Centro de Oftalmología Barraquer.
Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona.
J Glaucoma. 2019 Jun;28(6):546-549. doi: 10.1097/IJG.0000000000001236.
The purpose of this study was to describe the long-term results of partial bleb excision in late-onset bleb-related complications by a single experienced surgeon using the same surgical technique.
This was a retrospective study of 21 eyes of 11 women and 10 men aged 34 to 87 years (mean 64±12.8 y) who underwent first repair of late-onset bleb leaks with or without numerical hypotony (NH) and dysesthesia. The surgical technique consists of removing nonviable conjunctiva until the functional tissue becomes visible, thus adapting to individual conditions, and later conjunctival advancement. Complete success was defined as maintenance of intraocular pressure control without additional bleb revision, surgery, or glaucoma medications. Qualified success met these criteria, but with glaucoma medications.
The mean follow-up was 5.6±4.4 years (1 to 17 years). Sixty-two percent of the cases were considered complete success, and a moderate number of cases (19%) needed glaucoma medication for achieving qualified success at the end of the follow-up period. Interestingly, bleb leak with NH seems to have long-term outcomes, like the other bleb-related complications (in terms of success and failures), with a significant intraocular pressure increase at 1 month after revision that tended to remain within normal values and lead to visual acuity recovery without recurrent NH.
Partial bleb excision seems to be a good technique for different late-onset bleb-related complications. Bleb leak with NH showed a good long-term response, like the other bleb revision indications.
本研究旨在描述由一位经验丰富的外科医生使用相同手术技术对迟发性滤泡相关并发症进行部分滤泡切除的长期结果。
这是一项回顾性研究，共纳入 11 名女性和 10 名男性的 21 只眼，年龄 34 至 87 岁（平均 64±12.8 岁），这些患者均因迟发性滤泡渗漏伴或不伴数值性低眼压（NH）和感觉异常而首次接受修复。手术技术包括切除失活的结膜，直至可见功能组织，从而适应个体情况，然后进行结膜推进。完全成功定义为无需进一步滤泡修复、手术或抗青光眼药物即可维持眼内压控制。合格成功符合这些标准，但需要使用抗青光眼药物。
平均随访时间为 5.6±4.4 年（1 至 17 年）。62%的病例被认为是完全成功的，有相当数量的病例（19%）需要抗青光眼药物治疗才能在随访结束时达到合格成功。有趣的是，NH 伴滤泡渗漏似乎具有长期的结果，与其他滤泡相关并发症（在成功和失败方面）一样，在修复后 1 个月眼压显著升高，眼压趋于维持在正常范围内，并导致视力恢复，不再出现 NH。
部分滤泡切除似乎是治疗不同迟发性滤泡相关并发症的一种良好技术。NH 伴滤泡渗漏显示出良好的长期反应，与其他滤泡修复指征相似。
