滤过泡针刺分离联合5-FU治疗青光眼术后早期滤过泡功能不良  

Needling exclusion combined with 5-FU for the treatment of malfunction filtering bleb in early stage after glaucoma filtration surgery

作　　者：叶婷 范玮[2] Ye Ting;Fan Wei(Chengdu Aier Eye Hospital,Chengdn 610041,China;Department of Ophthalmology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]成都爱尔眼科医院,成都610041 [2]四川大学华西医院眼科,成都610041

出　　处：《中华眼外伤职业眼病杂志》2018年第8期574-576,共3页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的 观察滤过泡针刺分离联合球结膜下5-FU注射治疗青光眼小梁切除术后早期滤过泡功能不良的临床效果.方法 分析36例（41只眼）复合式小梁切除术后3个月滤过功能不良的临床资料.其中33只眼为Ⅳ型包裹性囊状泡,8只眼为Ⅲ型瘢痕泡,保守降眼压无数.以1ml注射针头针刺分离滤过泡周围的纤维瘢痕,联合滤过泡对侧球结膜下注射5-FU 0.2nnl（5 mg）,1次/2 d,共注射5次.其中32只眼针刺1次,5只眼针刺2次有效.另4只眼针刺3次仍无效,遂行小梁切除术.针刺治疗后均联合干扰素α2b和糖皮质激素滴眼液抗瘢痕治疗、指压按摩,观察治疗后眼压、滤过泡形态变化及并发症.结果 治疗后3个月眼压由治疗前的（29.01±3.77） mmHg,降为（17.24±2.76） mmHg（1 mmHg=0.133 kPa）（t=10.817,P=0.001）.治疗后Ⅰ型滤过泡9只眼,Ⅱ型滤过泡28只眼,Ⅲ型滤过泡4只眼.治疗中1只眼出现角膜上皮点状脱落,终止抗瘢痕治疗.结论 青光眼术后早期出现功能不良的滤过泡,采用针刺分离联合结膜下5-FU注射、干扰素α2b滴眼、指压按摩等方法可促进功能性滤过泡的形成.Objective To observe the clinical efficacy of the needling exclusion combined with 5-FU for the treatment of malfunction filtering bleb in early stage after glaucoma trabeculectomy surgery.Methods A total of 41 eyes of 36 cases with malfunction filtering bleb in 3 months after compound trabeculectomy were invalid with conservative treatment.There were Ⅳ type for cystic bleb encapsulation in 33 eyes,Ⅲ type for scar bleb in 8 eyes.The fibrous scar around filtering bleb was needling separation with 1 ml injection needle,all cases were injected with 5-FU 0.2 ml （5 mg） beneath contralateral bulbar conjunctiva every 2 days total 5 times.The needling was effective once in 32 eyes and needling was effective twice in 5 eyes.The needling 3 times treatment still failed in 4 eyes,then trabeculectomy was performed.All cases were treated with interferon α.2b,Glucocorticoid eye drops and pressure massage.The intraocular pressure （IOP）,the form of filtering bled and complications were observed after surgery.Results The IOP 3 months after treatment was decreased from （29.01 ±3.77） mmHg to （17.24 ＋ 2.76） rnmHg （1 mmHg =0.133 kPa） （t =10.817,P =0.001）.There were type Ⅰ filtering blebs in 9 eyes,type Ⅱ in 28 eyes and type Ⅲ in 4 eyes.The corneal epithelium was damaged in 1 eye and the treatment of scar was terminated.Conclusion It is effective to promote the formation of functional filtration blebs for earlier malfunctional filtering blebs after glaucoma trabeculectomy with needling exclusion combined with injection of 5-FU,INFα2b,Glucocorticoid eye drops and pressure massage.

关 键 词：滤过泡 小梁切除术 青光眼 针刺分离 抗瘢痕 

分 类 号：R779.6[医药卫生—眼科]