关键词:  , 青光眼/外科学；针刺分离术

Abstract:

Objective To investigate the efficacy of the first needling revision combined with scleral channel reconstruction for late-failed filtering bleb after glaucoma filtration surgery. Design Retrospective cases series. Participants 25 eyes of 24 patients were underwent bleb needling combined with sclera channel reconstruction from March 2014 to October 2016 in the Eye Hospital of Wenzhou Medical University  Methods For late failed filtering bleb, subconjunctival scarring was separated by the needle, then the needle was advanced under the sclera flap to separate, then puncture into the anterior chamber, or puncture into the anterior chamber directly through whole sclera if the edge of sclera flap was invisible, to ensure that the anterior chamber communicates with the filtering bleb. Conjunctive injection of 5-Fu was given after the operation and the patients were followed-up to observe the intraocular pressure (IOP). Success was defined as postneedling IOP≤21 mmHg with or without any antiglaucoma medications. Main Outcome Measures  IOP, complications and numbers of anti-glaucoma medications. Results The average interval between index filtering operation and bled revision was 53.5±67.7 months. Mean IOP was 28.4±9.8 mmHg before surgery and 24.6±11.9 mmHg at last postoperative follow-up. Mean follow-up was 7.6±7.8 months. The mean number of anti-glaucoma medications was reduced from 2.7±1.1 preoperatively to 0.8±0.9 at 6 months postoperatively. The success rate was 44% at 6 months. Conclusions Needling revision with sclera channel reconstruction is a safe and easy procedure, having an acceptable success rate of surgery for the treatment of late-failed bleb. This procedure can be recommended before second filtering surgery for failing bleb. (Ophthalmol CHN, 2019, 28: 39-42)

Key words: glaucoma/surgery, needling revision