光眼滤过术后远期失败滤过泡的效果。设计回顾性病例系列。研究对象 2014年3月至2016年10月在温州医科大学附属眼视光医院进行初次滤过泡针刺分离联合巩膜通道重建的患者24例25眼,平均年龄(46.2±16.6)岁。方法对于远期失败滤过泡,先利用针头进行囊壁的切开和分离,再伸入巩膜瓣下进行巩膜下分离,并穿刺进入前房以确保前房与滤过泡相通,术后球结膜下注射5-FU。成功的定义为不使用或使用降眼压药物后眼压≤21mmHg。主要指标眼压,并发症,降眼压药物使用数量。结果前一次滤过手术与本次针刺分离术平均间隔(53.5±67.7)个月。术前平均眼压(28.4±9.8)mmHg,末次随访平均眼压(24.6±11.9)mmHg。平均随访(7.6±7.8)个月。术前降眼压药物使用数为(2.7±1.1)种,术后6个月为(0.8±0.9)种。术后6个月成功率为44%。结论针刺分离联合巩膜通道重建术简单,具有可接受的手术成功率,是青光眼滤过术后远期滤过功能不良在再次滤过手术治疗前可选择的方法。

Objective To investigate the efficacy of the first needling revision combined with scleral channel reconstruction for late-failed filtering bleb after glaucoma filtration surgery.Design Retrospective cases series.Participants 25 eyes of 24 patients were underwent bleb needling combined with sclera channel reconstruction from March 2014 to October 2016 in the Eye Hospital of Wenzhou Medical University Methods For late failed filtering bleb,subconjunctival scarring was separated by the needle,then the needle was advanced under the sclera flap to separate,then puncture into the anterior chamber,or puncture into the anterior chamber directly through whole sclera if the edge of sclera flap was invisible,to ensure that the anterior chamber communicates with the filtering bleb.Conjunctive injection of 5-Fu was given after the operation and the patients were followed-up to observe the intraocular pressure(IOP).Success was defined as postneedling IOP≤21 mmHg with or without any antiglaucoma medications.Main Outcome Measures IOP,complications and numbers of anti-glaucoma medications.Results The average interval between index filtering operation and bled revision was 53.5±67.7 months.Mean IOP was 28.4±9.8 mmHg before surgery and 24.6±11.9 mmHg at last postoperative follow-up.Mean follow-up was 7.6±7.8 months.The mean number of anti-glaucoma medications was reduced from 2.7±1.1 preoperatively to 0.8±0.9 at6 months postoperatively.The success rate was 44%at 6 months.Conclusions Needling revision with sclera channel reconstruction is a safe and easy procedure,having an acceptable success rate of surgery for the treatment of late-failed bleb.This procedure can be recommended before second filtering surgery for failing bleb.