Cambridge NIHR Biomedical Research Centre, University of Cambridge, Cambridge, UK.
Department of Ophthalmology, North Middlesex University Hospital NHS Trust, London, UK.
Br J Ophthalmol. 2018 Dec;102(12):1667-1671. doi: 10.1136/bjophthalmol-2017-311348. Epub 2018 Feb 9.
Bleb needling is widely used to restore flow and lower intraocular pressure (IOP) in a failing trabeculectomy. We aimed to measure the safety and efficacy of needling in a large cohort and identify factors that were associated with success and failure.
This retrospective audit included all patients who underwent needling at Addenbrooke's Hospital, Cambridge over a 10-year period. Data were available on 91 patients (98% of patients identified), including 191 needlings on 96 eyes. Success was defined as IOP below 21 mm Hg or 16 mm Hg or 13 mm Hg consistently, without reoperation or glaucoma medication. Risk factors for failure were assessed by Cox proportional hazard regression and Kaplan-Meier curves.
Success defined as IOP <16 mm Hg was 66.6% at 12 months and 53% at 3 years and success defined as IOP <21 mm Hg was 77.1% at 12 months and 73.1% at 3 years. Failure after needling was most common in the first 6 months. Factors that predicted failure were flat or fibrotic blebs (non-functional) and no longer injected, while success was predicted by achieving a low IOP immediately after needling. No significant complications were identified.
Needling was most successful soon after trabeculectomy, but resuscitation of a long-failed trabeculectomy had lower likelihood of success. The safety and efficacy compare favourably with alternative treatment approaches.
水分离术在广泛用于修复失败的小梁切除术的功能，并降低眼内压（IOP）。我们旨在通过大样本量研究来评估水分离术的安全性和有效性，并确定与成功和失败相关的因素。
本回顾性研究纳入了在剑桥阿登布鲁克医院接受水分离术的所有患者，研究时间跨度为 10 年。共有 91 名患者（已识别患者的 98%）的数据可用，其中 96 只眼进行了 191 次水分离术。成功定义为持续的 IOP<21mmHg、16mmHg 或 13mmHg，无需再次手术或使用青光眼药物。通过 Cox 比例风险回归和 Kaplan-Meier 曲线评估失败的风险因素。
定义为 IOP<16mmHg 的成功率为 12 个月时为 66.6%，3 年时为 53%；定义为 IOP<21mmHg 的成功率为 12 个月时为 77.1%，3 年时为 73.1%。水分离术后的失败最常见于最初的 6 个月。预测失败的因素为扁平或纤维化的滤过泡（无功能）且不再注射，而成功的预测因素为水分离术后即刻眼压降低。未发现明显的并发症。
水分离术在小梁切除术后的早期最为成功，但长期失败的小梁切除术的复苏成功率较低。该方法的安全性和有效性与其他治疗方法相当。
