Palejwala Neal, Ichhpujani Parul, Fakhraie Ghasem, Myers Jonathan S, Moster Marlene R, Katz L Jay
William and Anna Goldberg Glaucoma Service, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA.
Eur J Ophthalmol. 2010 Nov-Dec;20(6):1026-34. doi: 10.1177/112067211002000624.
To assess the success of needling in failed filtration blebs and the potential benefit of using either 5-fluorouracil (5-FU) or mitomycin C (MMC).
In this retrospective, comparative observational case series, 107 eyes that underwent needle revision with either 5-FU or MMC between July 2003 and May 2008 at Wills Eye Institute were selected. Exclusion criteria included follow-up less than 1 month and a history of glaucoma drainage device. Intraocular pressure (IOP) and number of glaucoma medications were recorded preoperatively and postoperatively. Success was defined as >20% decrease in IOP if glaucoma medications were resumed or <10% decrease in IOP if medications were not resumed post needling or fewer medications than pre needling.
Sixty-five patients received 5-FU and 42 patients received MMC for needling. Mean IOP changed from 23.9 mmHg to 13.8 mmHg in the MMC group and from 23.3 mmHg to 13.02 mmHg in the 5-FU group (both p<0.001). Mean glaucoma medications changed from 1.7 to 0.7 in the MMC group and 2.0 to 0.8 in the 5-FU group (both p<0.001) at the end of follow-up. After a mean follow-up of 14.5 months, overall survival was 49.5%. Mean time to failure was 7.7 months. There was a moderately weak association between survival and the immediate postoperative IOP (r=0.262, p=0.01). In comparing MMC and 5-FU, there was no statistically significant difference in survival rate (p=0.267).
Bleb needling may be a safe and effective means of prolonging bleb survival. The only factor associated with success was the immediate postoperative IOP. There was no apparent difference between the use of 5-FU and MMC in this population. A prospective study may provide further confirmation of this finding.
评估对失败滤过泡进行针刺的成功率以及使用5-氟尿嘧啶（5-FU）或丝裂霉素C（MMC）的潜在益处。
在这个回顾性、比较性观察病例系列中，选取了2003年7月至2008年5月期间在威尔斯眼科研究所接受5-FU或MMC针刺修复的107只眼。排除标准包括随访时间少于1个月以及有青光眼引流装置史。记录术前和术后的眼压（IOP）以及青光眼药物使用数量。成功的定义为，如果恢复使用青光眼药物，IOP降低>20%；如果针刺后未恢复使用药物，IOP降低<10%，或者使用的药物比针刺前更少。
65例患者接受5-FU针刺，42例患者接受MMC针刺。MMC组的平均IOP从23.9 mmHg降至13.8 mmHg，5-FU组从23.3 mmHg降至13.02 mmHg（两者p<0.001）。随访结束时，MMC组的平均青光眼药物使用数量从1.7降至0.7，5-FU组从2.0降至0.8（两者p<0.001）。平均随访14.5个月后，总体存活率为49.5%。平均失败时间为7.7个月。存活率与术后即刻IOP之间存在中度弱关联（r=0.262，p=0.01）。比较MMC和5-FU时，存活率无统计学显著差异（p=0.267）。
滤过泡针刺可能是延长滤过泡存活的一种安全有效的方法。与成功相关的唯一因素是术后即刻IOP。在该人群中，5-FU和MMC的使用之间没有明显差异。前瞻性研究可能会进一步证实这一发现。
