针拨联合5-氟尿嘧啶结膜下注射治疗功能不良滤过泡的临床观察

目的观察针拨联合5-氟尿嘧啶(5-FU)注射对青光眼小梁切除术后早中期功能不良滤过泡的处理效果和影响因素.方法对34例(40只眼)青光眼患者术后2～8周内滤过功能不良滤过泡行针拨联合5-FU 结膜下注射,其中14只眼经过重复针拨联合5-FU注射,针拨后随访3个月.结果 40只眼术后退败滤过泡和早期失败滤过泡类型低平限局肥厚充血型23只眼、包囊型13只眼、袋状下垂充血型4只眼.针拨后滤过泡外观形态轻度膨隆弥散型26只眼、多腔或薄壁型9只眼、限局肥厚型或无滤过泡5只眼.针拨前患者的眼压为 (23.6±2.1) mm Hg(1 mm Hg＝0.133 kPa),针拨后即刻为(13.7±5.4) mm Hg,随访结束时,具有功能滤过泡眼的眼压为(16.3±2.9) mm Hg;与针拨前比较两者差异有统计学意义(P<0.01).失败滤过泡眼经多次用药,眼压控制在(19.6±2.6) mm Hg.针拨后滤过泡3个月的生存率为(87.51±5.23)%(生存率±标准误).Logistic回归分析显示,青光眼类型、内眼手术史及患者年龄对针拨效果无影响,手术后间隔时间较长者针拨效果较差(P=0.046),但中效水平时间t=5.9(周).针拨术中结膜下出血6只眼,术后未见任何并发症.结论针拨联合5-FU注射对小梁切除术后退败滤过泡和早期失败滤过泡是一有效、安全及简便的处理方法,具有危险因素的滤过泡多需重复针拨和5-FU注射,手术后间隔时间长者效果差,6周时成功的可能性接近50%.

Clinical observation of needle revision and 5-fluorouracil subconjunctival injection on the dysfunctional filtering blebs

OBJECTIVE: To investigate the efficacy of needle revision with 5-fluorouracil (5-FU) on the dysfunctional filtration blebs after trabeculectomies and to assess the factors that may impact the success. METHODS: Fourty eyes of 34 patients underwent the needle revision of the malfunctional blebs with 5-FU at clinic visits in 2 - 8 weeks immediately after trabeculectomies and were followed up for 12 weeks. RESULTS: After revision through needling procedures, the blebs were diffused and elevated in 26 eyes, thinned and multicysted in 9 eyes, thickened and focalized or invisible in profile in 5 eyes. Intraocular pressures (IOPs) were significantly (P < 0.01) lowered from (23.6 +/- 2.1) mm Hg (1 mm Hg = 0.133 kPa) of pre-needling to (16.3 +/- 2.9) mm Hg of post-needling in 35 functional filtering blebs. The Kaplan-Meier survival curve for the 40 eyes showed a success rate of (87.51 +/- 5.23)% within the follow-up time. Logistic regression did not show significant difference in needle revision among the types of glaucoma, the history of intraocular surgery, and the ages of patients. However, poorer responses were observed following greater intervals of needling operation from previous trabeculectomy (P = 0.046). The time interval for the median efficacy level is 5.9 weeks. Subconjunctival hemorrhage occurred in 6 eyes during the needle revision, and no other post-needling complications were found during the follow-up time. CONCLUSIONS: The needle revision combined with 5-FU is an effective, safe, and simple method of improving early dysfunctional filtration blebs after trabeculectomies. The success rate of needle revision was about 50% at 6 weeks and the delay of needle revision may result in poor responses.