复发性青光眼小梁切除术中应用不同抗代谢药物的疗效

Effects of different antimetabolites applied intraoperatively on the outcome of trabeculectomy for recurrent glaucoma

目的探讨在复发性青光眼小梁切除术中使用不同抗代谢药物的疗效。方法将72例88眼复发性青光眼患者随机分为4组,均行规范化小梁切除术,术中分别使用环孢素(Cs,20 g/L)、丝裂霉素(MMC,0.2 g/L)、氟尿嘧啶(Fu,50 g/L)及干扰素α-2b(IFN—α2b,50万U/mL)。术后随访6个月,观察视力、眼压、滤过泡及并发症发生情况。结果①各组术后视力变化的差异均无统计学意义(P值均>0.05)。②各组术后功能性滤过泡均显著多于无功能性滤过泡(P值均<0.05),Cs组功能性滤过泡比例显著高于MMC组、Fu组和IFN-α2b组(P值均<0.05),MMC组功能性滤过泡比例显著高于Fu组和IFN-α2b组(P值均<0.05)。③术后1周和1个月,各组间平均眼压的差异均无统计学意义(P值均>0.05);术后3和6个月,Fu组和IFN-α2b组的平均眼压显著高于Cs组和MMC组(P值均<0.05),Cs组与MMC组的差异无统计学意义(P值均>0.05)。术后6个月,Cs组的眼压控制率显著高于Fu组、IFN-α2b组和MMC组(P值均<0.05)。MMC组显著高于Fu组和IFN-α2b(P值均<0.05)。④MMC组术后各种并发症的发生率均显著高于其他3组(P值均<0.05)。结论4种抗代谢药物用于复发性青光眼的小梁切除术,均有助于获得更多的功能性滤过泡和更满意的眼压控制率,其中Cs的作用较为显著且并发症较少,MMC作用较好但并发症相对多见,而Fu和IFNα-2b术中一次使用效果不甚理想。

Objective To evaluate the effects of intraoperative application of different antimetabolites on the outcome of trabeculectorny for recurrent glaucoma. Methods Seventy-two patients with recurrent glaucoma（involving 88 eyes） were randomly divided into 4 groups to receive standard trabeculectomy, during which 4 antimetabolites, namely eyelosporin （Cs, 20 g/L）, mitomyein（MMC, 0.2 g/L）, fluorouraeil（FU, 50 g/L） and interferon α2b （IFN-α2b, 5 × 10^5 U/mL） were used. All patients were followed up for 6 months after the operation and the visual acuity, intraocular pressure, the filtering bleb, and the complications were observed. Results The visual acuity increased and remained unchanged in the majority of the patients after the operation, with only a few cases of deterioration. No significant differences were found in the visual acuity changes between the 4 groups（all P 〈0.05）. The operations resulted in significantly increased ratio of functional blebs in all the 4 groups, and the ratio was the highest in Cs group, followed by MMC group（all P〈 0.05）. The ratios of effectively controlled intraoeular pressure were above 75% in all groups. At 1 week and 1 month after the operation, the intraocular pressure was similar between the groups, but at 3 and 6 months, the pressure was significantly lower in the Cs and MMC groups（and comparable between these two groups）, and till 6 months, the ratio of controlled intraocular pressure was the highest in Cs group, followed by MMC group（all P 〈 0.05）. Such complications as bleb leakage, anterior uveitis, shallow anterior chamber, sustained low intraocular pressure and macular edema occurred postoperatively in all groups, but MMC was associated with a significantly higher incidence of the complications than the other 3 antimetabolites（all P 〈 0.05）. Conclusion The 4 antimetabolites applied in trabeculectomy for recurrent glaucoma all help to obtain more functional blebs and effective control of the intraocular pressure. Cs is more effective for the treatment and causes with fewer complications, whereas MMC, in spite of its effectiveness, is associated with higher incidence of complications. Fu and IFNα-2b do not appear to work well for a single-dose administration in the operation.