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目的观察针拨联合5氟尿嘧啶(5FU)注射对青光眼小梁切除术后早中期功能不良滤过泡的处理效果和影响因素。方法对34例(40只眼)青光眼患者术后2～8周内滤过功能不良滤过泡行针拨联合5FU结膜下注射,其中14只眼经过重复针拨联合5FU注射,针拨后随访3个月。结果40只眼术后退败滤过泡和早期失败滤过泡类型:低平限局肥厚充血型23只眼、包囊型13只眼、袋状下垂充血型4只眼。针拨后滤过泡外观形态:轻度膨隆弥散型26只眼、多腔或薄壁型9只眼、限局肥厚型或无滤过泡5只眼。针拨前患者的眼压为(23.6±2.1)mmHg(1mmHg=0.133kPa),针拨后即刻为(13.7±5.4)mmHg,随访结束时,具有功能滤过泡眼的眼压为(16.3±2.9)mmHg;与针拨前比较两者差异有统计学意义(P<0.01)。失败滤过泡眼经多次用药,眼压控制在(19.6±2.6)mmHg。针拨后滤过泡3个月的生存率为(87.51±5.23)%(生存率±标准误)。Logistic回归分析显示,青光眼类型、内眼手术史及患者年龄对针拨效果无影响,手术后间隔时间较长者针拨效果较差(P=0.046),但中效水平时间t=5.9(周)。针拨术中结膜下出血6只眼,术后未见任何并发症。结论针拨联合5FU注射对小梁切除术后退败滤过泡和早期失败滤过泡是一有效、安全及简便的处理方法,具有危险因素的滤过泡多需重复针拨和5FU注射,手术后间隔时间长者效果差,6周时成功的可能性接近50%。
Objective To observe the effect and influencing factors of acupuncture combined with 5-fluorouracil (5FU) injection on early-middle stage dysfunctional bleb in glaucoma after trabeculectomy. Methods Forty-four eyes (40 eyes) of glaucoma were treated with subconjunctival injection of 5FU and filtered perfused dysfunctions within 2 to 8 weeks after operation. 14 of them were injected with 5FU after repeated needling and dialysis. 3 months. Results In the 40 eyes, the types of retrograde filtering baffle and early defecation filtration bleb were 23 cases of hypertrophic and hyperfatty type, 13 cases of capsular type and 4 eyes of pouch type. Needle dial filter bleb Appearance: slightly bulging 26 diffuse type, multi-cavity or thin-walled type 9 eyes, limited bureau hyperplasia or no filter blebs 5 eyes. The intraocular pressure was (23.6 ± 2.1) mmHg (1mmHg = 0.133kPa) in patients before needle dialing and (13.7 ± 5.4) mmHg immediately after dialing. At the end of follow-up, the intraocular pressure 2.9) mmHg; There was a significant difference between before and after dialysis (P <0.01). Failure to filter foam by multiple medication, intraocular pressure control (19.6 ± 2.6) mmHg. Needle dial after filtering bleb 3 months survival rate was (87.51 ± 5.23)% (survival rate ± standard error). Logistic regression analysis showed that the type of glaucoma, the history of intraocular surgery and the age of the patients had no effect on the needle dial effect, but the needle dial effect was worse after the operation longer interval (P = 0.046), but the median effective time t = 5.9 ). Needle dial surgery in conjunctival hemorrhage in 6 eyes, no complications after surgery. Conclusions Acupuncture combined with 5FU injection is an effective, safe and easy treatment for retrograde filtration bleb and early failure filtration bleb after trabeculectomy. The filtering bleb with risk factors need repeated needling and 5FU injection, Elderly patients with poor interval after surgery have a poor chance of success of nearly 50% at 6 weeks.