选择性结膜下注射丝裂霉素C对滤过泡形态及眼压的影响

Influence of selective subconjunctival injection of mitomycin C on the morphology of filtering bleb and intraocular pressure

目的探讨小梁切除术后早期选择性一次或多次结膜下注射低浓度丝裂霉素C(Mitomycin C,MMC)对滤过泡形态及眼压的影响。方法收集2011年1月至2012年3月就诊于我院的60例原发性急性闭角型青光眼且需行小梁切除术的患者,随机分为A、B两组各30例,A组术后根据滤过泡形态、结膜充血状态一次或多次结膜下注射低浓度MMC(0.2 mg/ml),B组术中一次性使用MMC(0.33 mg/ml),随访1年,记录并比较两组患者滤过泡形态及眼压的差异。结果术后1年A组扁平弥散型滤过泡占总数的66.7%,B组扁平弥散型滤过泡占总数的36.7%,两组比较差异有统计学意义(P=0.038)。术后1年时A组眼压控制良好者占76%,B组眼压控制良好者占80%,两组比较差异无统计学意义(P=1.000)。A组出现2眼角膜上皮缺损,1例局部注射部位结膜苍白;B组出现1例角膜上皮缺损,5眼滤过泡渗漏,2眼低眼压黄斑病变。结论小梁切除术后选择性结膜下注射较低浓度的MMC使得扁平弥散型滤过泡的比率增加,与术中一次性使用MMC相比两组均能较好控制眼压,手术成功率相似,此种治疗方式安全有效,且无严重并发症发生。

Objective To explore the influence of one or more times selective subconjunctival injections of low-concentration mitomycin C （MMC） at early stage on the morphology of filtering bleb and IOP after trabeculectomy. Methods Sixty patients with primary acute angle-closure glaucoma who needed trabeculectomy in our hospital from January 2011 to March 2012 were divided into two groups randomly （n=30）. In group A, according to the mor-phology of filtering bleb and the state of conjunctival congestion, low-concentration of MMC （0.2 mg/ml） was subcon-junctival injected once or more times. In group B, MMC （0.33 mg/ml） was used once during operation. The filtering bleb and IOP in two groups were recorded and followed up for one year, and then compared. Results 1 year after the operation, the ratio of typeⅡfiltering bleb in group A was 66.7%, while that in group B was 36.7%（P=0.038）. The ratio of well-controlled IOP was 76%in group A and that in group B was 80%（P=1.000）. In group A, there were 2 cases of persistent corneal epithelial defect and 1 case of partial pale conjunctiva at the site of injection. In group B, there were 1 case of persistent corneal epithelial defect, 5 cases of filtering bleb leaking and 2 cases of ocular hypotensional macu-lopathy. Conclusion Selective subconjunctive injection of low-concentration MMC after trabeculectomy could improve the ratio of flat and diffuse filtering bleb. The IOPs in both groups are well controlled and the rates of successful operation are similar. This treatment is effective and safe, with no severe complications observed.