小梁切除术后滤过泡针拨失败危险因素分析

The Risk Factors for Posttrabeculectomy Bleb Needling Failure

摘要: 术后滤过泡功能不良而眼压升高患者165只眼。其中原发性青光眼97眼，眼外伤继发性青光眼16眼，眼后段手术继发性青光眼17眼，青光眼白内障联合手术23眼，二次或多次抗青光眼手术12眼，分离滤过泡时间在手术后2周到3个月，随访3~6个月。结果：其中成功133眼，失败32眼，成功率80.6%，失败率19.4%。失败者中原发性青光眼11只，成功率88.7%，失败率11.3%；眼外伤继发青光眼5只眼，成功率69.9%，失败率31.3%；眼后段手术继发性青光眼7只眼，成功率59.8%，失败率41.2%；青光眼白内障联合手术4只眼，成功率80.6%，失败率17.4%；二次或多次抗青光眼手术5只眼，成功率58.3%，失败率41.7%。结论：滤过泡分离成功率与青光眼类型有关。原发性青光眼滤过泡分离成功率高，继发性或多次抗青光眼滤过泡分离成功率低。

Abstract: Purpose: To analyze the risk factors for failure of posttrabeculectomy bleb needling. Methods: This retrospective observational study included 165 eyes that suffered from posttrabeculectomy filtering bleb needling due to high intraocular pressure from September 2002 to October 2013. In these eyes, primary glaucoma was presented in 97 eyes, traumatic secondary glaucoma was pre-sented in 16 eyes, secondary glaucoma associated with posterior segments operations was pre-sented in 17 eyes, trabeculectomy with cataract surgery was presented in 23 eyes and more than once trabeculectomy was presented in 12 eyes. The bleb needling was performed from 2 weeks to 3 months after trabeculectomy. The follow-up was at 3 - 6 months after the bleb needling operation. Results: In the 165 eyes, 133 eyes (80.6%) achieved success, and 32 eyes (19.4%) failed. In the 97 eyes with primary glaucoma, 11 eyes (11.3%) failed. In the 16 eyes with traumatic secondary glaucoma, 5 eyes (31.3%) failed. In the 17 eyes with secondary glaucoma associated with posterior segments operations, 7 eyes (41.2%) failed. In the 23 eyes with trabeculectomy with cataract surgery, 4 eyes (17.4%) failed. In the 12 eyes with more than once trabeculectomy surgery, 5 eyes (41.7%) failed. Conclusions: The success rate of posttrabeculectomy bleb needling is associated with the type of glaucoma. The success rate of bleb needling in patients with primary glaucoma is higher than that in secondary glaucoma eyes or eyes with more than once anti-glau- coma surgery.