Department of Ophthalmology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Ophthalmology. 2011 Apr;118(4):755-62. doi: 10.1016/j.ophtha.2010.08.020. Epub 2010 Nov 5.
To assess the efficacy of needle revision using mitomycin C (MMC) for reviving failed filtering blebs during the late postoperative period and its safety for the corneal endothelium.
Prospective interventional case series.
We recruited 125 eyes from 98 patients with uncontrolled glaucoma. All had at least 1 failed trabeculectomy, a flat filtering bleb, and a patent internal ostium on gonioscopy. The average time between the last trabeculectomy and needle revision was 5.3±5.3 years (range, 6 months to 30 years).
Needling revision with a subconjunctival injection of 8 μg of MMC.
Intraocular pressure (IOP) and number of hypotensive medications at latest visit, central corneal thickness (CCT), corneal endothelial cell density (ECD), coefficient of variation of cell size (CV), and hexagonality before and after needling.
We performed 186 needling procedures on 125 eyes (mean, 1.5±0.6 procedures/eye). Seventy-three eyes (58.4%) were needled once, 44 eyes (35.2%) were needled twice, 7 eyes (5.6%) were needled 3 times, and 1 eye (0.8%) was needled 4 times. We reestablished aqueous flow and obtained a raised bleb in 115 eyes (92%). After an average follow-up of 20.8±12.0 months, the mean IOP decreased from 20.1±5.2 mmHg preoperatively to 13.2±6.8 mmHg (P<0.001), and the mean number of hypotensive medications per eye decreased from 2.4±1.1 to 0.8±1.3 (P<0.001) at the latest visit. The overall success rate (IOP ≤16 mmHg) was 76% (58.4% without medication and 17.6% with hypotensive medications). Kaplan-Meier survival rates were 91.2% at the 1-month follow-up, 84.5% at 6 months, 81.0% at 1 year, 74.6% at 2 years, and 66.3% at 3 years. We studied the corneal endothelium in 42 eyes of 36 patients. There was no statistically significant difference between preoperative CCT, ECD, CV, or hexagonality and postoperative measurements at 1 week and 1, 3, 6, and 12 months.
Needling revision with adjunctive MMC is effective for reviving flat filtering blebs and controlling IOP, even several years after the original trabeculectomy, and seems to be safe for the corneal endothelium.
评估在术后晚期使用丝裂霉素 C（MMC）进行针拨以恢复失败的滤过泡的疗效及其对角膜内皮的安全性。
前瞻性干预性病例系列。
我们从 98 例患有未控制青光眼的患者中招募了 125 只眼。所有患者均至少有 1 次失败的小梁切除术、扁平滤过泡和房角镜检查可见的通畅的内口。最后一次小梁切除术和针拨之间的平均时间为 5.3±5.3 年（范围为 6 个月至 30 年）。
结膜下注射 8μg MMC 进行针拨。
末次随访时的眼压（IOP）和降压药物的数量、中央角膜厚度（CCT）、角膜内皮细胞密度（ECD）、细胞大小变异系数（CV）和六边形细胞比例，在针拨前后进行测量。
我们对 125 只眼（平均每眼 1.5±0.6 次）进行了 186 次针拨。73 只眼（58.4%）针拨 1 次，44 只眼（35.2%）针拨 2 次，7 只眼（5.6%）针拨 3 次，1 只眼（0.8%）针拨 4 次。我们重建了房水流出，并使 115 只眼（92%）的滤过泡隆起。平均随访 20.8±12.0 个月后，平均 IOP 从术前的 20.1±5.2mmHg 降至 13.2±6.8mmHg（P<0.001），平均每只眼降压药物的数量从 2.4±1.1 降至 0.8±1.3（P<0.001）。总体成功率（IOP≤16mmHg）为 76%（无药物治疗者占 58.4%，药物治疗者占 17.6%）。Kaplan-Meier 生存率在 1 个月随访时为 91.2%，6 个月时为 84.5%，1 年时为 81.0%，2 年时为 74.6%，3 年时为 66.3%。我们对 36 例患者的 42 只眼进行了角膜内皮研究。术后 1 周和 1、3、6 和 12 个月时，CCT、ECD、CV 和六边形细胞比例的术前和术后测量值之间无统计学差异。
在最初的小梁切除术多年后，用丝裂霉素 C（MMC）辅助的针拨对于恢复扁平滤过泡和控制眼压非常有效，并且似乎对角膜内皮安全。
