临床与手术室行纤维包裹性滤过泡针刺对比：一项回顾性病例系列研究。

Comparative outcome analysis of bleb needling of fibrotic blebs in the clinic versus the operating room: a retrospective case series.

机构信息

University of Missouri School of Medicine, Columbia, MO, USA.

Department of Ophthalmology, Mason Eye Institute, University of Missouri Health Care, 1 Hospital Drive, Columbia, MO, 65201, USA.

出版信息

BMC Ophthalmol. 2021 Mar 4;21(1):115. doi: 10.1186/s12886-021-01870-1.

DOI:10.1186/s12886-021-01870-1

PMID:33663403

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7934488/

Abstract

BACKGROUND

To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb.

METHODS

A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling.

RESULTS

At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32).

CONCLUSION

Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

摘要

背景

比较在诊所与手术室（OR）对失败滤过泡行针拨术治疗的成年青光眼患者的 6 个月结果。

方法

对 41 例青光眼患者的 47 只眼进行回顾性病例系列研究，这些患者均因先前滤过泡成形术中形成的滤过泡瘢痕而接受了 MMC 针拨术，其中 32 只眼在诊所、15 只眼在 OR 进行。这些患者先前的滤过泡成形术包括小梁切除术（14 只眼）、ExPress 分流器（16 只眼）和内路 XEN 凝胶支架（17 只眼）。主要结局是针拨术成功，定义为在 6 个月内无需进一步降低眼压的情况下，眼压≤18mmHg，无需使用 0 种降眼压药物。

结果

6 个月时，在诊所与 OR 行针拨术的成功率相似（28% vs. 20%，P=0.54）。在有既往小梁切除术、ExPress 分流器和 XEN 凝胶支架的患者中，成功率无统计学差异（29% vs. 38% vs. 12%，P=0.26）。比较 6 个月时诊所与 OR 行针拨术的情况，两组平均眼压（14.2mmHg vs. 14.9mmHg，P=0.73）、平均降眼压药物（1.4 种 vs. 1.7 种，P=0.69）、进一步降低眼压的手术率（16% vs. 27%，P=0.37）或并发症发生率（0% vs. 7%，P=0.32）均无差异。