Holmes David P, Manning David K
Department of Ophthalmology, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.
Department of Ophthalmology, Hunter Cataract and Eye Centre, Charlestown, Australia.
J Curr Glaucoma Pract. 2020 Jan-Apr;14(1):37-42. doi: 10.5005/jp-journals-10078-1270.
This pilot study evaluates the safety and efficacy of a novel surgical technique using fibrin glue to treat bleb dysesthesia post-trabeculectomy due to intrapalpebral extension.
Trabeculectomy remains the gold standard for control of intraocular pressure (IOP) in refractory glaucoma. Bleb dysesthesia following antifibrotic-enhanced trabeculectomy is common, resulting in a significant decrease in quality of life. Symptoms include pain, foreign body sensation, and excessive tearing. Treatments include lubrication, topical nonsteroidal anti-inflammatory drugs (NSAIDs), bandage contact lens, bleb needling, compression sutures, Nd:YAG laser treatments, autologous blood injection, and cryopexy. These procedures can be time-consuming, risk bleb function, and may be ineffective at symptom control; thus, a novel technique is required.
This is a retrospective case series of eyes undergoing bleb dissection with scleral cutdown and conjunctival closure with ARTISS fibrin tissue glue. Reported cases have been followed up for 6 months. Outcomes assessed include complications, IOP, medication usage, subjective pain score, visual field, and cup-to-disk (C:D) ratio.
This small pilot series demonstrated that patients suffering from bleb dysesthesia due to intrapalpebral bleb extension can be successfully treated with a novel surgical approach combining conjunctival dissection to sclera with fibrin tissue glue closure. There was no significant effect on bleb function and no contribution to glaucoma progression over a 6-month period. A significant reduction in patient discomfort with no new surgical complications was noted.
This demonstrates a safe and effective novel surgical approach to treat patients with this condition. The technique is easily learnt and can be employed in an outpatient setting. The technique is readily accepted by patients in group who are often reticent to undergo further intervention. Most importantly, it does not compromise bleb function or destabilize glaucoma control.
Holmes DP, Manning DK. Intrapalpebral Extending Dysesthetic Bleb Revision with Fibrin Glue. J Curr Glaucoma Pract 2020;14(1):37-42.
本前瞻性研究评估一种使用纤维蛋白胶治疗因睑内延伸导致小梁切除术后滤过泡感觉异常的新型手术技术的安全性和有效性。
小梁切除术仍然是难治性青光眼眼压（IOP）控制的金标准。抗纤维化增强小梁切除术后滤过泡感觉异常很常见，导致生活质量显著下降。症状包括疼痛、异物感和流泪过多。治疗方法包括润滑、局部非甾体抗炎药（NSAIDs）、绷带式隐形眼镜、滤过泡针刺、压迫缝线、Nd:YAG激光治疗、自体血注射和冷冻疗法。这些操作可能耗时、有滤过泡功能风险，且可能在症状控制方面无效；因此，需要一种新技术。
这是一组接受滤过泡分离联合巩膜切开及使用ARTISS纤维蛋白组织胶进行结膜闭合手术的眼睛的回顾性病例系列。报告的病例随访了6个月。评估的结果包括并发症、眼压、药物使用情况、主观疼痛评分、视野和杯盘比（C:D）。
这个小型前瞻性系列研究表明，因睑内滤过泡延伸而患有滤过泡感觉异常的患者可以通过一种将结膜分离至巩膜并使用纤维蛋白组织胶闭合的新型手术方法成功治疗。在6个月期间对滤过泡功能没有显著影响，也没有导致青光眼进展。注意到患者不适显著减轻，且没有新的手术并发症。
这证明了一种治疗这种疾病患者的安全有效的新型手术方法。该技术易于学习，可在门诊环境中应用。该技术很容易被通常不愿接受进一步干预的患者群体所接受。最重要的是，它不会损害滤过泡功能或破坏青光眼的控制。
霍姆斯DP，曼宁DK。用纤维蛋白胶修复睑内延伸的感觉异常性滤过泡。《当代青光眼实践杂志》2020；14(1):37 - 42。
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