Clinical Effect Observation Of The Different Operations For Glaucoma Patients On The Treatments Of The Advanced Follicular Fibrosis After The First Filtering Operation

BackgroundGlaucoma is the leading cause of irreversible blinding eye disease in the world.It is a group of diseases characterized by progressive depressive optic nerve atrophy and characteristic visual field defects.Pathological increased intraocular pressure is the main risk factor and the only one.Controllable risk factors.Common clinical IOP lowering methods include drugs,lasers,and surgery.Nowadays;more and more glaucoma doctors are focusing their attention on the development of new drugs for reducing intraocular pressure and non-filtering bubble-dependent surgery.This will undoubtedly bring happiness to glaucoma patients,but at the same time it will inevitably increase its economic burden;On the one hand,most new drugs and innovative surgeries are still in the clinical trial stage,and they still need long-term and extensive further exploration and research.In fact,filtering surgery is still the current mainstream surgery.The filtering surgery refers to the direct or indirect drainage of aqueous humor from the anterior chamber to the subconjunctival space,absorption into the blood through the conjunctiva and lymphatic tissue,including trabeculectomy and aqueous drainage device implantation.The trabeculectomy surgery is still the gold standard for the current filtering surgery.Cairns first proposed the concept of a half-layer scleral flap in 1968,which marked the formation of a modern classic trabeculectomy.In order to improve the success rate of surgery,many scholars have made a lot of improvements in their technique,mainly using loosely tunable adjustment sutures,and joint use of anti-metabolites such as Mitomycin-C(MMC)and 5-fluorouracil(5-Fu),thinning scleral flaps,viscoelastics and amniotic membranes.These methods greatly promote the formation of postoperative functional filtration blebs.The trabeculectomy with these modified techniques is also known as the composite trabeculectomy.Although we have made tremendous efforts,the fibrosis of the filtration passages is still inevitable.It will be proliferated,wrapped,scarred and lead to gradual failure of surgery with the repair of the body wounds.In the early postoperative period,filtering fibrosis can be relieved or cured by eyeball massage,acupuncture separation combined with 5-Fu subconjunctival injection.However,in the late postoperative period,fibrosis of the filtering bleb.is severe and patients are often requires secondary surgery.For this type of refractory glaucoma patients who have the fibrosis of the filtering bleb after the first trabeculectomy,trabeculectomy or external filtering drainage device implantation is usually performed at another site.The common drainage device is Ex--PRESS P200 glaucoma drainage drainage nail and Ahmed FP7 glaucoma drainage valve.Drainage implantation does not bite the trabecula,cut the iris and has less interference with the anterior chamber.It has the advantages of the simple operation,less trauma,safe and effectivity and short operation time.However,these drainage implants are expensive,our country is a populous country that still belongs to developing countries.The cost is a relatively heavy economic burden on both countries and individuals.So compared with trabeculectomy,what are the effects of lowering the intraocular pressure and safety and how are the two kinds of drains clinically effect in reducing intraocular pressure and safety.At present,there is no report comparing the surgical effects of the three surgical methods on the treatment for glaucoma patients with fibrosis after the first trabeculectomy at home and abroad.Therefore,in the first part of this article,we will collect and count the early clinical data of postoperative ectopic surgery in patients with refractory fibrillation with advanced fibrosis after the first trabeculectomy.The research on the effective comparition of the trabeculectomy,Ex-PRESS glaucoma drainage nail implantation and Ahmed glaucoma drainage valve implantation for the treatment of patients with filament fibrosis after the first trabeculectomy were performed.Early clinical data were summarized and analyzed statistically to explore the clinical advantages and hygienic economic value of drainage implantation in patients with reoperation.For the filtering bleb fibrosis patients with a second operation,according to the surgical site,it will be divided into the in-situ,ectopic reoperation.The ectopic reoperation has the difficulty of operation.Its effect of lowering the intraocular pressure obviously has a significant advantage.In domestic literature reports,the one-year success rate of the ectopic secondary operation is as high as 76%-76%,but in-situ reoperation reports were few.In foreign literature reports,the success rate of the in-situ revision surgery was only 64.0%-69.7%,which was significantly less than that of the ectopic secondary operation.However,the former sacrifices the cost of sacrificing a new conjunctival surgical space.In order to save the surgical site and preserve the future surgical area,the patient’s comfort of the upper filter bleb is also considered better than other sites.Many scholars recommend in-situ revision surgery.In fact,as early as 1941,when the classic trabeculectomy was not proposed,Ferrer published a method of conjunctival filtering bleb recanalization.There are three advantages of in-situ bleb resurfacing.First,physicians can create appropriate opportunities for subsequent ectopic secondary surgery to reduce postoperative inflammatory reactions and adverse effects of anti-glaucoma drugs on ectopic secondary surgery.Second,the reoperation does not require the use of aqueous drainage implants,which can save a considerable amount of medical expenses.Third,the patient’s psychological identity is better.At present,the method of recanalization of filtering blebs is mostly the in-situ dissection of the conjunctival and scleral flaps of the filtered blebs,followed by removal of scar tissue and dredging of the filtering passages,which is also known as open recanalization.In patients with the advanced fibrosis fibrosis,most conjunctiva is of hypertrophy and hyperemia,scar tissue and scleral flap are attached and long-term anti-glaucoma drugs have toxic side effects,which leads to time-consuming and laborious operation of open revascularization surgery.On the other hand,although the role of amniotic membrane in promoting epithelial tissue repair,inhibiting local inflammatory response,preventing neovascularization and scar formation is an indisputable fact,the role of amniotic membrane in filtering bleb recanalization has not received sufficient attention now.Therefore,it is necessary to improve the operation of filtering bleb surgery to simplify the operation and reduce the damage.We performed UBM on patients with advanced fibrosis after the first filtration surgery.We found that advanced filtration bleb scars caused different failures in the filtration tract.Many patients had the fibrotic filtering bleb of the unblocked inner passageway in the filter aisle and a latent liquid dark cavity that is interlinked with the anterior chamber under the scleral flag or the liquid dark cavity of the cap.For the patients,we had designed a minimally invasive incision combining 5-Fu and amniotic membrane transplantation.The adherent conjunctiva and sclera flaps were separated,combined with 5-Fu filtration zone immersion and amniotic membrane transplantation.The late failed filtration channels were cleared in a minimally invasive manner.In the second part of this article,we would use the minimally invasive filtering bleb revision surgery and the open revision surgery in our hospital during the same period for advanced filtering bleb fibrosis after the filtering surgery.The study was a prospectively and non-randomized clinical controlled trial.It was to investigate the clinical effect and safety of the modified minimally invasive technique in the treatment of patients with the filtering bleb fibrosis.We summarized and analyzed the corresponding clinical data.Based on the results of the above two studies,we investigated the personalized treatment plan for patients with advanced filtering bleb fibrosis after the first filtration surgery.The main research contents and results were summarized as follows.One Early clinical effect of the trabeculectomy,Ex-PRESS drainage nail implantation and Ahmed drainage valve implantation on the patients with advanced fibrotic filtering bleb PurposeTo observe the early clinical effect and safety of trabeculectomy,Ex-PRESS drainage nail implantation and Ahmed drainage valve implantation on the glaucoma patients with on the patients with advanced fibrotic filtering bleb after the first trabeculectomy.MethodsThe early postoperative clinical data of the glaucoma patients accepting the second heterotopic surgery were selected in our hospital after the first trabeculectomy.Thirty patients(34 eyes,Trabecula Group)who underwent the trabeculectomy again were included.Twenty-two patients(25 eyes,Ex-PRESS Group)underwent Ex-PRESS P200 drainage nail implantation,and 25 patients(28 eyes,Ahmed Group)underwent Ahmed FP7 drainage valve implantation.The theoretical hospitalized days,the visual acuity and the intraocular pressure(IOP)changes and complications before and after surgery were observed.ResultThere was no significant difference in the age,sex and glaucoma types among the three groups(P>0.05).The theoretical hospitalized days,the visual acuity changes and the incidence of postoperative filtering bleb leakage in the Ex-Press Group and Ahmed Group were better than those in the Trabecula Group and the differences were statistically significant.But there was no statistical significance between the Ex-Press Group and Ahmed Group.There were statistically significant differences in intraoperative IOP(P<0.05).The IOP was compared among the three groups before and after surgery and the range in the reduced IOP of the Ex-press Group and Ahmed Group was slightly higher than the Trabecula Group,but the difference was not statistically significant(P>0.05).ConclusionFor patients with refractory glaucoma for filtering bleb fibrosis of the first trabeculectomy and needing heterotopic reoperation,compared with the trabeculectomy,the Ex-PRESS drainage nail implantation and Ahmed drainage valve implantation could be a good choice.Two Clinical effect of the in-situ microinvasive revision surgery on the fibrotic filtering bleb with the guidance of UBMObjectiveTo investigate the clinical effect of microinvasive revision surgery on the patients of the fibrotic filtering bleb with the guidance of UBM.MethodsA prospective,nonrandomized clinical controlled trial was conducted,which had 2 groups according to the results wih UBM during the same period in our hospital,including the patients with the microinvasive revision surgery(28 cases 28 eyes,group A)and the in-situ traditional revision surgery of larger incision 27 cases of 27 eyes,group B).The clinical data of the cases were selected and the main observation targets were the change of the postoperative visual acuity(VA),intraocular pressure(IOP),the operating success rate and the complications.ResultsThere were no significant differences in the gender,the age,the glaucoma types,the primary operation modes,the postoperative follow-up time and the preoperative VA(P>0.05);The average length of hospital stay,3 days of the postoperative VA and the postoperative complications of Group A were better than Group B and the difference was statistically significant(P<0.05).There was no statistically significant difference in the average IOP at each time point of the two groups(P>0.05).At the end of follow-up,the success rate of the two groups was 64.3%,66.6%;and the difference was not statistically significant(P<0.05).ConclusionThe in-situ microinvasive revision surgery on the basis of the UBM examination is a good choice for patients with the fibrotic filtering bleb of the unblocked inner passageway in the filter aisle and a latent liquid dark cavity that is interlinked with the anterior chamber under the scleral flag or the liquid dark cavity of the cap.