Gollakota SriRamani, Garudadri Chandra S, Mohamed Ashik, Senthil Sirisha
*VST Glaucoma Centre †Ophthalmic Biophysics, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.
J Glaucoma. 2017 Sep;26(9):816-821. doi: 10.1097/IJG.0000000000000726.
To study the outcomes of large diameter soft bandage contact lens (BCL) in managing early trabeculectomy bleb leak.
Of 972 eyes that underwent fornix-based trabeculectomy between 2011 and 2015, 19 eyes with bleb leak with at least 1 year follow-up were eligible. Bleb leak was conservatively managed using large diameter BCL (≥15.5 mm in diameter). Success was defined as complete, if bleb leak resolved and the intraocular pressure (IOP) was ≥5 and ≤18 mm Hg with no additional antiglaucoma medication and failure if surgical intervention was needed.
Mean age (±SD) of subjects was 43.5±11.9 years. Mitomycin C was used in 15/19 eyes. Median time (interquartile range) from trabeculectomy to bleb leak was 9 days (interquartile range: 8 to 19 d). Bleb leak was treated with 15.5 mm BCL in 16 eyes and 17 mm lens in 3 eyes. Bleb leak resolved with BCL in 17 [89.5%; 95% confidence interval (95% CI), 68.6-97] and 2 eyes (10.5%; 95% CI, 2-31) required bleb resuturing. Mean duration of BCL wear for bleb leak resolution was 23.7±8.9 days. Mean IOP increased from 5.8±2.7 to 12.5±3.1 mm Hg after resolution of bleb leak (P<0.05). At 16 months, complete success probability of trabeculectomy was 89.4% (95% CI, 75.6%-100%).
Large diameter BCL was effective in the management of early bleb leak with good intermediate term success for IOP control. We suggest a trial of soft contact lens of appropriate diameter to manage early bleb leaks, before planning any invasive intervention.
研究大直径软性包扎接触镜（BCL）在处理早期小梁切除术后滤过泡渗漏中的效果。
在2011年至2015年间接受穹窿部小梁切除术的972只眼中，有19只出现滤过泡渗漏且至少随访1年的眼符合条件。使用大直径BCL（直径≥15.5 mm）对滤过泡渗漏进行保守治疗。如果滤过泡渗漏消失且眼压（IOP）在无需额外抗青光眼药物的情况下≥5且≤18 mmHg，则定义为成功；如果需要手术干预，则定义为失败。
受试者的平均年龄（±标准差）为43.5±11.9岁。19只眼中有15只使用了丝裂霉素C。从小梁切除术到滤过泡渗漏的中位时间（四分位间距）为9天（四分位间距：8至19天）。16只眼使用15.5 mm的BCL治疗滤过泡渗漏，3只眼使用17 mm的镜片。17只眼（89.5%；95%置信区间[95%CI]，68.6 - 97）的滤过泡渗漏通过BCL得以解决，2只眼（10.5%；95%CI，2 - 31）需要对滤过泡进行缝合。滤过泡渗漏解决所需的BCL佩戴平均时长为23.7±8.9天。滤过泡渗漏解决后，平均眼压从5.8±2.7 mmHg升高至12.5±3.1 mmHg（P<0.05）。在16个月时，小梁切除术的完全成功率为89.4%（95%CI，75.6% - 100%）。
大直径BCL在处理早期滤过泡渗漏方面有效，且在眼压控制方面中期效果良好。我们建议在计划任何侵入性干预之前，先尝试使用合适直径的软性接触镜来处理早期滤过泡渗漏。
