小梁切除联合丝裂霉素C治疗青光眼再手术远期疗效观察

Long-term effect of trabeculectomy combined with MMC on repeated surgery for glaucoma

目的:探讨小梁切除联合应用丝裂霉素C治疗青光眼再手术的远期疗效。方法:回顾性分析19例21眼常规小梁切除无功能滤过泡、眼压失控再次手术的病例资料,手术方式为再次小梁切除联合应用丝裂霉素C并术后随访1～3a。疗效判定标准:A疗效好:眼压<16mmHg、视力≥0.3、视盘与视野损害无进展。B疗效较好:不用或仅用局部抗青光眼药物眼压≤21mmHg、视力0.1～0.25、视盘与视野损害无进展。C疗效差:眼压失控、药物不能控制在正常范围或手术治疗。手术成功判定标准:AB项为手术成功标准。结果:随访1a以上19例21眼(100%),随访3a以上16例(18眼)(76%)。术后平均眼压16.3±4.1mmHg。较术前眼压35.8±5.32mmHg明显降低.(P≤0.001)、11眼眼压控制在13±2.7mmHg,8眼局部应用抗青光眼一种药物眼压控制好,较术前眼压难以控制有显著意义。检眼镜观察杯盘比值与视野检查,术前术后无显著差异。术后裸眼与矫正视力为0.02～0.5,视力满意(>0.3)8眼(38%),17眼(0.1以上)保持有用视力(81%)。根据上述标准:疗效好8眼、疗效较好9眼、4眼疗效差。1a手术成功率86%。3a手术成功率76%。本组病例术后早期并发症:角膜上皮损害6眼,低眼压、浅前房发生9眼,其中滤过强与渗漏4眼,2眼脉络膜脱离,1眼发生睫状环阻塞性青光眼。3a随访晶状体浑浊加重5眼,2眼再一次出现眼压失控行抗青光眼联合手术。结论:小梁切除联合应用丝裂霉素C治疗青光眼手术成功率高,远期效果好,再次手术疗效满意。

AIM：To evaluate the long-term effect of trabeculectomy combined with MMC on repeated surgery for Glaucoma. METHODS：This retrospective study included 19 cases（21 eyes） with Glaucoma patients for trabeculectomy and followed up for 1- 3 years. Definition of effect for surgery were determined as A Nice ：Intraocular Pressure（IOP） ≤ 16 mmHg , visual acuity 1〉0.3 , Optic Nerve and vision field without advanced damage ; B Good ： no antiglaucoma medication or only local medication of topical antiglaucoma drops, IOP≤21mmHg, visual acuity≥0.1-0.25 and optic Nerve and vision field without advanced damage; C No effect：lOP could not been controlled and also with antiglaucoma topical drops. Definition of successful surgery ： A and B is successful. RESULTS： The study included 19 cases （21 eyes） with 100% patients who followed up for over one year, 16 cases （18 eyes） with 76% patients who followed up for over 3 years. After surgery, the average IOP was significantly lowered to 16.3±4.1mmHg from 35.8± 5.32mmHg （ P≤0.001）, there were 11 cases which the IOP was 13±2.7mmHg, 8 cases which the lOP were controlled with topical antiglaucoma drops. There was no significantly difference in the cup-disc ratio （C/D） and the vision field . the visual acuity after surgery was 0.02-0.5. there were 8 eyes with 38% patients who had visual acuity〉0.3 ,17 eyes with 81% patients who had visual acuity 〉0.1.Based on the criteria for successfulsurgery ： A 8eyes, B 9 eyes, C 4 eyes. The successful rate of surgery was 86% at one year, 76% at three years. Among 21 eyes for early complication： there were 6 eyes with the corneal epithelial defect, 9 eyes with lower IOP and shallow anterior chamber, two eyes with choroidal detachment,1 eye with dliary block glaucoma .After followed-up for three years, there were 5 eyes with advanced cataract, 2 eyes were uno derwent cataract surgery combined with antiglaucoma because of uncontrolled IOP. CONCLUSION： Trabeculectomy combined MMC has a high successful rate in treatment of glaucoma with good long-term effect, Observation from repeated surgery also showed satisfactory results.