Mardelli P G, Lederer C M, Murray P L, Pastor S A, Hassanein K M
University of Missouri-Kansas City School of Medicine, Department of Ophthalmology, Eye Foundation of Kansas City, Missouri 64108, USA.
Ophthalmology. 1996 Nov;103(11):1946-55. doi: 10.1016/s0161-6420(96)30403-x.
The purpose of the study is to determine the efficacy and safety of Mitomycin C (MMC) augmented slit-lamp needle revision of failed filtration surgery.
The authors retrospectively reviewed the charts of 62 patients (62 eyes) (age, 72 +/- 15 years) with failed filtration surgery who underwent needle revision using MMC. A mixture of 0.01 ml of MMC (0.4 mg/ml) and 0.02 ml of bupivacaine with epinephrine was injected subconjunctivally. Twenty to 30 minutes later, a 30-gauge needle was used to perforate the area of subconjunctival fibrosis and re-establish flow.
Overall, 118 needing procedures (mean, 1.9 +/- 1.4 revisions per eye; range, 1-7) were performed on 62 eyes (mean follow-up, 9.9 +/- 3.7 months; range, 4.5-20.1 months). Thirty-six patients (58.1%) were needled once and 26 patients (41.9%) underwent more than 1 needling procedure. Intraocular pressure decreased from 24.1 +/- 6.4 mmHg (range, 18-44) before surgery to 11.5 +/- 4.8 mmHg (range, 1-26) at last follow-up (P = 5.51 x 10(-21)). Antiglaucoma medications decreased from 1.6 +/- 1.0 to 0.3 +/- 0.6 (P = 3.8 x 10(-14)). Successful single-needling procedure was highly correlated with race (white) and past conventional glaucoma filtration surgery of more than 4 years. Complications included serous choroidal detachment (10 eyes), suprachoroidal hemorrhage (1 eye), bleb leak (5 eyes), iris blocking sclerostomy (2 eyes), hyphema (2 eyes), corneal abrasion (2 eyes), and hypotony (1 eye).
Mitomycin needle revision appears to be an extremely effective way to revive failed filtration surgery. The incidence of complications compares favorably to trabeculectomy with MMC.
本研究旨在确定丝裂霉素C（MMC）辅助下裂隙灯针拨术治疗滤过性手术失败的疗效和安全性。
作者回顾性分析了62例（62眼）滤过性手术失败患者（年龄72±15岁）的病历，这些患者接受了使用MMC的针拨术。将0.01 ml的MMC（0.4 mg/ml）与0.02 ml含肾上腺素的布比卡因混合后结膜下注射。20至30分钟后，使用30号针穿刺结膜下纤维化区域并重新建立房水引流。
总体而言，对62眼进行了118次必要操作（平均每眼1.9±1.4次拨术；范围1 - 7次）（平均随访9.9±3.7个月；范围4.5 - 20.1个月）。36例患者（58.1%）接受了1次针拨术，26例患者（41.9%）接受了1次以上针拨术。眼压从手术前的24.1±6.4 mmHg（范围18 - 44）降至最后随访时的11.5±4.8 mmHg（范围1 - 26）（P = 5.51×10⁻²¹）。抗青光眼药物从1.6±1.0种减少至0.3±0.6种（P = 3.8×10⁻¹⁴）。单次针拨术成功与种族（白人）以及既往超过4年的传统青光眼滤过手术高度相关。并发症包括浆液性脉络膜脱离（10眼）、脉络膜上腔出血（1眼）、滤过泡渗漏（5眼）、虹膜阻塞性巩膜造口术（2眼）、前房积血（2眼）、角膜擦伤（2眼）和低眼压（1眼）。
丝裂霉素针拨术似乎是挽救失败滤过性手术的一种极其有效的方法。并发症发生率与丝裂霉素小梁切除术相比更具优势。
