比较失败的小梁切除术后滤过泡针拨术与结膜下贝伐单抗和 5-氟尿嘧啶注射。

Comparison of needle revision with subconjunctival bevacizumab and 5-fluorouracil injection of failed trabeculectomy blebs.

机构信息

Glaucoma Division, Ulucanlar Training and Research Eye Hospital, Ankara, Turkey.

出版信息

J Ocul Pharmacol Ther. 2012 Oct;28(5):542-6. doi: 10.1089/jop.2012.0035. Epub 2012 Jun 25.

DOI:10.1089/jop.2012.0035

PMID:22731246

Abstract

PURPOSE

To evaluate the efficacy and complications of bevacizumab versus 5-fluorouracil (5-FU)-augmented bleb needling of failed filtration blebs following trabeculectomy.

METHODS

Twenty-seven eyes of 27 patients with bleb failure were included. Patients were randomly assigned to receive either 5-FU or bevacizumab. Needling was performed in the operating room under sterile conditions. After the needling procedure, a viscoelastic material was injected subconjunctivally around the bleb area to avoid the entrance of 5-FU or bevacizumab into the anterior chamber. Bevacizumab (1.25 mg/0.1 mL) was injected into 12 eyes and 5-FU injected into 15 eyes subconjunctivally. All of the patients were controlled weekly until a filtration bleb was maintained. Intraocular pressure (IOP), bleb appearance, and complications were noted in each group. Success was defined as absolute if the IOP 21 mmHg or less without any medication or surgical intervention at last visit, and qualified if the IOP 21 mmHg or less with topical antiglaucomatous medications. The patients were followed from 11 to 26 (median, 17) months.

RESULTS

The IOP decreased, from 31.2±3.2 mmHg to 16.1±2.1 mmHg, in the bevacizumab group on the first postoperative day. The IOP was within normal limits in 1 (8.3%) patient without medication and controlled with topical antiglaucomatous drops in 2 (16.7%) patients. The total success rate was 25% at the time of the last visit. Success was not achieved in 9 (75%) eyes. The IOP was 32.0±4.6 mmHg preoperatively and 12.2±2.6 mmHg on the first postoperative day in the 5-FU injected patients. The total success rate was 80%; 8 (53.3%) eyes showed absolute success, whereas 4 (26.7%) eyes showed a qualified success. A statistically significant difference between groups in terms of success rates was observed (P=0.04).

CONCLUSIONS

Subconjunctival 5-FU application is a more effective therapy than bevacizumab application for needling procedures in failed trabeculectomy blebs.

摘要

目的

评估贝伐单抗与 5-氟尿嘧啶（5-FU）增强的小梁切除术失败滤过泡的针刺相比的疗效和并发症。

方法

纳入 27 例 27 只眼滤过泡失败患者。患者随机分为贝伐单抗组或 5-FU 组。在手术室无菌条件下进行针刺。针刺后，在滤过泡区域周围的结膜下注射粘性物质，以防止 5-FU 或贝伐单抗进入前房。12 只眼结膜下注射贝伐单抗（1.25mg/0.1mL），15 只眼结膜下注射 5-FU。所有患者每周进行一次检查，直至维持滤过泡。观察两组眼压（IOP）、滤过泡外观和并发症。末次随访时，如果 IOP 21mmHg 以下且无需任何药物或手术干预则定义为绝对成功，如果 IOP 21mmHg 以下且需要局部抗青光眼药物则定义为合格成功。患者随访 11 至 26 个月，中位数为 17 个月。

结果

贝伐单抗组患者术后第 1 天 IOP 从 31.2±3.2mmHg 降至 16.1±2.1mmHg。1 例（8.3%）患者无需药物治疗，IOP 正常，2 例（16.7%）患者需要局部抗青光眼药物治疗。末次随访时总成功率为 25%。9 只眼（75%）未成功。5-FU 组患者术前 IOP 为 32.0±4.6mmHg，术后第 1 天 IOP 为 12.2±2.6mmHg。总成功率为 80%；8 只眼（53.3%）绝对成功，4 只眼（26.7%）合格成功。两组间成功率差异有统计学意义（P=0.04）。