丝裂霉素C对HAD房水引流物置入术远期疗效的影响

Long-term Follow-up Study on Hunan Aqueous Drainage Implantation Combined with Mitomycin C for Refractory Glaucoma

目的:评价丝裂霉素 C(mitomycin C,MMC)对国产 HAD(Hunan aqueous drainage implant,HAD)房水引流物置入术治疗难治性青光眼远期疗效的影响。方法:1995年7月～2001年7月,共为154例(159只眼)难治性青光眼患者施行了HAD房水引流物置入术。所有病例分为两组:MMC组与未用MMC组,其中65只眼术中联合应用MMC(0.4mg/ml,1～5min),94只眼术中未用 MMC。以 6mmHg≤术后眼压≤21mmHg作为手术成功标准,采用Kaplan-Meier寿命表分析术后1～6a.不同时点的手术成功率。结果:术后平均随访54.6mon(12～72mon)。术前平均眼压(46.8±14.5)mmHg;术后1年时眼压为(17.4±10.1)mmHg。术后1～6a手术成功率依次为83.7%,77.2%,72.2%,69.0%,62.5%,57.1%。术后1～5a,MMC组与未用MMC组的手术成功率分别为90.0%、77.3%,87.1%、67.3%,83.3%、61.1%,81.3%、56.7%,75.0%、50.0%;两组间差异有显著性。术后1a时眼部超声图像检查,后部滤过泡的平均高度MMC组为(3.8±0.9)mm,而未用MMC组为(2.1±1.4)mm。术后视力不变或改善的有95只眼(81.9%),两组间无明显差异。术后远期(一年以上)常见的并发症有眼压升高(23例,19.8%)、引流管与周围虹膜粘连(18例,15.5%)、白内障加速形成(15例,12.9%)等,两组间无明显差异,未见MMC的严重并发症发生。

Purpose:To investigate the long-term therapeutic effect of Hunan aqueous drainage (HAD) implantation with and without adjunctive intraoperative mitomycin C (MMC) for refractory glaucoma. Methods: 154 cases (159 eyes) with refractory glaucoma underwent Hunan aqueous drainage (HAD) implantation from July 1995 to July 2001. Sixty-five eyes were combined with MMC (0.4mg/ml, 1 to 5 mins). With success defined as the introcular pressure (IOP) greater than 6 mmHg but no greater than 21 mmHg at the last visit. Results:The mean period of postoperative follow-up was 54.6 (range, 12-72) months. The IOP was lowered from preoperative (46.8 ± 14.5) mmHg to postoperative (16.8± 11.3) mmHg at the 1st year after surgery. The success rate with MMC and without MMC were 90.0%, 77.3% (P<0.05) at the 1st year, 87.1%, 67.3% (P<0.05) at the 2nd year, 83.3% , 61.1% (P<0.05) at the 3rd year, 81.3% , 56.7% (P<0.05) at the 4th year,and 75.0%,50.0% (P<0.05) at the 5th year using Kaplan-Meier life-table analysis. The height of the posterior bleb underwent standardized ocular echography at the 1st year was (3.8±0.9)mm and (2.1±1.4)mm, respectively. Ninty-five eyes (81.9%) with visual acuity remained or improved after the surgery (P>0.05). The most frequent complications for long-term follow-up included elevated IOP (IOP> 22mmHg) (19.8%), the iris adherent to the proximal orifice of the tube (15.5%), developed cataract formation (12.9%) and so on (P>0.05).We didn't find any severe complications after using MMC. Conclusion-.This study suggests that HAD implantation is an effective method in the management of refractory glaucoma in spite of its unneligible complications and combined with MMC can improve the prognosis. Eye Science 2003; 19:81-85.