5-氟尿嘧啶增强的小梁切除术针拨术：流出阻力的位置有影响吗？

5-Fluorouracil augmented needle revision of trabeculectomy: does the location of outflow resistance make a difference?

机构信息

Department of Ophthalmology, University Hospitals Leicester, Infirmary Square, Leicester, UK.

出版信息

J Glaucoma. 2013 Aug;22(6):463-7. doi: 10.1097/IJG.0b013e31824484ce.

DOI:10.1097/IJG.0b013e31824484ce

PMID:23603826

Abstract

PURPOSE

To determine whether the outcome of needle revision of trabeculectomy is influenced by the presumed anatomic location of resistance to aqueous outflow.

DESIGN

Retrospective case note review.

PARTICIPANTS

Thirty-four eyes of 30 consecutive patients undergoing their first needle revision of trabeculectomy.

METHODS

We compared 2 types of needle revision: "type-1 needling," limited to breaking down fibrosis in the subconjuctival-subtenon space, and "type-2 needling," which additionally involved needling underneath the scleral flap.

MAIN OUTCOME MEASURES

Unqualified success was defined as a postneedling intraocular pressure (IOP) >4 mm Hg and ≤21 mm Hg at the most recent follow-up without further surgery, medications, or repeat needling. Qualified success was defined as a successful patient who required medications or repeat needling.

RESULTS

The mean follow-up period was 2.1 ± 0.1 years (range, 1.0 to 3.8 y). Sixteen type-1 and 18 type-2 procedures were performed at a median of 124 days (22 d to 14 y) after trabeculectomy. IOP decreased from a mean of 28.2±1.3 mm Hg (19 to 52 mm Hg) preneedling to 6.7±0.8 mm Hg (2 to 22 mm Hg) on the first postoperative visit and 15.1±0.7 mm Hg (8 to 27 mm Hg) at the most recent follow-up. The overall success rate was 82.4% (47.1% unqualified and a further 35.3% qualified). There was no significant difference in the success rates between type-1 (14/16) and type-2 (14/18) needle revisions (Fisher exact test, P=0.66). Similar proportions of eyes undergoing type-1 and type-2 needling underwent a second needling procedure. There was no significant difference in the IOP reduction between type-1 and type-2 needling (Mann-Whitney U test, P=0.78).

CONCLUSIONS

Needle revision is an effective technique for trabeculectomy bleb remodeling and can result in a sustained reduction in IOP. The location of the obstruction did not influence outcome, with type-1 and type-2 needle revisions equally likely to succeed.

摘要

目的

确定小梁切除术的针拨术结果是否受房水流出阻力的假定解剖位置影响。

设计

回顾性病历审查。

参与者

30 例连续患者的 34 只眼，均接受首次小梁切除术的针拨术。

方法

我们比较了两种类型的针拨术：“1 型针拨术”，仅限于打破结膜下-腱膜下空间中的纤维化；“2 型针拨术”，还涉及到在巩膜瓣下进行针拨。

主要观察指标

未合格的成功定义为最近一次随访时的眼压（IOP）>4mmHg 且≤21mmHg，无需进一步手术、药物治疗或重复针拨术。合格的成功定义为需要药物治疗或重复针拨术的成功患者。

结果

平均随访时间为 2.1±0.1 年（范围为 1.0 至 3.8 年）。在小梁切除术之后的中位数为 124 天（22 天至 14 年）时，进行了 16 次 1 型和 18 次 2 型手术。IOP 从术前的平均 28.2±1.3mmHg（19 至 52mmHg）下降到第一次术后就诊时的 6.7±0.8mmHg（2 至 22mmHg）和最近一次随访时的 15.1±0.7mmHg（8 至 27mmHg）。总体成功率为 82.4%（47.1%不合格，进一步有 35.3%合格）。1 型（14/16）和 2 型（14/18）针拨术的成功率无显著差异（Fisher 确切检验，P=0.66）。接受 1 型和 2 型针拨术的眼有相似比例的眼需要进行第二次针拨术。1 型和 2 型针拨术的眼压降低无显著差异（Mann-Whitney U 检验，P=0.78）。