丝裂霉素C与青光眼滤过泡并发症的相关关系

Research on the relationship of mitomycin-C and filtration bleb complications

目的分析小梁切除术中应用丝裂霉素C(mitomycin-C,MMC)与青光眼滤过泡相关并发症的关系。方法对31例36只眼在小梁切除术中应用了MMC而导致的滤过泡相关并发症的患眼进行临床分析,分析其滤过泡形态、眼压、视力的改变和黄斑水肿的发生及与术中MMC的浓度、放置时间、放置部位之间的关系。结果31例36只眼中发生滤过泡渗漏11只眼、滤过泡感染1只眼、巨大薄壁滤过泡7只眼、单纯薄壁滤过泡7只眼、低眼压合并黄斑囊样水肿10眼;并发症的发生时间平均(1724±2000)m;平均视力下降2行以上;并发症的发生与MMC放置的位置显著相关,与时间呈正相关,与浓度无关;眼压下降与MMC浓度呈负相关。结论小梁切除术后滤过泡并发症的发生与MMC的应用密切相关,结膜瓣下与巩膜瓣下同时放置、放置时间长者比较容易发生并发症;高浓度者容易造成低眼压。

Objective To analyze the relationship of mitomycin-C(MMC)and filtration bleb related complications in trabeculectomy.Methods Thirty-one cases(36 eyes)with bleb related complications after applying MMC in trabeculectomy were analyzed.The effect of MMC concentration,applying duration and placement site on the morphology of the bleb,intraocular pressure(IOP),change of vision,and macular edema were considered.Results In 31 cases(36 eyes),bleb leakage was found in 11 eyes,and bleb infection in 1 eye,enormous thin-wall bleb in 7 eyes,simple thin-wall bleb in 7 eyes,low IOP complicated with cystoid macular edema in 10 eyes.The mean time of onset of the bleb complications were 17 24±20 00 months.The mean visual sight decreased more than 2 lines.The bleb complications were significantly related to the placement site of MMC(r=0 578, P =0 008),and positively related to the applying duration(r=0 456, P =0 038),but not related to the MMC concentration(r=-0 3991, P =0 073).The decrease of IOP was negatively related to the MMC concentration(r=-0 540, P =0 005).Conclusions Filtration bleb complications after trabeculectomy were closely related to the applications of MMC.Simultaneous placement of MMC under the conjunctival and scleral flap and longer duration of placement tend to cause the complications.And high concentration of MMC may be more likely to cause low IOP.