科研之友
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摘要
Purpose: To study the effect of topical application of mitomycin C on enhancing the efficacy of needling in the management of bleb failure.
Patients and Methods: Thirty-six eyes of 32 consecutive patients with an intraocular pressure over 21 mm Hg, without bleb or with a thick, flat bleb after the second postoperative month after trabeculectomy, were included in the study. Needling with mitomycin C was performed in the other 18 eyes with bleb failure (group A) and needling without antimetabolite was performed in 18 eyes (group B). Topical application of mitomycin C (0.4 mg/mL) with a microsponge over the conjunctiva at the failed bleb for 5 minutes (group A) was performed; after irrigation, the needling procedure was the same in both groups. A 30-gauge needle was used to perforate the area of subconjunctival and subscleral fibrosis and to reestablish flow; conjunctival puncture was at least 7 mm away from the bleb and no sutures were taken after needling. Follow-up was performed for 1 year after needling.
Results: Overall, 55 needling procedures were performed; needling was done twice in 17 eyes in group B, whereas only 2 eyes needed more than 1 needling procedure in group A. The difference was statistically highly significant, and the mean follow-up was 8.9 +/- 3.7 months. Mean intraocular pressure was 28.9 +/- 4.2 mm Hg and 27.8 +/- 4.7 mm Hg in group A and group B respectively before any intervention; this decreased to a mean of 19.8 +/- 2.7 mm Hg and 20.5 +/- 4.8 mm Hg respectively without medication after 6 months of last needling. Complications included diffuse corneal punctate epitheliopathy lasting for 2 to 3 weeks (2 eyes in group A), subconjunctival hemorrhage (3 eyes in each group), and hyphema (2 eyes in each group).
Conclusions: Topical application of mitomycin C with needle revision seems to be an extremely effective way to revive failed filtration surgery. The incidence of complications related to mitomycin C was minimal.
- 出版日期2011-11
