采用丝裂霉素C辅助对失败的滤过性手术进行手术修复。

Surgical revision of failed filtration surgery with mitomycin C augmentation.

作者信息

Anand Nitin, Arora Seema

机构信息

Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield HD3 3EA.

出版信息

J Glaucoma. 2007 Aug;16(5):456-61. doi: 10.1097/IJG.0b013e31803bbb30.

DOI:10.1097/IJG.0b013e31803bbb30

PMID:17700288

Abstract

AIM

The aim of the study was to assess the outcomes of surgical revision with reopening of the scleral flap in eyes with failed glaucoma surgery and adjunctive mitomycin C (MMC).

METHODS

Retrospective, noncomparative, interventional case series. Fifty-four eyes of 54 consecutive patients with previously failed trabeculectomy or deep sclerectomy who underwent formal surgical revision (23 with concurrent phacoemulsification) were included. MMC, 0.2 mg/mL for 2 to 3 minutes, was applied under a fornix-based conjunctival flap. The preexisting scleral flap was dissected open to reestablish filtration.

RESULTS

Mean follow-up was 39.5+/-10 months. Kaplan-Meier survival analysis showed that the probability (with 95% confidence intervals) of maintaining an intraocular pressure (IOP) between 5 and 18 mm Hg and 20% decrease from preoperative IOP was 64% (47% to 76%) with medications and/or needle revision and 38% (26% to 53%) without, 3 years after surgery. Mean IOP before surgery was 23.6+/-7.2 mm Hg and 14.4+/-6.0 three years after surgery (last IOP before further glaucoma procedure carried forward). Needle revision for bleb failure or high IOP was carried out in 23 eyes (42.5%) and further glaucoma surgery in 5 eyes (9.3%). Patients were on an average of 2+/-1.1 glaucoma medications before surgery. At last follow-up, the number of medications had decreased to 0.8+/-1.2 (P<0.000), with 23 eyes (42.5%) requiring medications to control IOP. Significant complications included delayed suprachoroidal hemorrhage (3 eyes, 5.6%), delayed bleb leaks (5 eyes, 9.3%), hypotony (2 eyes, 3.7%), and blebitis (2 eyes, 3.7%).

CONCLUSIONS

There is a progressive increase in IOP with time after surgical revision of failed glaucoma surgery with adjunctive MMC. A significant proportion of eyes will eventually require a needle revision procedure and/or glaucoma medications to further lower IOP. Also, there is a significant incidence of complications associated with this procedure.

摘要

目的

本研究旨在评估对青光眼手术失败的眼睛重新打开巩膜瓣并辅助使用丝裂霉素C（MMC）进行手术翻修的效果。

方法

回顾性、非对照、干预性病例系列研究。纳入54例连续患者的54只眼睛，这些患者先前小梁切除术或深层巩膜切除术失败，接受了正式的手术翻修（23例同时行白内障超声乳化术）。在结膜瓣下应用0.2mg/mL的MMC 2至3分钟。将原有的巩膜瓣切开以重建滤过。

结果

平均随访时间为39.5±10个月。Kaplan-Meier生存分析显示，术后3年，使用药物和/或针刺修复维持眼压（IOP）在5至18mmHg且较术前IOP降低20%的概率（95%置信区间）为64%（47%至76%），未使用药物和/或针刺修复的概率为38%（26%至53%）。术前平均IOP为23.6±7.2mmHg，术后3年为14.4±6.0mmHg（最后一次IOP在进一步青光眼手术前结转）。23只眼睛（42.5%）因滤过泡失败或高眼压进行了针刺修复，5只眼睛（9.3%）进行了进一步的青光眼手术。术前患者平均使用2±1.1种青光眼药物。在最后一次随访时，药物数量降至0.8±1.2种（P<0.000）,23只眼睛（42.5%）需要药物来控制IOP。显著并发症包括迟发性脉络膜上腔出血（3只眼睛，5.6%）、迟发性滤过泡渗漏（5只眼睛，9.3%）、低眼压（2只眼睛，3.7%）和滤过泡炎（2只眼睛，3.7%）。