Wilson Michelle E, Gupta Priya, Tran Kevin V, Arora Karun S, Lee Chun-Hao, Chang Dolly S, Friedman David S
Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins Hospital, Baltimore, MD.
J Glaucoma. 2016 Sep;25(9):720-6. doi: 10.1097/IJG.0000000000000511.
Needling of a scarred trabeculectomy bleb is often performed in the office using a slit-lamp microscope as an alternative to additional surgery to lower intraocular pressure (IOP). However, the success rate in an office setting is highly variable, with reported success rates as low as 13%. We report a retrospective assessment of an intraoperative needling technique for reviving failed blebs.
A retrospective chart review.
Patients undergoing the intraoperative modified bleb revision technique in the setting of a failed trabeculectomy due to scarring at the Wilmer Eye Institute, Johns Hopkins Hospital between August 16, 2010 and August 29, 2012.
Patients with uncontrolled IOP were operated on using a modified bleb needling technique. In this technique, a 25-G infusion cannula is placed in the anterior chamber and fibrotic adhesions within the bleb are lysed with a 25-G needle. The continuous infusion of balanced salt solution from the anterior chamber causes bleb elevation, which helps to guide the endpoint of lysis for the procedure. A subconjunctival injection of 5-fluorouracil is given at the conclusion of each case.
IOP reduction and number of glaucoma medications at postoperative day 1, week 1, month 1, month 3, month 6, and month 12.
A total of 33 eyes of 30 patients were included. At the visit before the procedure, the mean (±SD) IOP was 22.1±9.2 (range, 11 to 58) and subjects were using an average of 2.3±1.4 (range, 0 to 4) glaucoma medications. The mean IOP reduction was 8.7 mm Hg [95% confidence interval (CI), 5.6-11.8] at postoperative day 1, 8.1 mm Hg (95% CI, 4.0-12.3) at week 1, 8.9 mm Hg (95% CI, 5.3-12.5) at month 1, 8.1 mm Hg (95% CI, 4.2-12.0) at month 3, 8.2 mm Hg (95% CI, 3.9-12.5) at month 6, and 6.2 mm Hg (95% CI, 3.6-8.7) at month 12. IOP was reduced about 30% to 40% compared with baseline at each time point (P<0.05). The average reduction in medications used was 1.7 at day 1, 1.0 at month 1, 1.2 at month 3, 1.5 at month 6, and 0.5 at month 12. Seven patients underwent repeat needling. Overall, 64% of subjects maintained IOP at or below their target after 12 months.
A modified bleb needling procedure performed in the operating room can successfully lower IOP in the setting of a previous trabeculectomy in over 60% of subjects a year after the procedure.
在诊室使用裂隙灯显微镜对瘢痕化的小梁切除泡进行针刺，常作为降低眼压（IOP）的额外手术的替代方法。然而，诊室环境下的成功率差异很大，报告的成功率低至13%。我们报告了一项对恢复失败滤过泡的术中针刺技术的回顾性评估。
回顾性病历审查。
2010年8月16日至2012年8月29日期间在约翰霍普金斯医院威尔默眼科研究所因瘢痕化导致小梁切除失败而接受术中改良滤过泡修复技术的患者。
对眼压控制不佳的患者采用改良的滤过泡针刺技术进行手术。在该技术中，将一根25G的输液套管置于前房，并用一根25G的针溶解滤过泡内的纤维化粘连。从前房持续输注平衡盐溶液可使滤过泡隆起，这有助于指导该操作的溶解终点。每例手术结束时结膜下注射5-氟尿嘧啶。
术后第1天、第1周、第1个月、第3个月、第6个月和第12个月时的眼压降低情况及青光眼药物使用数量。
共纳入30例患者的33只眼。在手术前的就诊时，平均（±标准差）眼压为22.1±9.2（范围11至58），受试者平均使用2.3±1.4（范围0至4）种青光眼药物。术后第1天平均眼压降低8.7 mmHg [95%置信区间（CI），5.6 - 11.8]，第1周降低8.1 mmHg（95% CI，4.0 - 12.3），第1个月降低8.9 mmHg（95% CI，5.3 - 12.5），第3个月降低8.1 mmHg（95% CI，4.2 - 12.0），第6个月降低8.2 mmHg（95% CI，3.9 - 12.5），第12个月降低6.2 mmHg（95% CI，3.6 - 8.7）。与基线相比，各时间点眼压均降低约30%至40%（P<0.05）。术后第1天使用药物平均减少1.7种，第1个月减少1.0种，第3个月减少1.2种，第6个月减少1.5种，第12个月减少0.5种。7例患者接受了重复针刺。总体而言，64%的受试者在12个月后眼压维持在或低于目标眼压。
在手术室进行的改良滤过泡针刺手术，在超过60%的受试者中，术后一年可成功降低既往小梁切除术后的眼压。
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