Departments of Ophthalmology and Vision Sciences and Laboratory Medicine and Pathobiology, University of Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, Canada.
Am J Ophthalmol. 2019 Nov;207:333-342. doi: 10.1016/j.ajo.2019.04.031. Epub 2019 May 13.
This study describes an incision-free minimally invasive conjunctival surgical (MICS) technique to repair late-onset leaking blebs after trabeculectomy.
A surgical technique to repair leaking blebs without incision or excision of conjunctiva is described. This is followed by retrospective review of all patients treated at the Glaucoma Unit at St. Michael's Hospital for bleb leaks repaired with MICS from 2012 to 2017. With Research Ethics Board approval, clinical data obtained from the charts included demographic information, vision, intraocular pressure (IOP) data before and after surgery, need for additional medication, and complications. Resolution of the bleb leak without the need for additional therapy or intervention for glaucoma control was considered a success.
The MICS approach was applied to 14 eyes of 13 consecutive patients with a leaking bleb. Mean age of presentation was 70.2 ± 14.8 years, and all patients had a history of mitomycin use at the time of glaucoma surgery. The onset of bleb leak following trabeculectomy ranged from 7 months to 16.3 years. Mean pre-operative IOP was 4.5 ± 2.8 mm Hg; IOP measured 12.3 ± 3.0 mm Hg immediately after the procedure. Complete resolution of the bleb leak was observed following surgery in all cases. The follow-up period ranged from 2 weeks to 61 months (10.2 ± 18.1). Recurrent bleb leak was reported in 1 patient 2 years following initial surgery. In all cases, the initially repaired filtering blebs remained functional at last follow-up, and no additional medications were required.
The MICS procedure is an effective option for treating late-onset leaking blebs without cutting or excising conjunctival tissue. The minimal requirements of this method make it additionally accessible to low-resource settings. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
本研究描述了一种经结膜微创（MICS）技术，用于修复小梁切除术后迟发性渗漏滤泡。
描述了一种无需切口或切除结膜即可修复渗漏滤泡的手术技术。随后对 2012 年至 2017 年期间在圣迈克尔医院青光眼科接受 MICS 治疗的所有患者进行回顾性分析。在获得伦理委员会批准的情况下，从病历中获取的临床数据包括人口统计学信息、视力、手术前后的眼压（IOP）数据、是否需要额外药物治疗以及并发症。如果无需进一步治疗或干预即可控制青光眼，则认为滤泡渗漏得到解决。
MICS 方法应用于 13 例连续患者的 14 只眼，这些患者的滤泡渗漏。患者的平均年龄为 70.2±14.8 岁，所有患者在青光眼手术时均有丝裂霉素使用史。滤过泡渗漏发生在小梁切除术后 7 个月至 16.3 年。术前平均 IOP 为 4.5±2.8mmHg；手术后立即测量 IOP 为 12.3±3.0mmHg。所有病例术后均观察到滤泡渗漏完全解决。随访时间从 2 周到 61 个月不等（10.2±18.1）。1 例患者在初次手术后 2 年报告滤泡再次渗漏。在所有病例中，最初修复的滤过泡在最后一次随访时仍然功能正常，无需额外药物治疗。
MICS 是一种治疗迟发性渗漏滤泡的有效方法，无需切割或切除结膜组织。该方法的最小要求使其在资源有限的环境中更易于应用。
本文的发表得到美国眼科学会的赞助。
