青光眼术中个性化使用丝裂霉素的疗效

Efficacy of individual application of mitomycin C in combined trabeculectomy

目的 探讨青光眼复合小梁切除术中个性化使用丝裂霉素（MMC）的疗效和并发症.方法 对我院原发性开角型青光眼的复合小梁切除术的48例（76眼）进行回顾性分析.76眼均行复合小梁切除术,术中使用MMC的浓度为0.3 mg/ml,放置MMC棉片时间为2～5 min.放置MMC时间主要根据患者年龄、眼球筋膜的厚度及术后目标眼压而定.手术成功率的3个标准是：（1）眼压≤18 mmHg（1 mmHg =0.133 kPa）和眼压降低20％;（2）眼压≤15 mmHg和眼压降低25％;（3）眼压≤12 mmHg和眼压降低30％.术后观察指标：手术成功率、视功能、渡过泡及并发症.随访12～36个月,平均（21.50 ±2.67）月.结果 术前平均眼压（31.28±7.67） mmHg,术后12个月平均眼压（13.28±3.87） mmHg,两者比较差异有统计学意义（t=4.162,P=0.000）.按手术成功率3个标准,术后12个月成功率分别为95.79％,86.32％,和71.12％;76眼均为功能滤过泡,其中Ⅰ型32眼、Ⅱ型44眼.7眼（9.21％）术后局部需用1种降眼压药才能控制眼压.术后并发症：8眼（10.53％）术后早期浅前房,未见其他严重并发症.结论 青光眼复合小梁切除术中个性化使用MMC能有效降低原发性开角型青光眼的眼压,并发症少.

Objective To evaluate the efficacy and complications of trabeculectomy with individual application of mitomycin C （MMC） for primary open-angle glaucoma.Methods The data of 76 eyes of 48 patients with primary open-angle glaucoma who underwent trabeculectomy with individual application of MMC were reviewed.All patients underwent trabeculectomy with application of 0.3 mg/ml MMC for 2 ～ 5 min which accorded to the age,Tenon＇ s capsule thickness and postoperative target intraocular pressure（IOP）.Success rates were defined according to three criteria：（1） IOP ≤ 18 mmHg （1 mmHg =0.133 kPa） and IOP reduction ≥ 20%;（2） IOP ≤15 mmHg and IOP reduction≥25%;and （3） IOP≤12 mmHg and IOP reduction≥30%.The success rate,visual acuity,type of filtering blebs and complications after the surgery were observed.The follow-up duration was 12 ～36 months with average （21.50 ± 2.67） months.Results Mean IOP decreased from （31.28 ± 7.67） mmHg before surgery to （13.28 ± 3.87） mmHg 1 year after the surgery （t =4.162,P =0.000）.The success rates were 95.79%,86.32% and 71.12% at 1 year after the surgery for the three criteria respectively.Type Ⅰ filtering blebs were observed in 32 eyes,and type Ⅱ in other 44 eyes.Seven eyes （9.21%） required one kind of antiglaucoma medications to control IOP.There were 8 eyes （10.53%） with shallow anterior chamber in the early stage after the surgery.No other complication were noted.Conclusion Trabeculectomy with individual application of MMC can effectively reduce IOP in open-angle glaucoma with few complications.