Kinoshita Nozomi, Ota Ayumi, Toyoda Fumihiko, Yamagami Hiroko, Kakehashi Akihiro
Department of Ophthalmology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Clin Ophthalmol. 2012;6:915-8. doi: 10.2147/OPTH.S31548. Epub 2012 Jun 15.
To report a new technique of blunt needle revision with viscoelastic materials via the anterior chamber for the treatment of early failed filtering blebs and elevated intraocular pressure after trabeculectomy, in which digital ocular massage and laser suture lysis have been ineffective.
A 27-gauge blunt needle attached to a syringe containing viscoelastic material was inserted into the anterior chamber from the inferior paracentesis. The needle tip was inserted into the subscleral flap space from the filtering fistula at the anterior chamber side, and the scleral flap was lifted bluntly. The needle tip was then inserted into the subconjunctival space where the viscoelastic agent was injected and the adhesion between the sclera and conjunctiva was separated bluntly. Blunt needle revision via the anterior chamber was performed 14 times in six eyes of six patients at Saitama Medical Center, Jichi Medical University from January 2007 to May 2009. All procedures were performed within 1 month after trabeculectomy.
The intraocular pressure remained 21 mmHg or lower for more than 6 months in three of six eyes. Slight bleeding from the iris occurred in one of the 14 procedures, and hypotony (intraocular pressure below 5 mmHg) occurred in one of the 14 procedures. No serious complications developed.
Blunt needle revision via the anterior chamber for early failed filtering blebs is a new, simple, and safe procedure.
报告一种通过前房使用粘弹性材料进行钝针修复的新技术，用于治疗小梁切除术后早期滤过泡失败和眼压升高，而在此之前数字眼球按摩和激光缝线松解均无效。
将连接装有粘弹性材料注射器的27号钝针从下方穿刺口插入前房。针尖从前房侧的滤过瘘口插入巩膜瓣下间隙，钝性抬起巩膜瓣。然后将针尖插入结膜下间隙并注入粘弹性剂，钝性分离巩膜与结膜之间的粘连。2007年1月至2009年5月，在自治医科大学埼玉医疗中心，对6例患者的6只眼进行了14次经前房钝针修复。所有手术均在小梁切除术后1个月内进行。
6只眼中有3只眼眼压在21 mmHg或更低水平维持超过6个月。14次手术中有1次出现虹膜轻微出血，14次手术中有1次出现低眼压（眼压低于5 mmHg）。未发生严重并发症。
经前房钝针修复早期失败的滤过泡是一种新的、简单且安全的手术方法。
