Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
Singapore Eye Research Institute, Singapore, Singapore.
Int Ophthalmol. 2022 Feb;42(2):443-453. doi: 10.1007/s10792-021-02061-z. Epub 2021 Dec 3.
To describe the outcomes of surgical bleb revisions from a tertiary glaucoma service in Singapore.
One hundred and thirty-one eyes of 129 patients who underwent surgical bleb revisions at the Singapore National Eye Centre between 2007 and 2014 were included in the study. The indications for bleb revision were: bleb-related infection (BRI), early and late bleb leak, early and late overfiltration, and bleb dysesthesia. Regression analysis was applied to elucidate risk factors.
The mean age of the patients was 66 years, 62.6% were male, and 88.5% were Chinese. The majority of the eyes had primary glaucoma (79.4%). The mean interval from the initial trabeculectomy or phaco-trabeculectomy to the bleb revision was 58.8 months. The overall success rate was 69.5%. By Kaplan-Meier survival analysis, the overall cumulative success range fell from 78.6% to 49.1% over 10 years. Eyes with early bleb leak had lower surgical success compared to eyes with late bleb leak, early overfiltration and late overfiltration (P = 0.026, log-rank test). The IOP improved significantly post-operatively for eyes with BRI, early bleb leak, late bleb leak, early overfiltration and overfiltration (P < 0.05). Vision improved significantly in eyes with early overfiltration, but deteriorated in eyes with BRI (P < 0.05).
The overall success rate for surgical bleb revisions was good with complete resolution of the primary problem in the majority of cases. However, eyes with early bleb leak were less likely to have successful outcomes and should be monitored more closely post-operatively.
描述新加坡一家三级青光眼服务中心行手术滤过泡修复术的结果。
本研究纳入了 2007 年至 2014 年间在新加坡国家眼科中心行手术滤过泡修复术的 129 例 131 只眼。行滤过泡修复术的指征包括：滤过泡相关性感染（BRI）、早期和晚期滤过泡渗漏、早期和晚期滤过泡过度引流，以及滤过泡感觉异常。回归分析用于阐明危险因素。
患者的平均年龄为 66 岁，62.6%为男性，88.5%为华人。大多数患者患有原发性青光眼（79.4%）。从初次小梁切除术或超声乳化白内障吸除术到滤过泡修复术的平均间隔时间为 58.8 个月。总体成功率为 69.5%。通过 Kaplan-Meier 生存分析，在 10 年内，总体累积成功率从 78.6%降至 49.1%。与晚期滤过泡渗漏、早期过度引流和晚期过度引流相比，早期滤过泡渗漏的眼手术成功率较低（P=0.026，log-rank 检验）。BRI、早期滤过泡渗漏、晚期滤过泡渗漏、早期过度引流和过度引流的眼术后眼压均显著降低（P<0.05）。早期过度引流的眼视力显著提高，但 BRI 的眼视力恶化（P<0.05）。
手术滤过泡修复术的总体成功率较高，大多数情况下可完全解决主要问题。然而，早期滤过泡渗漏的眼术后结果不太可能成功，应更密切地监测。
