Ex-PRESS青光眼引流器植入术后无功能滤过泡的处理

目的：探讨针刺分离联合结膜下注射5-氟尿嘧啶(5-FU)对Ex-PRESS青光眼引流器植入术后的早期功能不良滤过泡的效果和安全性。

方法：回顾性分析在我院行针刺分离联合结膜下注射5-FU治疗Ex-PRESS青光眼引流器植入术后3mo内因滤过泡功能不良而眼压升高患者18例23眼的病例资料，所有患者均随访至治疗后6mo，统计分析治疗前后眼压和滤过泡形态的变化及治疗的相关并发症。

结果：治疗前眼压平均为(24.13±2.94)mmHg(1mmHg=0.133kPa)，治疗后即刻、1、3、6mo的眼压分别为15.13±4.93、14.98±5.12、15.18±3.77、15.54±5.07mmHg，治疗后各时间点眼压与治疗前比较，差异均有统计学意义(P<0.05)。随访至治疗后6mo功能滤过泡形成率和治疗的总成功率均为83%。4眼(18%)治疗失败。治疗后常见并发症主要是滤泡结膜下出血、角膜上皮损伤，无严重并发症发生。

结论：采用针刺分离并结膜下注射5-FU治疗Ex-PRESS青光眼引流器植入术后早期功能不良滤过泡的患者是一种方便、安全、有效的方法。

The treatment of early postoperative non-functioning blebs after Ex-PRESS glaucoma drainage device implantation

AIM:To investigate the efficacy and safety of needle revision combined with subconjunctival injection of 5-Fluorouracil(5-FU)for the treatment of early non-functioning blebs after Ex-PRESS glaucoma drainage device implantation.

METHODS:The medical records of 18 cases(23 eyes)with non-functional blebs within postoperative 3mo treated with needle revision combined with subconjunctival injection of 5-FU after Ex-PRESS glaucoma drainage device implantation in our hospital were retrospectively analyzed. All cases were followed up for at least 6mo.The IOP, the changes of filtering blebs morphology before and after treatments and complications were analyzed.

RESULTS:The IOP before and immediately, 1, 3, 6mo after treatments were 24.13±2.94, 15.13±4.93, 14.98±5.12, 15.18±3.77 and 15.54±5.07mmHg(1mmHg=0.133kPa)respectively. The IOP at every time point after treatments was significantly decreased compared with that before treatments(all P<0.05). The formation rate of functional filter bleb and the total success rate were both 83% at 6mo after treatments. The treatment was failed in 4 eyes(18%). The most common complications were filter bleb subconjunctival hemorrhage and corneal epthelium damage. There were no other severe complications during the follow-up period.

CONCLUSION:It is safe, convenient and effective to treat early non-functional blebs after Ex-PRESS glaucoma drainage device implantation by needle revision combined with subconjunctival injection of 5-FU around the filtering bleb.