MMC与5-FU联合可调整缝线的小梁切除术治疗青光眼的疗效比较

Clinical observation of mitomycin and 5-fluorouracil with adjustable sutural trabeculectomy for glaucoma

目的:对比分析青光眼患者联合可调整缝线的小梁切除术中使用丝裂霉素C(mitomycin C,MMC)与5-氟尿嘧啶(5-fluorouracil,5-FU)的临床预后及并发症。方法:回顾性病例系列研究。选取本院2016-06/2017-10的71例71眼青光眼(包括原发性开角型青光眼和原发性慢性闭角型青光眼)患者,分为两组,其中MMC组36例,5-FU组35例,均给予联合可调整缝线的小梁切除术,分别使用MMC、5-FU抗瘢痕治疗,术后随访6mo,比较两组患者的临床眼压控制疗效、滤过泡形态及并发症发生率。结果:MMC组患者术后眼压控制低于5-FU组,差异有统计学意义(P<0. 05),MMC组总手术成功率与5-FU组比较,差异无统计学意义(P>0. 05),MMC组功能性滤过泡形成率高于5-FU组,MMC组非功能性滤过泡形成率低于5-FU组,差异有统计学意义(P <0. 05),MMC组与5-FU组并发症发生率差异无统计学意义(P>0. 05)。结论:MMC及5-FU作为抗瘢痕药均能提高青光眼小梁切除手术的成功率,MMC能将眼压降到更低,形成功能性滤过泡方面MMC优于5-FU,根据患者制定个性化的手术方案MMC与5-FU的并发症发生率无明显差异,使用5-FU时需术后多次分离滤过泡及结膜下再次注射5-FU。

AIM： To take a contrastive analysis of glaucoma patients＇ clinical prognosis and complications after the usage of mitomycin（ MMC） or 5-fluorouracil（ 5-FU）combined with adjustable sutural trabeculectomy. METHODS： Retrospective case series reseach was undertaken. We divided the 71 cases（ including primary open angle glaucoma and primary chronic angle-closure glaucoma） into two groups： MMC group（ 36 cases） and5-FU group（ 35 cases）. Both were treated with combined adjustable sutural trabeculectomy with the usage of MMC or 5-FU anti-cicatricial treatment,and followed up to compare intraocular pressure,filtered bubble form and complications.RESULTS： The intraocular pressure of MMC group was lower than 5-FU group with statistical significance（ P〉0. 05）; there was no significant difference in total surgical success rate between groups（ P〉0.05）. Functional filtering bleb formation rate in MMC group was higher than 5-FU group while the formation rate of nonfunctional filtering bleb in MMC group was lower than 5-FU group（ P〈0.05）,which showed no significant difference in complication rate between groups（ P〉0. 05）, but the types of complications were different.CONCLUSION： Both MMC and 5-FU can improve the success rate of glaucoma trabeculectomy as anti-cicatricial drugs. MMC can lower the intraocular pressure,is superior to 5-FU in the formation of functional filtering bleb. There was no significant difference in the incidenceof complications between MMC and 5-FU according to personalized surgical protocols based on patients. When5-FU is used,it is necessary to separate the filtering blebs repeatedly after operation and to reinject 5-FU under conjunctiva.