针拨联合丝裂霉素C结膜下注射治疗抗青光眼术后失败滤过泡

目的:观察利用针拨联合丝裂霉素C结膜下注射治疗抗青光眼术后失败滤过泡的效果。方法:对抗青光眼小梁手术后3~22wk失败滤过泡34例(35眼)用针拨联合丝裂霉素C滤过泡旁注射,并随访6mo以上,观察滤过泡重新形成和眼压下降情况。结果:成功29例(29眼),手术前平均眼压为23.74±6.2mmHg,手术后眼压平均为13±4.3mmHg。其中3例(3眼)重复针拨、注射。随访期结束后统计针拨前后眼压具有显著性差异,Kaplan-Meier生存分析2a滤过泡成功率82.9%±6.4%。针拨术中有4眼前房出血,2眼低眼压,未见丝裂霉素的其它毒性反应。结论:针拨联合丝裂霉素C结膜下注射可以重新建立功能性滤过泡,有效地控制眼压,减少青光眼患者再次手术的痛苦。它是挽救抗青光眼术后失败滤过泡的一种良好的方法,具有毒性小、安全可重复的特点。     

针刺分离联合结膜下注射5-FU治疗青光眼术后早期滤过泡功能不良

目的:探讨对于青光眼术后早期功能不良的滤过泡采用针刺分离联合结膜下注射5-FU的治疗效果。方法:青光眼滤过术后3mo内25眼功能不良的滤过泡采用针刺分离滤过泡周围纤维瘢痕,然后结膜下注射5-FU5～10mg,隔日1次共5次,分析治疗后眼压和滤过泡形态的变化及治疗后的眼部并发症。结果:25眼中,21眼眼压控制在21mmHg以下,其中18眼在15mmHg以下;滤过泡形态:有19眼表现为功能性滤过泡;并发症:常见并发症有角膜上皮损伤、结膜下出血、滤过泡损伤等。结论:对于青光眼术后早期功能不良的滤过泡采用针刺分离联合结膜下注射5-FU是安全、有效的。     

青光眼滤过术后异常滤过泡的治疗

目的 探讨青光眼滤过术后异常滤过泡的特点及处理方法。方法 观察62例具有异常滤过泡的滤泡形态及眼压情况，分别给予指压按摩、针刺断线、针刺分离、手术修复及药物治疗等治疗措施。结果 59例异常滤过泡经治疗后转化为功能性滤过泡，眼压得到有效控制。结论 术后细致观察青光眼滤过泡的形态，对异常滤过泡及时正确处理，可使部分非功能性滤过泡转化为功能性滤过泡，提高了青光眼的手术成功率。     

针刺分离联合结膜下注射5-Fu治疗早期功能不良滤过泡临床观察

目的 观察针刺分离联合结膜下注射5-Fu的方法,对青光眼术后早期功能不良的滤泡的治疗效果.方法 对青光跟滤过术后3月内21例25只眼功能不良的滤泡,采用针刺分离滤泡周围纤维瘢痕,然后结膜下注射5-Fu,隔日1次共5次,其中15只眼1次针刺分离,4只眼2次针刺分离,2只眼3次针刺分离;观察治疗后眼压和滤过泡形态的变化及治疗后的眼部并发症.结果 25只眼中,不加用任何抗青光眼药物,有21只眼眼压控制在21 mmHg以下.其中18只眼在15mmHg以下.滤泡形态:有19只眼表现为功能性过泡.结论 青光眼术后早期功能不良的滤泡采用针刺分离联合结膜下注射5-Fu是安全、简便、有效方法.     

反复针刺分离联合结膜下注射5-FU治疗青光眼术后滤过泡功能不良

目的:评估以反复针刺分离联合结膜下注射5-FU的方法处理青光眼术后功能不良滤过泡的效果。方法:回顾性分析2009-03/2013-02在我院以反复针刺分离联合结膜下注射5-FU的方法处理因青光眼术后滤过泡功能不良而眼压升高的连续病例34例34眼。分析治疗后眼压、滤过泡形态的变化及眼部并发症。结果:治疗后平均眼压从35.51mmHg降至14.43mmHg(P<0.05),成功率达91%。常见并发症包括角膜上皮损伤、结膜撕裂和脉络膜脱离等。结论:反复针刺分离联合结膜下注射5-FU的方法处理青光眼术后滤过泡功能不良安全有效。     

针刺分离术联合5—FU球结膜下注射治疗包裹性囊状滤过泡

为了探讨包裹性囊状滤过泡的治疗方法，应用针刺分离术联合滤过泡旁球结膜下注射５—氟尿嘧啶治疗小梁切除术后早期发生的包裹性囊状滤过泡２３例２４只眼，５—氟尿嘧啶的治疗量为５ｍｇ／次，总量为１５ｍｇ。治疗前眼压为３．９６±０．５ｋＰａ，治疗后眼压为２．５２±０．７３ｋＰａ，治疗前后眼压差异有显著性。治疗后有１８只眼形成功能性滤过泡，治疗的完全成功率为７５％，条件成功率为８７．５％。结果表明针刺分离术联合５—氟尿嘧啶滤过泡旁球结膜下注射治疗包裹性囊状滤过泡可获得良好的治疗效果，强调对包裹性囊状滤过泡应早期发现并治疗，以避免滤过性手术失败。     

滤过泡切除联合自体游离结膜移植治疗青光眼滤过术后滤过泡渗漏与低眼压

青光眼滤过术后滤过泡渗漏与低眼压的理想治疗方法是既可消除滤过泡渗漏与低眼压又能够维持滤过泡功能。印度医师回顾1997—2006年采用滤过泡切除联合自体游离结膜移植治疗青光眼滤过术后滤过泡渗漏与低眼压患者58眼（57例）。其中51眼存在滤过泡渗漏,7眼仅低眼压而无滤过泡渗漏。既往曾戴压迫式接触镜1眼,自血注射15眼,     

针刺分离结膜下注射干扰素治疗失败的滤过泡

目的观察青光眼滤过性手术后早期失败的滤过泡进行针刺分离和应用干扰素-α2b(INF-α2b)的疗效。方法将50例(50眼)早期失败的滤过泡(术后3月内)的病例随机分为INF组和对照组,各25眼。INF组应用干扰素-α2b行滤过泡针刺分离和结膜下注射,对照组采用单纯滤过泡按摩。随访6~12月。结果治疗前INF组与对照组平均眼压之间差异无统计学意义(P>0.05).INF组治疗前平均眼压为(31.00±5.57)mmHg,治疗后为(9.3±1.13)mmHg,治疗前、后眼压差异有统计学意义(P<0.01)。治疗1月后,INF组平均眼压为(12.30±3.56)mmHg,功能性滤过泡形成率为80%,条件成功率为88%;而对照组此3参数依次为(17.37±5.79)mmHg、48%和56%,两组相应参数之间的差异均具有统计学意义(P<0.05)。6月后INF组上述3参数为(14.15±4.6)mmHg、76%和84%;对照组为(23.35±6.05)mmHg、40%和52%,两组相应参数之间的差异均具有统计学意义(P<0.05)。结论应用干扰素-α2b对早期失败的滤过泡行针刺分离和结膜下注射治疗,可挽救一部分濒临失败的病例。     

青光眼滤过术后滤过泡失效的处理

滤过性手术是治疗青光眼的主要方法，术后球结膜下形成有功能的滤过泡是治疗成功的关键。但有些患眼并没有成功能的滤过泡，或虽形成有功能的滤过泡但在术后一段时期又发生滤过泡失效，同时滤过泡本身发生病变又会带来许多并发症。这是临床工作经常遇到，又必须处理的问题，因此，本就失败滤过泡和滤过泡相关并发症的处理作了综述。     

激光治疗青光眼滤过手术后失败的滤过泡

成功的青光眼滤过手术要求术后有完整的结膜和一条房水外流的通道来维持隆起的结膜滤过泡。早期失败或趋于失败的滤过泡可通过激光松解缝线治疗，同时激光松解缝线也是调节术后早期眼压和建立有滤过功能的滤过泡的一种有价值的辅助手段。滤过泡失败可分为眼内、巩膜和眼外...     

针刺分离联合结膜下注射5-氟尿嘧啶治疗小梁切除术后功能不良滤过泡

目的：：探究针刺分离联合结膜下注射5-氟尿嘧啶治疗小梁切除术后功能不良滤过泡的临床效果。方法：选取行小梁切除术后1~4 wk来院复诊的青光眼患者26例30眼,对功能不良的滤过泡进行针刺分离联合膜下注射5-氟尿嘧啶进行治疗。观察滤过泡形态、眼压和并发症,随访3 mo。结果：针刺分离后滤过泡形态有24眼表现为功能性滤过泡。针刺分离前患者眼压为26.4±2.8mmHg,分离后眼压为14.1±1.1mmHg,两者差异有统计学意义(P<0.05)。治疗后治愈率70%(21眼),有效率17%(5眼),总有效率87%。常见并发症包括结膜下出血、角膜上皮点状剥脱和前房积血。结论：针刺分离联合结膜下注射5-氟尿嘧啶对小梁切除术后功能不良滤过泡有着良好效果,值得在临床治疗中推广应用。     

Late needle revision of failed filtering bleb with adjunctive Mitomycin C

A 61-year-old man presented to our hospital with right eye pain and headache off and on for 1 month. He had twice trabeculectomy in the right eye 25 years ago without using antiglaucoma agents. Snellen visual acuity (VA) was 20/400 and intraocular pressure (IOP) was 52 mm Hg in his right eye. The slit-lamp examination of his right eye revealed corneal microcystic edema and two blebs were noted. The nasal upper bleb had thinner wall with obvious focal underlying uvea dark color and temporal upper bleb had relative thicker wall. Both blebs showed low lying and high vascularity. No pupillary block was present. Considering the risks of repeat trabeculectomy and drainage implant, needle revision was done on the temporal upper bleb.A mixture of lidocaine and mitomycin C (MMC) was prepared for a final MMC concentration of 0.07 mg/ml. After 15 minutes of subconjunctival injection of lidocaine-MMC mixture, the needle revision was done to disrupt any episcleral and scleral fibrosis. Restoration of aqueous drainage was considered to be the end point when the bleb height was restored. The right eye VA was 20/100 on postoperatively Day 1 and IOP was 8 mm Hg. The only minor complication was subconjunctival hemorrhage. The IOP was around 10-15 mm Hg without antiglaucoma agent during a 6-month follow-up. The temporal upper bleb remained moderate height without hypervascularity or cystic change and no corneal edema was noted.Bleb needling with adjunctive MMC is simple and safe. It should be considered in the management of failing or failed filtration blebs.     

Needling revision of failed filtering blebs after trabeculectomy: a retrospective study

PURPOSE: To determine the efficacy and safety of needling revision of failed filtering blebs. METHODS: We reviewed retrospectively 26 eyes that had undergone needling revision for a failed trabeculectomy. The needling revisions were performed either with adjunctive use of Mitomycin C, 5-Fluorouracil or without antimetabolites. The procedure was usually performed as a clinic procedure, using a 27-gauge needle. RESULTS: The mean follow-up time was 14.5 +/- 11.3 months (range 6.0-48.0 months). Intraocular pressure (IOP) decreased from 28.8 +/- 6.8 mmHg (range 19.0-40.0 mmHg) to 15.3 +/- 5.2 mmHg (range 7.0-35.0 mmHg). Twelve eyes (46.2%) achieved success, defined as IOP < or = 18 mmHg without medication; 11 eyes (42.3%) achieved qualified success, defined as IOP < or = 18 mmHg with antiglaucomatous medication, and three of 26 eyes (11.5%) were classified as failures. The success rate after the initial needling was 64% at 6 months and the same after 1 year and 2 years. The success rate after one or more needlings was 96% at 6 months and 77% at 1 year and 2 years. Complications developed in six of the 26 eyes (23.1%). These involved transient corneal epithelial defects in three eyes (11.5%), temporary conjunctival wound leak in two eyes (7.7%), and development of bullous keratopathy in one high risk eye (3.8%). CONCLUSION: Our results are comparable to the results of other studies. Needling revision appears to be a useful tool in the management of glaucoma.     

Long-term results of amniotic membrane transplantation-assisted bleb revision for leaking blebs

Background To report long-term results of amniotic membrane transplantation (AMT)-assisted bleb revision for intractable late-onset bleb leak. Methods Retrospective medical record review of six consecutive patients who underwent AMT-assisted bleb revision for late-onset bleb leak at the Kobe University hospital between December 2001 and March 2004. Results The median (range) of age was 60 (20–77) years. All patients had a history of trabeculectomy with adjunctive use of 0.4 mg/ml mitomycin C. The median (range) of interval between the prior trabeculectomy and bleb leak was 15 (4–54) months. Preoperative intraocular pressure (IOP) was lower than 10 mmHg in two cases, while it was 25 mmHg or higher in three patients, who had a localized, ischemic, thin-wall leaking bleb circumscribed with extensively scarred tissue. The median (range) of follow-up after the AMT-assisted bleb revision was 49 (41–67) months. Postoperative IOP was well controlled in all patients without medication or with a maximum of three glaucoma medications. No patients presented recurrence of the bleb leak or AMT-related complications during entire follow-up. All patients showed at final visit a diffuse bleb which extended posteriorly beyond the conjunctival incision line. Conclusion AMT-assisted bleb revision successfully treated intractable late-onset bleb leak. Further comparative studies are needed to confirm the present result. Financial support: This study was supported in part by Grant-in-Aid No. 16390499 (AN, MN) and No. 17591835 (MN) from the Ministry of Education, Culture, Sports, Science and Technology of the Japanese Government and by Suda Memorial Foundation for Glaucoma Research (MN). MN is a recipient of the 12th ROHTO award for Ophthalmic Research.     

Bleb revision with bleborhexis and clear corneal lamellar patch graft for overhanging cystic bleb

Background:Trabeculectomy is associated with several complications. One of the common complications with mitomycin assisted trabeculectomy is thin cystic bleb leading to bleb leak, hypotony and infections. Various technique of bleb repair and reconstruction have been described, such as conjunctival advancement, or scleral, pericardial or corneal patch graft.Purpose:To demonstrate bleb revision by bleborhexis and clear corneal lamellar patch graft for a patient with thin cystic leaking bleb leading to hypotony and decreased vision.Synopsis:This was a 75-year-old one-eyed lady, diagnosed with primary angle-closure glaucoma in both eyes with absent light perception in the left eye, had undergone a combined trabeculectomy and cataract surgery in the right eye 6 years ago. She presented with diminution of vision (6/18p), introacular pressure (IOP) of of 6 mmHg, thin cystic leaking overhanging bleb, and dysesthesia. Bleb repair by bleborhexis with lamellar corneal patch graft was performed. Bleborhexis is a technique in which the overhanging fibrosed thin cystic conjunctival bleb is peeled off the cornea smoothly to leave a uniform clear corneal surface. Clear cornea, uniform diffuse bleb, well-formed anterior chamber with and IOP of 15 mmHg was noted on the first post-operative day, with a vision of 6/12p. This procedure helped meticulous reconstruction of the bleb, early recovery of vision, maintanance of normotensive eye, and save the eye from potential infections.Highlights:Bleborhexis with lamellar corneal patch graft provides for an easy and a elegant surgical technique with minimal corneal tissue damage, faster healing and patient comfort. It could be the favored technique in patients with thin overhanging clebs.Video link: https://youtu.be/GeFYHWToueU     

Revision of dysfunctional filtering bleb by conjunctival advancement with bleb preservation: A simple choice for massive choroidals with hypotony following trabeculectomy

A 65-year-old diabetic and hypertensive male presented with a sudden diminution of vision after sustaining a trivial fingernail injury to his only good-seeing (right) eye. The patient underwent phacotrabeculectomy with posterior chamber intraocular lens (PCIOL) implantation 22 years previously. In his right eye visual acuity at presentation was counting fingers at 1.5 m with an accurate projection of light. Intraocular pressure (IOP) was 4 mmHg. The anterior chamber was uniformly shallow with a peripheral iridocorneal touch. Angle details could not be visualized. The bleb was avascular, thin and cystic with a positive forced Seidel test. Fundus examination showed 360° choroidal detachments. B-scan ultrasound revealed massive choroidals. Revision of dysfunctional filtering bleb by conjunctival advancement with bleb preservation and anterior chamber reformation with healon was performed. Postoperatively, the first day visual acuity improved to 6/36, the anterior chamber was deep, bleb was well covered with conjunctiva, the IOP was 10 mmHg and fundus examination revealed resolving choroidals. At the final follow up at 4 months, the patient did not require medication and visual acuity was 6/12, the bleb was functioning well with an IOP of 14 mmHg. Examination of the fundus revealed a cup-to-disc ratio of 0.5 with moderate non-proliferative diabetic retinopathy changes. The patient has been advised to maintain a strict glycemic control and return for routine follow up after 3 months.     

Needle revision of failing and failed trabeculectomy blebs with adjunctive 5-fluorouracil: survival analysis

PURPOSE: To report the outcome of 5-fluorouracil (5-FU)-augmented bleb needling revision of failed and failing filtration blebs and to identify risk factors for failure, indicators for success, and any complications of the procedure. DESIGN: Prospective, observational, noncomparative, interventional case series with survival analysis. METHODS: The results of 101 bleb needling procedures augmented with subconjunctival 5-FU injection were determined after a minimum follow-up of 9 months. Kaplan-Meier plots were constructed and a Cox proportional hazards regression analysis was performed to assess the association between study factors and time to failure. MAIN OUTCOME MEASURES: Reduction in intraocular pressure (IOP) by 2 criteria (<22 mmHg, >30%), glaucoma medications, complications, and factors associated with outcome. RESULTS: At the time of their last follow-up visit, 60 eyes had an IOP <22 mmHg, mean IOP being reduced from 26.5 mmHg to 15 mmHg [corrected] after a median of 1 needling procedure (mean, 1.6). The median interval between the "index" filtration surgery and the first (or only) needling procedure was 3.1 months, with a range of 10 days to 11 years. There was a reduction in mean number of topical antiglaucoma agents from 0.7 to 0.2 per successful eye and a median follow-up duration of 18.7 months (range, 9.3-52.8 months [corrected]). Thus, the overall cross-sectional success rate of the procedure at the time of the last visit was 59.4%. Strong evidence was found for an association between the immediate attainment of a low IOP (<11 mmHg) and longer survival times. None of the other proposed factors that may have affected outcome were identified as having a statistically significant effect; however, this may have been the result of the low statistical power for some of the factors in this study. CONCLUSIONS: These data suggest that bleb needling augmented with 5-FU is a safe and effective method by which a significant number of failed or failing filtration blebs can be rescued from failure. Attaining an immediate reduction in IOP to <11 mmHg seems to be a favorable factor with respect to reasonably long-term efficacy .     

丝裂霉素C联合针刺分离治疗无功能滤过泡的疗效

目的 对青光眼滤过术后功能不良滤过泡行丝裂霉素C(mitomycin C,MMC)球结膜下注射联合针刺分离术,观察其疗效.方法 对25例(27眼)青光眼术后滤过功能不良患者行MMC球结膜下注射联合针刺分离术,观察眼压、滤过泡及不良反应.结果 术后随访6～48个月,平均(23.0±9.7)个月.术后3个月眼压均有下降(P<0.01),其中16眼达到成功标准,成功率59.3%,7眼为部分成功,占25.9%,4眼失败,占14.8%.结论 球结膜下注射MMC联合针刺分离术对青光眼小梁切除术后功能不良滤过泡是一种安全、有效及相对简便的处理方法 .(中国眼耳鼻喉科杂志,2009,9:150-152)