Tai Tak Yee Tania, Moster Marlene R, Pro Michael J, Myers Jonathan S, Katz L Jay
*New York Eye and Ear Infirmary, Brooklyn, NY †Wills Eye Institute, Jefferson Medical College, Philadelphia, PA.
J Glaucoma. 2015 Apr-May;24(4):311-5. doi: 10.1097/IJG.0b013e31829f9bd3.
To report the 6-month comparative outcomes and bleb morphology for needle revision with bevacizumab and mitomycin C (MMC) versus MMC alone of failed trabeculectomy and ExPRESS shunt blebs.
Patients undergoing bleb needle revision procedures were enrolled in this study. All patients received a subconjunctival injection of 0.1 mL MMC (0.4 mg/mL) mixed with 0.1 mL preservative-free lidocaine (1%) at the beginning of the procedure. The patients were randomized into 2 cohorts assigned to receive either 1.0 mg (0.04 mL of 25 mg/mL) subconjunctival bevacizumab (treatment group) or 0.04 mL of balanced salt solution (control group) injected in an identical manner posterior to the bleb after the bleb needling. Success was defined as ≥20% reduction in intraocular pressure (IOP) without any IOP-lowering medications. Qualified success was defined as ≥20% reduction of IOP with IOP-lowering medications. Failure was defined as IOP>21 mm Hg, IOP reduction <20%, or need for additional surgery. Bleb morphology was classified using the Indiana Bleb Appearance Grading Scale.
Six months postoperatively, in treatment group (n=29), 57% of patients achieved complete success, and 43% failed. In control group (n=29), 41% of patients achieved complete success, 7% achieved qualified success, and 52% failed. The difference in success rates between the 2 groups was not statistically significant (P=0.35). At 6 months, the mean IOP was 11.52 in treatment group and 12.83 in control group (P=0.45); patients in treatment group were on a mean of 0.16 medications as compared with 0.58 medications in control group (P=0.058). For bleb morphology of treatment group compared with control group, the blebs had less vascularity (0.76 vs. 1.20, respectively, on a scale of 0 to 4, P<0.05) and greater extent (2.68 vs. 2.36, on a scale of 0 to 3, P=0.022) in treatment group.
There was no significant difference between the success rates and IOPs at postoperative month 6 between treatment and control groups. Postoperative blebs in the treatment group were less vascular and had greater extent.
报告小梁切除术和ExPRESS分流术滤过泡失败后，使用贝伐单抗联合丝裂霉素C（MMC）与单纯使用MMC进行针拨修复的6个月比较结果及滤过泡形态。
本研究纳入接受滤过泡针拨修复手术的患者。所有患者在手术开始时结膜下注射0.1 mL MMC（0.4 mg/mL）与0.1 mL无防腐剂利多卡因（1%）的混合液。患者被随机分为2组，一组在滤过泡针拨后以相同方式结膜下注射1.0 mg（0.04 mL 25 mg/mL）贝伐单抗（治疗组），另一组注射0.04 mL平衡盐溶液（对照组）。成功定义为眼压（IOP）降低≥20%且无需任何降眼压药物。合格成功定义为使用降眼压药物后IOP降低≥20%。失败定义为IOP>21 mmHg、IOP降低<20%或需要再次手术。滤过泡形态使用印第安纳滤过泡外观分级量表进行分类。
术后6个月，治疗组（n = 29）中，57%的患者取得完全成功，43%失败。对照组（n = 29）中，41%的患者取得完全成功，7%取得合格成功，52%失败。两组成功率差异无统计学意义（P = 0.35）。6个月时，治疗组平均IOP为11.52，对照组为12.83（P = 0.45）；治疗组患者平均使用0.16种药物，对照组为0.58种（P = 0.058）。治疗组滤过泡形态与对照组相比，治疗组滤过泡血管化程度更低（0至4分制下分别为0.76和1.20，P<0.05），范围更大（0至3分制下分别为2.68和2.36，P = 0.022）。
治疗组和对照组术后6个月的成功率和IOP无显著差异。治疗组术后滤过泡血管化程度更低且范围更大。
