Elsayed Thanaa Helmy Mohamed, El-Raggal Tamer Mohamed
Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Middle East Afr J Ophthalmol. 2010 Oct;17(4):369-73. doi: 10.4103/0974-9233.71598.
PURPOSE AND SETTINGS: This study was designed to evaluate the efficacy and safety of mitomycin-C (MMC) augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital.
A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 ± 3.4 years (range, 1-12 years). Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC (0.04 mg/mL) and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous outflow.
Follow-up ranged from 6 to 20 months (mean, 9.23 ± 5.25 months). One needling revision was performed in 22 eyes (73.3%) and eight eyes (26.7%) received two needle revisions. The mean intraocular pressure (IOP) decreased from 26.9 ± 2.85 mmHg (range, 21-34 mmHg) before surgery to 15.63 ± 3.15 mmHg (range, 10-24 mmHg) at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye.
MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery.
目的与背景：本研究旨在评估丝裂霉素C（MMC）辅助针刺术治疗先天性青光眼小梁切除术后滤过泡失败的疗效和安全性。本研究在艾因夏姆斯大学医院进行。
对25例先天性青光眼小梁切除术后滤过泡失败的患者的30只眼进行回顾性研究。受试者的平均年龄为7.3±3.4岁（范围1 - 12岁）。在全身麻醉下，采用结膜下注射0.1 mL MMC（0.04 mg/mL）与0.2 mL 1%利多卡因混合液辅助进行针刺术。用30号针头进行针刺，以分离结膜下纤维化区域并重建房水流出通道。
随访时间为6至20个月（平均9.23±5.25个月）。22只眼（73.3%）进行了1次针刺修复，8只眼（26.7%）接受了2次针刺修复。平均眼压（IOP）从手术前的26.9±2.85 mmHg（范围21 - 34 mmHg）降至最后随访时的15.63±3.15 mmHg（范围10 - 24 mmHg）。并发症包括6只眼出现明显的结膜下出血，2只眼术中滤过泡渗漏，1只眼脉络膜脱离，1只眼出现少量前房积血。
MMC针刺修复滤过泡似乎是治疗先天性青光眼患者小梁切除术后滤过手术失败的有效方法。该技术在降低眼压方面有效，同时保留剩余结膜以备进一步手术。
