The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Singapore National Eye Centre, Singapore, Republic of Singapore.
Ophthalmol Glaucoma. 2021 May-Jun;4(3):244-250. doi: 10.1016/j.ogla.2020.09.014. Epub 2020 Sep 28.
To investigate long-term outcomes of a modified bleb needling technique performed in the operating room in controlling intraocular pressure (IOP) and to report risk factors for procedure failure.
Retrospective, observational cohort study.
One hundred six eyes of 98 consecutive patients undergoing intraoperative bleb needling with a continuous infusion of balanced salt solution at the Wilmer Eye Institute, Johns Hopkins Hospital, in the setting of a failed trabeculectomy or express shunt, between May 2011 and December 2015.
Postoperative data were collected between May 2011 and August 2019. Success was defined as achieving a previously determined target IOP regardless of (qualified success) or without (complete success) glaucoma medications. Patients who underwent additional glaucoma surgery were censored in the survival analysis.
Primary outcome measures included IOP, attainment of target IOP, and number of glaucoma medications used at different time points pre- and post-operatively.
Needling was performed in 106 eyes at an average of 4.3 years from the time of trabeculectomy (standard deviation [SD], 6.5 years) and an average baseline IOP of 20.7 mmHg (SD, 7.2 mmHg). Further glaucoma surgery was required for 33 eyes. We observed a 70% qualified success rate with a mean IOP lowering of 25% (95% confidence interval [CI], 13.8%-36.4%) at 1 year after surgery and a 52% qualified success rate and 44.3% reduction in IOP (95% CI, 34.9%-53.6%) at 5 years after surgery. Nearly half and a third of the eyes did not require medications after 1 and 5 years, respectively. The average medication reduction was 0.8 at year 1 (95% CI, 0.5-1.1) and 0.4 at year 5 (95% CI, -0.2 to 1.0). Postoperative complications were uncommon. Poorer outcomes were not associated with the age of the bleb but were more likely in Black patients.
Reductions in IOP were maintained in most patients over the long term using a modified bleb needling technique, despite an average time from trabeculectomy of over 4 years. No significant adverse events were observed. Bleb needling may defer or avoid more invasive procedures such as tube-shunts or repeat trabeculectomy.
研究在手术室中采用改良的滤泡针刺技术控制眼内压（IOP）的长期效果，并报告手术失败的风险因素。
回顾性、观察性队列研究。
2011 年 5 月至 2015 年 12 月期间，在约翰霍普金斯医院威尔默眼科研究所，106 只眼睛的 98 例连续患者在失败的小梁切除术或快速引流术后接受术中滤泡针刺，并持续输注平衡盐溶液。
术后数据收集于 2011 年 5 月至 2019 年 8 月。成功定义为无论是否使用（合格成功）或不使用（完全成功）青光眼药物，均达到先前确定的目标 IOP。接受额外青光眼手术的患者在生存分析中被删失。
主要观察指标包括术前和术后不同时间点的 IOP、达到目标 IOP 和使用的青光眼药物数量。
在距小梁切除术平均 4.3 年（标准差[SD]，6.5 年）时对 106 只眼睛进行了针刺，基线时 IOP 平均为 20.7mmHg（SD，7.2mmHg）。需要进一步的青光眼手术治疗的有 33 只眼。我们观察到术后 1 年有 70%的合格成功率，IOP 降低 25%（95%置信区间[CI]，13.8%-36.4%），术后 5 年有 52%的合格成功率和 44.3%的IOP 降低（95%CI，34.9%-53.6%）。大约一半和三分之一的眼睛在术后 1 年和 5 年后分别不需要药物治疗。第 1 年平均药物减少 0.8（95%CI，0.5-1.1），第 5 年平均减少 0.4（95%CI，-0.2 至 1.0）。术后并发症并不常见。较差的结果与滤泡的年龄无关，但在黑人患者中更常见。
尽管距小梁切除术的平均时间超过 4 年，但使用改良的滤泡针刺技术，大多数患者的 IOP 降低在长期内得以维持。未观察到明显的不良事件。滤泡针刺术可能会推迟或避免更具侵袭性的手术，如管分流或重复小梁切除术。
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