青光眼小梁切除术中应用丝裂霉素抗瘢痕形成的远期疗效

The long-term effects of anti-cicatrization of mitomycin C in glaucomatous trabeculcctomy

目的:评价青光眼滤过性手术中局部应用丝裂霉素(MMC)后抑制滤过道瘢痕形成的效果,及其与保护视功能的关系。方法:44例(60眼)各型中晚期青光眼患者,随机分为MMC组及生理盐水对照组(各30眼)。MMC组小梁切除术中局部应用0.2mg/ml MMC5分钟,并用20ml生理盐水冲洗,术后追踪1～24月(18.0±3.9)。结果:(1)MMC组中为功能性滤过泡的眼占86.7%,对照组占53.3%(P<0.01)。(2)术后24小时波动眼压峰值MMC组为2.02±0.47kPa,对照组为2.51±0.77kPa(P<0.05)。(3)两年时MMC组(22眼)手术成功率为86.4%,显著多于对照组(55.0%,P<0.05),且MMC组的视野得到有效保护与扩大。结论:0.2mg/ml MMC可有效地减少青光眼术后滤过道瘢痕形成,提高小梁切除术的成功率。

Purpose: To evaluate the effect of anti-fibroblast proliferation of operative site after using 0.2mg/ml mitomycin C during the trabeculectomy in glaucoma. Methods. 44 patients(60 eyes)with middle or late primary or secondary glaucoma were randomly divided into mitomycin C and control groups before trabeculectomy surgery (30 eyes per group). 0.2mg/ml mitomycin C was topically applied during the trabeculectomy for 5 minutes, and the wound was then irrigated with 20ml normal saline. AH patients were followed up from 1 to 24 months (18.0±3.9 months). Results: (1)Functional filtering blebs were 86.7%in the mitomycin G group and 53.3% in the control group (P&lt;0.01). (2) The postoperative mean diurnal peak IOP was 2.02±0.47kPa and 2.51±0.77kPa respectively (P&lt;0.05). (3)The eyes with diurnal peakIOP±2.8kPa were 86.4%in the mi-tomycin C group and 55.0% in the control group at the end of the second postoperative year,and the visual field was effectively maintained in MMC group. Conclusions: MMC (0.2mg/ml) can effectively inhibit the scar formation,low down the IOP to a desired degree, thus providing a higher successful rate of trabeculectomy.