Radhakrishnan Sunita, Quigley Harry A, Jampel Henry D, Friedman David S, Ahmad Sameer I, Congdon Nathan G, McKinnon Stuart
Glaucoma Center of San Francisco, San Francisco, CA, USA.
Ophthalmology. 2009 Sep;116(9):1713-8. doi: 10.1016/j.ophtha.2009.04.003. Epub 2009 Jul 29.
To describe the results of revision surgery for complications of trabeculectomy in a case series from an academic glaucoma service.
Retrospective case series.
A total of 177 eyes of 167 adult patients who underwent revision of trabeculectomy at the Wilmer Eye Institute between 1994 and 2007.
Three indications for surgery were identified: hypotony without leak, bleb leak, and bleb dysesthesia. Revision was deemed successful when all of the following were true: the primary indication was eliminated, further intraocular pressure (IOP)-lowering surgery was not required, no major complication occurred, and a new bleb-related problem did not develop. Patients with less than 3 months of follow-up were excluded unless failure occurred earlier. Surgical procedures included variations on excision of thin or leaking conjunctiva with advancement.
Change in IOP, change in visual acuity, need for further IOP-lowering surgery, and complications after bleb revision.
Subjects' mean age was 67+/-14 years, 54% were female, and mean follow-up was 2.8+/-2.7 years, with a mean interval from trabeculectomy to revision of 3.5+/-3.7 years. Overall success rate was 63% (112/177), which was slightly higher for leak repair (65%; 64/98) and hypotony (63%; 32/51) than for dysesthesia (57%; 16/28) indications. By Kaplan-Meier analysis, overall cumulative success rates at 1, 2, 5, and 10 years after bleb revision were 80%, 75%, 50%, and 41%, respectively. IOP and visual acuity improved significantly in both hypotony and leak groups (P values ranging from 0.004 to <0.0001). Additional IOP-lowering surgery was required in 9%. In multivariate regression analysis adjusting for age, gender, and number of prior surgeries, patients with glaucoma other than primary open-angle glaucoma were twice as likely to have failed bleb revision.
Surgical bleb revision often provides successful resolution of bleb-related complications. Most patients maintain IOP control without need for further IOP-lowering surgery.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
描述在一个学术性青光眼诊疗机构的病例系列中，小梁切除术并发症的翻修手术结果。
回顾性病例系列。
1994年至2007年间在威尔默眼科研究所接受小梁切除术翻修的167例成年患者的177只眼。
确定了三种手术指征：低眼压无渗漏、滤过泡渗漏和滤过泡感觉异常。当以下所有情况均为真时，翻修被视为成功：主要指征消除、无需进一步降低眼压（IOP）的手术、未发生重大并发症且未出现新的与滤过泡相关的问题。随访时间少于3个月的患者被排除，除非更早出现失败情况。手术操作包括推进切除薄的或渗漏的结膜的不同术式。
眼压变化、视力变化、是否需要进一步降低眼压的手术以及滤过泡翻修后的并发症。
受试者的平均年龄为67±14岁，54%为女性，平均随访时间为2.8±2.7年，从小梁切除术到翻修的平均间隔时间为3.5±3.7年。总体成功率为63%（112/177），渗漏修复（65%；64/98）和低眼压（63%；32/51）的成功率略高于感觉异常（57%；16/28）指征。通过Kaplan-Meier分析，滤过泡翻修后1年、2年、5年和10年的总体累积成功率分别为80%、75%、50%和41%。低眼压和渗漏组的眼压和视力均有显著改善（P值范围为0.004至<0.0001）。9%的患者需要额外的降低眼压手术。在对年龄、性别和既往手术次数进行校正的多因素回归分析中，除原发性开角型青光眼以外的青光眼患者滤过泡翻修失败的可能性是前者的两倍。
手术性滤过泡翻修通常能成功解决与滤过泡相关的并发症。大多数患者无需进一步降低眼压的手术即可维持眼压控制。
在参考文献之后可能会有专利或商业披露。
