Greenfield D S, Miller M P, Suner I J, Palmberg P F
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA.
Am J Ophthalmol. 1996 Aug;122(2):195-204. doi: 10.1016/s0002-9394(14)72010-0.
To report the incidence of failing filtration blebs after trabeculectomy with mitomycin C and to report the outcome of needling procedures for failing filtration blebs in these eyes.
We conducted a retrospective analysis of 537 eyes of 434 patients who had trabeculectomy with mitomycin C and reviewed the clinical course of 441 eyes of 338 patients with a minimum of three months of follow-up.
In 441 eyes of 338 patients followed up for three months or more after trabeculectomy with mitomycin C, 88 (20.0%) eyes from 85 patients underwent needle elevation of the scleral flap. Forty-nine (22.4%) of 219 eyes required needle revision after trabeculectomy alone, and 39 (17.6%) of 222 eyes after trabeculectomy combined with cataract extraction and intraocular lens implantation. Mean intraocular pressure (IOP) after needle revision (17.9 +/- 11.6 mm Hg) was significantly less than the mean preneedling IOP (27.1 +/- 10.4 mm Hg, P < .00001, paired Student's t test). Sixty-three eyes of 60 patients had a minimum of three months of postneedling follow-up. Successful pressure control, defined as an IOP of 22 mm Hg or less with or without topical glaucoma control medications, was achieved in 46 (73.0%) of 63 eyes. Unsuccessful outcomes correlated significantly with higher preneedling IOP (R = 0.28, P = .03, df = 61) and prior surgery involving conjunctival incisions (R = 0.53, P < .00001, df = 61).
Needle elevation of the scleral flap may provide significantly long-lasting pressure reduction in eyes with failing mitomycin C blebs. Higher success rates are achieved in eyes with fewer prior conjunctival incisions, eyes requiring a single needle revision, and eyes with lower preneedling IOP.
报告丝裂霉素C小梁切除术后滤过泡失败的发生率，并报告对这些眼中滤过泡失败进行针刺手术的结果。
我们对434例接受丝裂霉素C小梁切除术的患者的537只眼进行了回顾性分析，并对338例患者的441只眼进行了至少3个月的随访，回顾其临床病程。
在338例接受丝裂霉素C小梁切除术后随访3个月或更长时间的患者的441只眼中，85例患者的88只眼（20.0%）进行了巩膜瓣针刺抬高术。单纯小梁切除术后219只眼中有49只眼（22.4%）需要针刺修复，小梁切除联合白内障摘除及人工晶状体植入术后222只眼中有39只眼（17.6%）需要针刺修复。针刺修复后的平均眼压（IOP）（17.9±11.6 mmHg）显著低于针刺前的平均眼压（27.1±10.4 mmHg，P<0.00001，配对学生t检验）。60例患者的63只眼进行了至少3个月的针刺后随访。成功的眼压控制定义为眼压在22 mmHg或以下，无论是否使用局部青光眼控制药物，63只眼中有46只眼（73.0%）实现了成功的眼压控制。失败的结果与针刺前较高的眼压（R=0.28，P=0.03，自由度=61）和先前涉及结膜切口的手术显著相关（R=0.53，P<0.00001，自由度=61）。
巩膜瓣针刺抬高术可能为丝裂霉素C滤过泡失败的眼提供显著持久的眼压降低。先前结膜切口较少的眼、需要单次针刺修复的眼以及针刺前眼压较低的眼成功率更高。
