针刺分离联合5-氟尿嘧啶注射治疗功能不良滤过泡的临床观察

目的：观察针刺分离联合5-氟尿嘧啶(5-FU)结膜下注射治疗青光眼小梁切除术后不同时期功能不良滤过泡的临床疗效、影响因素及安全性。
　　方法：对76例83眼小梁切除术后功能不良滤过泡进行针刺分离联合5-FU 结膜下注射,针刺分离后随访12mo,对随访时患者的眼压( intraocular pressure,IOP)、用药次数、角膜内皮、滤过泡的形态及并发症进行观察记录。
　　结果：针刺分离前患者的眼压为35.3依5.8mmHg(1kPa =7.5mmHg),随访结束时眼压为17.0依4.3mmHg,两者差异有显著统计学意义(t =24.846,P<0.01)；术前平均用药种类为1.7依0.9种,随访结束时平均用药种类为0.4依0.7种,两者差异有显著统计学意义(t =11.145,P<0.01)。针刺分离12mo 后滤过泡成功率为89.2%,其中完全成功率为69.9%,Kaplan-Meier 生存分析示83眼平均生存时间为11.0mo(95% CI：10.3~11.6)。青光眼的类型、滤过手术是否使用丝裂霉素 C(mitomycin C,MMC)、患者年龄及滤过手术至针刺分离的间隔时间对针刺分离效果无影响,针刺分离前滤过泡形态对针刺分离效果有影响,包囊型滤过泡较扁平型滤过泡针刺分离效果好,滤过手术后3mo 内进行针刺分离的患者比>3mo 的患者平均针刺分离的次数明显减少。
　　结论：针刺分离联合5-FU 结膜下注射是治疗小梁切除术后功能不良滤过泡的一种安全、有效的简单处理方法,小梁切除术后发现功能不良滤过泡应早期处理。

Clinical observation of needle revision and 5-fluorouracil subconjunctive injection for the dysfunctional filtering blebs

AIM:To investigate the efficacy and safety of needle revision with 5-fluorouracil(5-FU)on the dysfunctional filtering blebs after trabeculectomy and to assess the factors that may impact the success.

METHODS:Eighty-three eyes in 76 patients underwent the needle revision and 5-FU subconjunctive injection for the dysfunctional blebs after trabeculectomy and were followed up for 12mo. The intraocular pressure(IOP), the number of drugs, corneal endothclium, bleb morphology and complications were observed and recorded.

RESULTS:IOP decreased significantly from 35.3±5.8mmHg(1kPa=7.5mmHg)of pre-needling to 17.0±4.3mmHg of post-needling(P<0.01); the average numbers of medications decreased significantly from 1.7±0.9 of pre-needing to 0.4±0.7 of post-needing(P<0.01). At 12mo after needling, the success rate of filtering blebs was 89.2% and the complete success rate was 69.9%.The Kaplan-Meier survival analysis estimated mean survival period was 11.0mo(95%CI: 10.3-11.6). Statistically, there were no significant difference on needling effect with reference to the types of glaucoma, the use of mitomycin C(MMC)during the previous filtration surgery, the ages of patients, the intervals of needling operation from previous trabeculectomy, while there were significant difference on needling effect with reference to bleb appearance before needling, and the mean number of needling in patients that had surgery within 3mo were less than those who had surgery for more than 3mo.

CONCLUSION: The needle revision combined with 5-FU is a safe, effective and simple method. Dysfunctional blebs should be treated early after trabeculectomy.