青光眼滤过手术后的针拨修复结果：生存分析及预测因素

Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors.

作者信息

Rabiolo Alessandro, Marchese Alessandro, Bettin Paolo, Monteduro Davide, Galasso Mario, Dolci Maria Paola, Di Matteo Federico, Fiori Marina, Ciampi Carlo, Bandello Francesco

机构信息

Department of Ophthalmology, University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.

Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, Sacco Hospital, University of Milan, Milan, Italy.

出版信息

Eur J Ophthalmol. 2020 Mar;30(2):350-359. doi: 10.1177/1120672119830861. Epub 2019 Feb 25.

DOI:10.1177/1120672119830861

PMID:30798630

Abstract

PURPOSE

To evaluate the efficacy and safety of needle revision and examine factors predictive of failure.

METHODS

In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure.

RESULTS

The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively.

CONCLUSION

Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.

摘要

目的

评估针刺修复术的疗效和安全性，并研究预测失败的因素。

方法

本回顾性研究纳入了131例患者的157只眼睛，这些眼睛因小梁切除术失败而接受了联合5-氟尿嘧啶或倍他米松的针刺修复术。完全失败定义为再次进行青光眼手术、睫状体破坏手术、光感丧失、威胁视力的并发症、低眼压性黄斑病变以及手术性滤过泡修复。成功定义为在使用（合格）或不使用（完全）药物的情况下，眼压达到≤18（标准A）、≤15（标准B）和≤12 mmHg（标准C），且不存在任何完全失败的标准。

结果

中位（四分位间距）随访时间为25.0（41.0）个月。1年、2年和3年时的完全失败率分别为19%、26%和31%。对于标准A，1年时合格成功率和完全成功率分别为77%和69%，2年时分别为66%和51%，3年时分别为60%和47%。对于标准B，1年时合格成功率和完全成功率分别为67%和61%，2年时分别为48%和42%，3年时分别为44%和39%。对于标准C，1年时合格成功率和完全成功率分别为43%和41%，2年时分别为27%和25%，3年时分别为24%和23%。基线眼压高和初次手术分别与完全失败的高风险和低风险相关。