抗瘢痕化治疗在青光眼滤过性手术中的应用研究进展

Application of anti-scarring therapy in glaucoma filtration surgery

青光眼滤过性手术(glaucoma filtering surgery,GFS)后滤过泡区域的瘢痕化是导致手术失败的主要原因。抗代谢药物丝裂霉素(mitomycin-C,MMC)是GFS抗瘢痕化治疗的首选,但其细胞毒性又会带来严重的并发症。新的抗瘢痕方法包括手术技术改良(如制作不同深度结膜瓣)、对滤过道采用物理屏障(如生物可降解胶原基质植入物、透明质酸钠、羊膜、角膜基质透镜、全氟丙烷气体)、抗瘢痕化药物(除MMC、5-氟尿嘧啶外还有糖皮质激素和非甾体类抗炎药、调节转化生长因子-β药物以及中药决丹化瘀汤、青光安颗粒等)、眼球按摩、β射线放射治疗等。

Scarring around the filtering bleb after glaucoma filtering surgery(GFS)is a major cause of surgical failure.The antimetabolic drug mitomycin-C(MMC)is the first-line treatment for scarring in GFS,but its cytotoxicity can lead to serious complications.Newer anti-scarring approaches include improved surgical techniques(e.g.creation of conjunctival flaps of varying depth),use of physical barriers to the filtration pathway(e.g.biodegradable collagen matrix implants,biodegradable collagen matrix implants,sodium hyaluronate,amniotic membranes,corneal stromal lenses and perfluoropropane gas),and anti-scarring drugs(glucocorticosteroids and non-steroidal anti-inflammatory drugs in addition to MMC,5-fluorouracil and transforming growth factor-beta-regulating drugs,and the Chinese herbal medicines Dan Huayu Tang,glaucoma and granules,etc.),eye massage,β-radiation therapy,and so on.