PURPOSE To evaluate the long-term outcome of 'bleb-sparing epithelial exchange' surgery for dysfunctional filtering blebs in paediatric and adult eyes. METHODS Patients who had undergone bleb revision ≥ 5 years back and were on regular follow-up were included. Age, ocular diagnosis, details of primary filtering surgery including mitomycin-C (MMC) usage, indication and year of bleb revision were recorded. After bleb revision, the mean intraocular pressure (IOP), glaucoma medications and best corrected visual acuity (BCVA) up to 5 years were noted. On last review, clinical details, bleb characteristics and swept source anterior segment tomographic (SSOCT) assessment of bleb were recorded. Comparative analysis of paediatric and adult eyes was performed. MAIN OUTCOME MEASURES Change in IOP and BCVA. 'Complete success' was defined as IOP ≥ 6 to ≤ 18mmHg without use of any topical glaucoma medications and 'Qualified success' when ≥ 1 topical glaucoma medication(s) was required. RESULTS A total of 51 eyes of 51 consecutive patients were studied, among which 22 were children. The mean duration between filtering surgery and bleb revision was 4.54 ± 1.53 years in paediatric and 6.48 ± 3.5 years in the adult group, p = 0.04. Children underwent trabeculotomy + trabeculectomy with 0.04% MMC, while adults underwent trabeculectomy with 0.02% MMC. The mean pre-revision IOP was 6.38 ± 2.80 and 6.51 ± 2.78 mmHg in the paediatric and adult group respectively, p = 0.86. At 3 months post-revision, it increased to 11.81 ± 3.48 and 12.75 ± 3.52 mmHg respectively (p < 0.001). At final review, mean IOP of paediatric group was 10.90 ± 2.59 and adult group was 11.86 ± 2.66 mmHg, p = 0.20. At 5 years, complete success was 68.18% and 72.41%, and qualified success was 31.87% and 27.59% in the former and latter group respectively, p = 0.49. No failures were seen. Kaplan-Meier probability at 5 years for IOP target ≤ 18, ≤ 15 and ≤ 12 in children was 95.45%, 63.64% and 50% and in adults 93.10%, 65.52% and 41.38% respectively. BCVA improved up to 1 year in paediatric group, with continued improvement in adults up to 3 years. SSOCT measured bleb height was 0.88 ± 0.37 and 1.32 ± 0.49mm in children versus adults (p = 0.006) and wall thickness, 0.35 ± 0.22 and 0.58 ± 0.24mm respectively, p = 0.008. CONCLUSION Bleb-sparing epithelial exchange is an equally safe and effective technique with good long-term success in both paediatric and adult dysfunctional blebs.

中文翻译：

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超过5年的儿童和成人功能失常性气泡的“保留气泡的上皮交换”的临床和ASOCT评估。

目的评估小儿和成年眼功能失调滤过泡的“保留上皮起泡更换”手术的长期效果。方法包括≥5年前经历过球囊翻修并定期随访的患者。记录年龄，眼部诊断，初次滤过手术的详细信息，包括丝裂霉素C（MMC）的用法，适应症和起泡年限。起泡后，应记录平均眼压（IOP），青光眼药物和5年以内的最佳矫正视力（BCVA）。在最近的综述中，记录了临床细节，起泡特征和对起泡的扫描源前段层析成像（SSOCT）评估。进行了儿科和成年眼睛的比较分析。主要观察指标IOP和BCVA发生变化。“完全成功” 定义为在不使用任何局部青光眼药物的情况下IOP≥6至≤18mmHg，并且在需要≥1种局部青光眼药物的情况下定义为“合格成功”。结果对51例连续患者的51只眼进行了研究，其中22例为儿童。儿科滤过手术与起泡修复之间的平均持续时间在儿童组为4.54±1.53年，在成人组为6.48±3.5年，p = 0.04。儿童接受0.04％MMC小梁切开+小梁切除术，而成年人接受0.02％MMC小梁切开术。小儿和成人组的平均修订前眼压分别为6.38±2.80和6.51±2.78 mmHg，p = 0.86。修订后3个月，其分别增加至11.81±3.48和12.75±3.52 mmHg（p <0.001）。最终评估时，小儿组的平均IOP为10.90±2.59，成人组的平均IOP为11.86±2。66毫米汞柱，p = 0.20。在第5年，前一组和后一组的完全成功率分别为68.18％和72.41％，合格成功率分别为31.87％和27.59％，p = 0.49。没有看到失败。IOP指标≤18，≤15和≤12的5岁儿童的Kaplan-Meier概率分别为95.45％，63.64％和50％，成人为93.10％，65.52％和41.38％。小儿组的BCVA改善长达1年，成年人的BCVA持续改善长达3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性泡中均具有良好的长期成功。前一组和后一组的合格成功率分别为18％和72.41％，分别为31.87％和27.59％，p = 0.49。没有看到失败。IOP指标≤18，≤15和≤12的5岁儿童的Kaplan-Meier概率分别为95.45％，63.64％和50％，成人为93.10％，65.52％和41.38％。小儿组的BCVA改善长达1年，成年人的BCVA持续改善长达3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性泡中均具有良好的长期成功。前一组和后一组的合格成功率分别为18％和72.41％，分别为31.87％和27.59％，p = 0.49。没有看到失败。IOP指标≤18，≤15和≤12的5岁儿童的Kaplan-Meier概率分别为95.45％，63.64％和50％，成人为93.10％，65.52％和41.38％。小儿组的BCVA改善长达1年，成年人的BCVA持续改善长达3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性泡中均具有良好的长期成功。没有看到失败。IOP指标≤18，≤15和≤12的5岁儿童的Kaplan-Meier概率分别为95.45％，63.64％和50％，成人为93.10％，65.52％和41.38％。小儿组的BCVA改善长达1年，成年人的BCVA持续改善长达3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性泡中均具有良好的长期成功。没有看到失败。IOP指标≤18，≤15和≤12的5岁儿童的Kaplan-Meier概率分别为95.45％，63.64％和50％，成人为93.10％，65.52％和41.38％。小儿组的BCVA改善长达1年，成年人的BCVA持续改善长达3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性泡中均具有良好的长期成功。在成年人中持续改善直至3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性起泡中均具有良好的长期成功。在成年人中持续改善直至3年。SSOCT测得的儿童与成人之间的气泡高度分别为0.88±0.37和1.32±0.49mm（p = 0.006），壁厚分别为0.35±0.22和0.58±0.24mm，p = 0.008。结论保血上皮置换术是一种同等安全有效的技术，在小儿和成人功能失调性起泡中均具有良好的长期成功。