Erdem Burak, Imamoglu Serhat, Ercalik Nimet Yesim
Ministry of Health, Ordu University Training and Research Hospital , Ordu , Turkey.
Ministry of Health, Haydarpasa Numune Training and Research Hospital , İstanbul , Turkey.
Cutan Ocul Toxicol. 2019 Dec;38(4):395-400. doi: 10.1080/15569527.2019.1650060. Epub 2019 Aug 12.
To evaluate the efficacy of 5-fluorouracil (5-FU) needling of encapsulated blebs (EBs) after Ahmed glaucoma valve (AGV) implantation in patients with medically uncontrolled secondary glaucoma. Thirty-eight eyes of 37 patients who underwent AGV implantation due to secondary glaucoma with EB were recruited in this retrospective non-randomized study. 5-FU needling (0.1 mL of 50 mg/mL) was performed for the restore of the aqueous outflow. Success after needling was defined as last intraocular pressure (IOP) ≤21 mmHg or ≥6 mmHg (with or without the use of antiglaucoma medication) without loss of light perception. The mean follow-up time was 14.5 ± 8.5 (5-36) months after needling. The mean interval between the AGV implantation and the needling was 10.2 ± 7.5 (2-32) weeks. Patients were examined after needling at the 2nd hour, 1st week, 1st month, 3rd month, 6th month, and at the final visit. The success rates were 84.2%, 94.7%, 94.7%, 86.8%, 83.3%, and 71.1%, respectively. The Kaplan-Meier survival analysis revealed 96.4%, 77.4%, and 60.3% cumulative predictive success rates for the 6th, 12th, and 24th months, respectively. The mean IOP before needling was 28 ± 8.4 mmHg. At the final visit, the mean IOP was 18.1 ± 7.5 mmHg ( ≤ 0.001). Complications after needling included Seidel without hypotony (three eyes, 7.9%), hyphema (one eye, 2.6%), and decompression retinopathy (one eye, 2.6%). Neovascular glaucoma was the only factor that affected efficacy of treatment negatively ( = 0.003). Bleb needling with 5-FU seems to be a safe and effective method in patients with EB formation after AGV implantation in secondary glaucoma cases.
评估5-氟尿嘧啶（5-FU）针刺包裹性房水囊肿（EBs）对药物治疗无法控制的继发性青光眼患者在植入艾哈迈德青光眼引流阀（AGV）后的疗效。本回顾性非随机研究纳入了37例因继发性青光眼合并EB而接受AGV植入术的患者的38只眼。采用5-FU针刺（0.1 mL的50 mg/mL）以恢复房水流出。针刺成功定义为末次眼压（IOP）≤21 mmHg或≥6 mmHg（无论是否使用抗青光眼药物）且无光感丧失。针刺后平均随访时间为14.5±8.5（5 - 36）个月。AGV植入与针刺之间的平均间隔时间为10.2±7.5（2 - 32）周。在针刺后的第2小时、第1周、第1个月、第3个月、第6个月以及末次随访时对患者进行检查。成功率分别为84.2%、94.7%、94.7%、86.8%、83.3%和71.1%。Kaplan-Meier生存分析显示，第6、12和24个月的累积预测成功率分别为96.4%、77.4%和60.3%。针刺前平均眼压为28±8.4 mmHg。在末次随访时，平均眼压为18.1±7.5 mmHg（P≤0.001）。针刺后的并发症包括无低眼压的前房渗漏（3只眼，7.9%）、前房积血（1只眼，2.6%）和视网膜减压性病变（1只眼，2.6%）。新生血管性青光眼是唯一对治疗效果有负面影响的因素（P = 0.003）。对于继发性青光眼病例中AGV植入后形成EB的患者，5-FU房水囊肿针刺似乎是一种安全有效的方法。
