翼状胬肉手术中应用丝裂霉素C对角膜内皮的影响

The effect of mitomycin C on corneal endothelium in pterygium surgery

目的评价翼状胬肉手术中应用0.2g/L丝裂霉素C于巩膜上5min,术后角膜内皮密度的变化。方法从2009年5月至2010年5月,共计43例患者纳入研究(18男、25女),所有患者均接受巩膜暴露法翼状胬肉切除术,术中进行到胬肉头颈部切除后,给予0.2g/L丝裂霉素C于巩膜上5min,然后给予注射用生理盐水冲洗。术前、术后患眼角膜中央进行内皮计数,取3次平均值。结果在丝裂霉素C应用组,术前平均角膜内皮细胞密度为(2254±128)cells/mm2,术后1周、1个月、3个月分别为(1775±63)cells/mm2、(1707±41)cells/mm2、(1780±72)cells/mm2。各时间点和术前比较均有统计学意义(P<0.02)。对照组术前平均角膜内皮细胞密度(2352±118)cells/mm2,术后1周、1个月、3个月分别为(2345±120)cells/mm2、(2260±162)cells/mm2、(2230±144)cells/mm2。各时间点和术前比较没有有统计学意义。术后没有观察到药物副作用和手术并发症。结论巩膜暴露法翼状胬肉切除术中,给予0.2g/L丝裂霉素C于巩膜上5min,对术眼的角膜内皮细胞密度有一定影响。需要进一步观察丝裂霉素C的不同浓度和持续时间,找到该药物最佳治疗效果和最小副作用。

Objective To evaluate changes in endothelial cell count after pterygium surgery with 5-minute application of mitomycin C（MMC）0.2 g/L.Methods The study participants included 43 consecutive patients（18 men and 25 women）who underwent pterygium surgery with MMC at a major tertiary center between May 2009 and May 2010.The bare sclera technique was used in all cases.After excision of the head and neck of the pterygium,a surgical sponge soaked with MMC 0.2 g/L was placed on the exposed sclera for 5 minutes,with the conjunctival layer draped over the sponge.Thereafter,the sclera was irrigated with balanced salt solution,and surgery was completed.Endothelial images were acquired at the center of the cornea with a specular microscope（average of 3 measurements）before surgery and at 1 week,1 month,and 3 months after surgery.Results In the group in which MMC,mean preoperative endothelial cell count was（2254±128）cells/mm2,Mean postoperative values were（1775±63）cells/mm2 at 1 week,（1707±41）cells/mm2 at 1 month,and（1780±72）cells/mm2 at 3 months.The difference in cell count from the preoperative value was significant at all time points（P 0.02）.In the group in which MMC wasn＇t applied,mean preoperative endothelial cell count was（2352±118）cells/mm2,and mean postoperative values were（2345 ±120）cells/mm2 at 1 week,（2260±162）cells/mm2 at 1 month,and（2230±144）cells/mm2 at 3 months.No endothelial cell loss was documented in this group.There were no adverse drug effects and no serious operative complications.Conclusion A 5-minute application of MMC 0.2 g/L to the bare sclera during pterygium surgery has an immediate and significant effect on endothelial cell density,which remains stable for up to 90 days.Furthermore,longer-term studies are needed of different concentrations and durations of the drug and of procedures where in MMC is applied before excision of the pterygium head.