应用低浓度丝裂霉素C的非穿透性小梁切除术

Intraoperative application of low dose mitomycin C in non-penetrating trabecular surgery

目的评价在非穿透性小梁手术(non-penetrating trabecular surgery,NPTS)中应用0.1mg/ml丝裂霉素C(mitomycin C,MMC)的临床疗效及安全性.方法将21例(30只眼)具备NPTS手术适应症的开角型青光眼分为两组.Ⅰ组:14例(20只眼),应用0.1mg/mlMMC,放置时间为5min;Ⅱ组:7例(10只眼),行NPTS联合透明质酸生物胶植入.所有患者的随访时间为12～51个月,平均(30.35±8.89)个月.术后对两组患者的视力、眼压、滤过泡及并发症进行对比观察.结果 (1)视力:术后1个月时,Ⅰ组与Ⅱ组的视力变化比较,差异无显著意义(P=0.220).(2)眼压:术后6、12、24个月时,Ⅰ组平均眼压分别为(15.40±3.51)mmHg、(15.24±3.10)mmHg、(15.48±2.69)mmHg;Ⅱ组平均眼压分别为(16.65±2.50)mmHg、(16.29±2.92)mmHg、(17.22±2.06)mmHg.两组患者术后不同时间(6、12、24个月)眼压值差异无显著意义(t=0.956、0.853、1.665,P=0.348、0.402、0.110).术后24个月时,采用寿命表分析法计算,Ⅰ组和Ⅱ组的完全成功率分别为78.89%和55.60%,两组差异无显著性(χ2=1.076,P＞0.05);加用局部抗青光眼药物及(或)行Nd:YAG激光击射非穿透区残留组织,Ⅰ组和Ⅱ组的条件成功率分别为89.47%和88.89%,差异亦无显著性(χ2=0.0002,P＞0.05).(3)滤过泡:末次随访时Ⅰ组16只眼(84.21%)、Ⅱ组6只眼(66.67%)有微囊状或平坦弥散滤过泡,比较两组的滤过泡构成情况未见明显差异(P=0.216).(4)并发症:Ⅰ组术后早期少量前房积血2只眼,轻度房水闪光5只眼;Ⅱ组术后早期1只眼有轻度房水闪光.(5)前房角镜检查:5只眼(Ⅰ组3只眼,Ⅱ组2只眼)虹膜根部与非穿透区残存小梁网有局限性前粘连.结论 NPTS术中应用0.1mg/ml MMC可产生与透明质酸生物胶植入相当的降眼压效果.但MMC的应用有效地降低了患者的经济负担.

Objective To evaluate the effectiveness and safety of non-penetrating trabecular surgery(NPTS)with the use of 0 1mg/ml mitomycin C(MMC).Methods 30 eyes of 21 patients with open angle glaucoma were divided into 2 groups randomly.In 20 eyes of 14 patients(group Ⅰ)a sponge soaked with MMC(0 1mg/ml)was applied for 5 minutes in the scleral bed,and in 10 eyes of 7 patients(group Ⅱ)a reticulated hyaluronic acid implant was sutured in the scleral bed.The mean follow up period was(30 35±8 89)months(12 to 51 months).The postoperative visual acuity,intraocular pressure(IOP),filtering blebs and complications in the two groups were compared.Results (1)Visual acuity:The visual acuity at postoperative 1 month was not significantly different between group ⅠandⅡ( P =0 220).(2)IOP:At postoperative 6,12,and 24 months,the mean IOP in groupⅠwas(15 40±3 51)mmHg,(15 24±3 10)mmHg,(15 48±2 69)mmHg and that in group Ⅱ was(16 65±2 50)mmHg,(16 29±2 92)mmHg,(17 22±2 06)mmHg respectively.The mean IOP at postoperative 6,12,and 24 months was not significantly different between the two groups(t=0 956,0 853,1 665, P =0 348,0 402,0 110).At postoperative 24 months,the life-table complete success rates of groupⅠandⅡ were 78 89% and 55 60%.With medication and(or)Nd:YAG laser goniopuncture,the qualified success rates were 89 47% and 88 89% in groupⅠ and Ⅱ.There were no statistical difference in complete and qualified suc-cess rates between the two groups(Log-Rank test:χ 2=1 076,0 0002, P >0 05).(3)filtering blebs:16 eyes(84 21%)in groupⅠ and 6 eyes(66 67%)in groupⅡ had micro-sac or diffuse blebs.There was no difference in the category of blebs between the two groups( P =0 216).(4)Complications:In group Ⅰ,there were 5 eyes with minimal anterior chamber reaction and 2 eyes with a small quantity of hyphema.In group Ⅱ,there was one eye with minimal anterior chamber reaction.(4)Gonioscopy:peripheral anterior synechiae to the non-penetrating trabecular meshwork could be observed in 3 eyes of group Ⅰand 2 eyes of group Ⅱ.Conclusions In our study,the clinical effectiveness of NPTS with 0 1mg/ml MMC is similar to that of NPTS with reticulated hyaluronic acid implant.But the former lessens the patients′ burden greatly for it′s low cost.