Catoira Y, Wudunn D, Cantor L B
Department of Ophthalmology, Indiana University, Indianapolis, Indiana 46202, USA.
Am J Ophthalmol. 2000 Nov;130(5):574-9. doi: 10.1016/s0002-9394(00)00653-x.
To assess the outcome of advancing a conjunctival flap with preservation of the bleb in eyes undergoing filtration bleb revision after trabeculectomy.
A retrospective review of cases from a university-based referral practice identified 30 eyes of 30 patients that had undergone bleb revision after trabeculectomy by advancement of a conjunctival flap over the de-epithelialized bleb. Success was defined as resolution of the bleb-associated complication necessitating the revision (leak, hypotony, discomfort) with maintenance of intraocular pressure greater than or equal to 6 and less than or equal to 21 mm Hg without glaucoma medications. Qualified success met the above criteria but with the use of glaucoma medications. Summary data including visual acuity were obtained.
On the 30 eyes, 30 conjunctival advancement procedures were performed. Seventeen were for bleb leaks, 10 for prolonged hypotony without bleb leak, and three for dysesthetic bleb. Eighteen eyes (60%) were classified as a complete success and 24 eyes (80%) achieved at least a qualified success. Cumulative probability of at least qualified success was 77% at 2 years. Failures included inadequate intraocular pressure control (one eye), recurrent bleb leak (three eyes), and hypotony without bleb leak (two eyes). The mean preoperative intraocular pressure for all eyes increased from 4.4 +/- 3.7 mm Hg to 12.3 +/- 6.2 mm Hg (P <.00001) at the final visit with a mean follow-up of 18.9 +/- 15.5 months. Visual acuity improved or remained within 1 line of preoperative acuity in all but five patients. Complications included two patients with mild ptosis and four patients with hypertropia.
Advancement of a conjunctival flap with preservation the preexisting bleb often provides successful resolution of bleb-associated complications.
评估小梁切除术后行滤过泡修复术时，推进结膜瓣并保留滤过泡的手术效果。
对一家大学附属医院转诊病例进行回顾性研究，确定30例患者的30只眼，这些患者在小梁切除术后通过在去上皮化滤过泡上推进结膜瓣进行滤过泡修复。成功定义为因滤过泡相关并发症（渗漏、低眼压、不适）而行修复术，术后眼压维持在大于或等于6且小于或等于21mmHg，无需使用青光眼药物。合格成功是指符合上述标准，但需使用青光眼药物。收集包括视力在内的总结数据。
30只眼均进行了30次结膜推进手术。其中17次用于滤过泡渗漏，10次用于无滤过泡渗漏的持续性低眼压，3次用于感觉异常的滤过泡。18只眼（60%）被分类为完全成功，24只眼（80%）至少达到合格成功。2年时至少合格成功的累积概率为77%。失败包括眼压控制不佳（1只眼）、滤过泡反复渗漏（3只眼）和无滤过泡渗漏的低眼压（2只眼）。所有眼术前平均眼压从4.4±3.7mmHg升至末次随访时的12.3±6.2mmHg（P<.00001），平均随访时间为18.9±15.5个月。除5例患者外，所有患者视力均有改善或维持在术前视力1行范围内。并发症包括2例轻度上睑下垂和4例上斜视患者。
推进结膜瓣并保留原有的滤过泡通常能成功解决滤过泡相关并发症。
