小梁显微切除术中应用丝裂霉素C对术后角膜内皮的影响

Corneal endothelial cell loss after mitomycin （MMC）-augmented trabeculectomy

目的探讨小梁切除术中应用丝裂霉素C（MMC）对术后角膜内皮的影响。方法对原发性开角型青光眼患者14例14只眼，行复合式小梁显微切除术后随访观察12个月。采用共焦显微镜分别在术前、术后3月、术后12月，对内皮细胞的密度、平均细胞大小、六角型细胞的比率变化、中央角膜厚度进行检测，并加以分析。结果术前平均细胞密度（2516±533）个／mm^2，术后3个月及12个月分别为：2326±563个，mm^2，（2274±549）个／mm^2。细胞丢失率分别为9．3％、9．9％。与术前相比，差异均有统计学意义（P〈0．05）术后3～12个月内皮细胞丢失差异无统计学意义（P〉0．05）。随访12个月，平均细胞大小及六角形细胞比率变化尚未稳定。结论小梁切除术中使用MMC前后角膜内皮细胞丢失明显。观察3-12个月，细胞丢失没有进展。提示MMC对角膜内皮细胞没有持续的毒性作用；内皮细胞增生活跃。

Objective To determine the effect on the corneal endothelium of mitomycin （MMC）-augmented trabeculectomy 3 and 12 months postoperatively. Methods Fourteen eyes of 14 patients with well-established primary open angle glaucoma were followed for 12 months after surgery. The endothelial cell density, the variation in mean cell size, the percentage of hexagonal cells and the central corneal thickness were measured. Results The mean endothelial cell density was 2516± 533 cells/mm^2 before surgery and 2326± 563 cells/mm^2 and 2274± 549 cells/mm^2 at 3 and 12 months after surgery, respectively, representing a cell loss of 9.3% and 9.9%. （P 〈0.05）. The cell loss from 3 to 12 months was non-significant （P 〉0.05）. After 12 months of follow-up, the variation in mean cell size and the percentage of hexagonal cells had not yet stabilized around the preoperative values. Conclusions The significant cell loss occurs during or immediately mitomycin （MMC）-augmented tmbeculectomy. MMC has no prolonged toxic effect on the corneal endothelium. From 3 to 12 months postoperatively, active adaptations are taking place.