The role of needle revision and 5-fluorouracil application over the filtration site in the management of bleb failure after trabeculectomy: a prospective study
The role of needle revision and 5-fluorouracil application over the filtration site in the management of bleb failure after trabeculectomy: a prospective study
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DOI：
10.1023/a:1022550125261
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发表时间：
2003-03
影响因子：
1.4
通讯作者：
I. Durak;Z. Ozbek;A. Yaman;M. Soylev;G. Cıngıl
中科院分区：
文献类型：
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作者：
I. Durak;Z. Ozbek;A. Yaman;M. Soylev;G. Cıngıl
本研究纳入了49例连续患者的53只眼，这些患者的眼内压（IOP）超过21 mmHg;在小梁切除术后第二周后无滤过泡或有厚而扁平的滤过泡。在手指按摩和/或激光缝线松解术失败后，在术后2周至10个月内使用含5 mg（0.2 ml）5-FU的26号结核菌素注射器进行针头翻修。当在针刺过程中观察到水泡形成时，不进行5-FU注射。在没有形成滤过泡的情况下，在巩膜瓣区域结膜下注射5-FU，并重复最多6次，直到维持功能性滤过泡。53只眼中有14只眼（26.4%）的缝针翻修术成功作为初始手术，9只眼（16.9%）保持成功。44只眼睛（83.1%）注射了5-FU，因为针头翻修没有提供滤过泡形成（39只眼睛）或没有保持初始成功（5只眼睛）。在任何干预之前，平均IOP为27.8±4.7 mmHg（范围，22-41），在平均随访25.1个月后降至20.5±4.8 mmHg（范围，8-35），差异具有统计学显著性（p<0.001）。14例患者针翻修后的平均IOP为18.9±4.9 mmHg（范围，8-29），14例患者中有9例保持成功，平均IOP为16.3±3.7 mmHg。最后一次5-FU注射后的平均IOP为21.4±4.6 mmHg（范围：13 - 35 mmHg）。5-FU注射的平均次数为2.4（范围，1 - 6）。在平均25.1个月（范围，1-48个月）的随访期间，3只眼（5.7%）出现持续3-4周的弥漫性角膜点状上皮病变，9只眼（17%）出现结膜下出血。对于小梁切除术后早期和中期滤过泡失败的患者，针头翻修和/或滤过泡区域结膜下注射5-FU是一种安全、相对有效的方法，并发症发生率低。
Fifty-three eyes of 49 consecutive patients with an intraocular pressure (IOP) over 21 mmHg; without bleb or with a thick, flat bleb after the second postoperative week following trabeculectomy were included in the study. Needle revision was performed with a 26-gauge tuberculin syringe containing 5 mg (0.2 ml) 5-FU in a period of 2 weeks to 10 months postoperatively after unsuccessful digital massage and/or laser suture-lysis. 5-FU injection was not performed when a bleb formation was observed during needling. In case of no bleb formation, 5-FU was injected subconjunctivally over the scleral flap area and repeated a maximum of six times until a functioning bleb was maintained. Needle revision was successful in 14 of 53 eyes (26.4%) as an initial procedure and nine (16.9%) eyes maintained success. Forty-four eyes (83.1%) had 5-FU injection since needle revision did not provide bleb formation (39 eyes) or did not maintain initial success (five eyes). Mean IOP was 27.8±4.7 mmHg (range, 22–41) before any intervention and decreased to 20.5±4.8 mmHg (range, 8–35) after a mean follow-up of 25.1 months and the difference was statistically significant (p<0.001). Mean IOP after needle revision in 14 patients was 18.9±4.9 mmHg (range, 8–29) and 16.3±3.7 mmHg in nine out of 14 patients that maintaned success. Mean IOP after the last 5-FU injection was 21.4±4.6 mmHg (range, 13∼35 mmHg). The mean number of 5-FU injections was 2.4 (range, 1 – 6). During a mean follow-up of 25.1 months (range, 1–48 months), three eyes (5.7%) had diffuse corneal punctate epitheliopathy lasting for 3–4 weeks and subconjunctival hemorrhage was seen in nine eyes (17%). Needle revision and/or subconjunctival injection of 5-FU over the bleb area is a safe, relatively efficient approach with a low rate of complications to overcome the early and mid term bleb failure after trabeculectomy.