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Late Needling mit 5-Fluorouracil bei drohender Sickerkissenvernarbung

Late needling with 5-fluorouracil when scarring of filtering bleb seems imminent

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Zusammenfassung

Hintergrund

Evaluation von Needlings und 5-Fluorouracil- (5-FU-)Injektionen später als 4 Monate nach vorausgehender filtrierender Operation.

Patienten und Methode

Retrospektive Analyse von 17 Augen von 14 Patienten, bei denen mindestens ≥4 Monate nach Trabekulektomie (TE) mit Mitomycin C (MMC) ein Sickerkissen-Needling mit 5-FU-Injektionen durchgeführt wurde (1 Operateur). Absoluter Erfolg wurde definiert als Drucksenkung >30% des Ausgangswerts ohne Therapie. Bei POWG musste zusätzlich ein IOD ≤18 mmHg vorliegen. Die durchschnittliche Nachbeobachtungszeit betrug 8,1 Monate (3–24 Monate).

Ergebnisse

Durchschnittlich 31,3 Monate (4–108  Monate) nach TE wurden 1–4 Needlings (Ø 1,6) mit 1–5 5-FU-Injektionen (Ø 3,1) nach klinischen Erfordernissen kombiniert. Der Ausgangs-IOD betrug durchschnittlich 25 mmHg (±SD 6,02, Median 25 mmHg). Post Needling und 5-FU-Injektionen lag der IOD bei der letzten Kontrolle im Mittel bei 13,64 mmHg (±SD 5,2, Median 13 mmHg) (p<0,001). Der absolute Erfolg betrug 82,4%. Im Mittel konnte der IOD um 11,2 mmHg (0–22 mmHg) gesenkt werden. Die durchschnittliche Tensiosenkung der erfolgreichen Ausgänge (14 von 17 Augen) betrug 55% der Ausgangswerte. 3 Augen mussten einer weiteren Therapie zugeführt werden. Komplikationen waren 2 Hyphäma, 1 Sickerkisseneinblutung, 3 Erosiones corneae.

Schlussfolgerung

Late Needling mit 5-FU-Injektionen kann die Sickerkissenfunktion auch nach ≥4 Monaten wiederherstellen. Die hohe Erfolgsquote, niedrige Komplikationsrate und einfache Prozedur rechtfertigen ein solches Vorgehen als Alternative vor invasiveren Maßnahmen.

Abstract

Background

Evaluation of needling and 5-fluorouracil (5-FU) injections more than 4 months after preceding filtration surgery.

Patients and Method

Retrospective analysis of 17 eyes in 14 patients who underwent needling of the filtering bleb and administration of 5-FU by injection at least 4 months after trabeculectomy (TE) with mitomycin C (MMC; same surgeon throughout). Complete success was defined as a reduction of intraocular pressure (IOP) by >30% from the baseline value without further medication and, in cases of primary open-angle glaucoma, IOP of 18 mmHg. The mean period of follow-up was 8.1 months (3–24 months).

Results

One to four needlings (Ø 1.6) with one to five injections (Ø 3.1) of 5-FU were performed as required according to clinical need an average of 31.3 months (4–108 m) after TE. The mean baseline IOP was 25 mmHg (±SD 6.02; median 25 mmHg). After needling and 5-FU injection the mean IOD at the last hospital visit was 13.64 mmHg (±SD 5.2, median 13 mmHg; p<0,001). Complete success was achieved in 82.4% of these cases. The mean reduction in IOP was 11.2 mmHg (0–22 mmHg). In the cases with successful outcome (14 of 17 eyes) the mean IOP reduction from baseline was 55%. Three eyes required further treatment. Complications encountered were hyphaema (2 cases), subconjunctival bleeding (1 case) and corneal erosion (3 cases).

Conclusion

Late needling and injections of 5-FU can restore filtering bleb function even over 4 months after initial surgery. The high success rate and low incidence of complications together with the simple procedure justify regarding this approach as an alternative that can be used before passing on to more invasive interventions.

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  1. Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein,Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Müller, S. Pape, C. Kusserow, H. Hoerauf & H. Laqua

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  1. M. Müller
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  2. S. Pape
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  3. C. Kusserow
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Correspondence to M. Müller.

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Müller, M., Pape, S., Kusserow, C. et al. Late Needling mit 5-Fluorouracil bei drohender Sickerkissenvernarbung. Ophthalmologe 104, 305–310 (2007). https://doi.org/10.1007/s00347-007-1497-x

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