5-氟尿嘧啶针刺修复失败的结膜滤过泡修复失败的危险因素。

Risk factors for failure of 5-fluorouracil needling revision for failed conjunctival filtration blebs.

作者信息

Shin D H, Kim Y Y, Ginde S Y, Kim P H, Eliassi-Rad B, Khatana A K, Keole N S

机构信息

Kresge Eye Institute, Wayne State University School of Medicine, 4717 St. Antoine Blvd., Detroit, MI 47201-1423, USA.

出版信息

Am J Ophthalmol. 2001 Dec;132(6):875-80. doi: 10.1016/s0002-9394(01)01232-6.

DOI:10.1016/s0002-9394(01)01232-6

PMID:11730652

Abstract

PURPOSE

To investigate the risk factors for failure of 5-fluorouracil (5-FU) needling revision, a useful procedure for restoring a failed filtration bleb.

DESIGN

Interventional case series.

METHODS

Retrospectively conducted study.

SETTING

Institutional.

STUDY POPULATION

Sixty-four eyes of 64 consecutive glaucoma patients that underwent 5-FU needling revisions for failed filtering bleb following either trabeculectomy or phaco-trabeculectomy with or without adjunctive mitomycin C (MMC).

OBSERVATION PROCEDURES

Goldmann applanation tonometry, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis.

MAIN OUTCOME MEASURES

Successful outcome of the initial 5-FU needling revision, arbitrarily defined as target intraocular pressure (IOP) control with not more than two topical glaucoma medications and no additional 5-FU needling or other surgical procedures, was analyzed by Kaplan-Meier survival analysis, and risk factors for failure of the initial 5-FU needling revision were analyzed by Cox proportional hazards regression analysis.

RESULTS

The cumulative success rate of the initial 5-FU needling revision was 45% at 1 year, 33% at 2 years, and 28% at 4 years. Failure of the initial 5-FU revision correlated significantly with preneedling IOP > 30 mm Hg (P =.0003), lack of MMC use during the previous filtration surgery (P =.013), and IOP >10 mm Hg immediately following needling revision (P =.0012) according to Cox's proportional hazards regression analysis.

CONCLUSIONS

Pre-needling IOP > 30 mm Hg, lack of MMC use during the previous filtration surgery, and IOP > 10 mm Hg immediately after needling were found to be significant risk factors for failure of the initial 5-FU needling procedure. Therefore, it is important to monitor IOP closely following needling revision in those patients with such risk factors. They are more likely to require additional therapeutic interventions, including repeat needling revisions.

摘要

目的

探讨5-氟尿嘧啶（5-FU）针刺修复术失败的危险因素，这是一种恢复失败滤过泡的有效方法。

设计

干预性病例系列研究。

方法

回顾性研究。

地点

机构研究。

研究对象

64例连续青光眼患者的64只眼，这些患者在小梁切除术或超声乳化小梁切除术后，无论是否联合丝裂霉素C（MMC），因滤过泡失败而接受5-FU针刺修复术。

观察程序

Goldmann压平眼压测量、Kaplan-Meier生存分析和Cox比例风险回归分析。

主要观察指标

通过Kaplan-Meier生存分析评估首次5-FU针刺修复术的成功结果，成功结果被任意定义为使用不超过两种局部青光眼药物且无需额外的5-FU针刺或其他手术操作即可控制目标眼压；通过Cox比例风险回归分析首次5-FU针刺修复术失败的危险因素。

结果

首次5-FU针刺修复术的累积成功率在1年时为45%，2年时为33%，4年时为28%。根据Cox比例风险回归分析，首次5-FU修复术失败与针刺前眼压>30 mmHg（P = 0.0003）、前次滤过手术未使用MMC（P = 0.013）以及针刺修复术后即刻眼压>10 mmHg（P = 0.0012）显著相关。