定量丝裂霉素在小梁切除术中的应用观察

Standard Mitomycin-C in Primary Trabeculectomy

目的:观察定量丝裂霉素应用于小梁切除术中抗增殖的疗效及并发症发生率。方法:慢性闭角型青光眼术48例(66只眼)分两组,用药组小梁切除加丝裂霉素6.6ug应用;对照组单纯小梁切除。比较两组术后滤过泡存在时间及并发症发生率。用UBM检查滤过泡形态及浅前房原因,OCT检查黄斑水肿。结果:用药组33只眼,术后3个月时3只眼滤过泡囊样变。UBM检查1年时31只眼滤过泡形态良好,2只眼包裹瓣下有潜腔。术后Ⅱ°浅前房1只眼。UBM示睫状体浅脱离。对照组术后1年滤过泡粘连8只眼(P=0.039)。2只眼囊变。25只眼滤泡形态良好。术后浅前房Ⅱ°4只眼,UBM示2只眼睫状体脱离。术后1年眼压用药组15.88mmHg±2.64mmHg,对照组15.52mmHg±2.45mmHg。OCT检查无黄斑水肿发生。结论:小梁切除术中小剂量应用丝裂霉素滤过泡形成率高,安全无严重并发症发生。

Objective: To examine the complication and results of trabeculectomy with standard mitomycin-C (MMC). Methods: 48 cases (66 eyes) with chronic closed angle glaucoma were divided into two groups: medical group that would be received trabeculectomy with MMC 6.6ug; control group that would undergo trabeculectomy. Incidence of complications and functioning filtering blebs were compared. Shape of blebs and shallow chamber were surveyed with UBM. Macular edema was checked with OCT. Results: After a mean follow-up one year, there were three cystic thin avascular blebs of thirty-three eyes in medical group, two failed filtering blebs and thirty-one functioning filtering blebs with UBM. Preoperative and postoperative intraocular pressures (IOP) were 29.94±5.88 mmHg and 15.88±2.64 mmHg separately. One case who appeared Ⅱ°shallow chamber had cyclodial detachment with UBM. In control group, there were eight eyes with failed filtering blebs (P=0.039) and twenty-five functioning filtering blebs with UBM. Two eyes appeared cystic blebs. Preoperative and postoperative IOP were 21.11±4.94 mmHg 15.52±2.45 mmHg separately. There were no hypotony and macular edema with OCT. Conclusion: It should be safe and effective to have small standard MMC in primary trabeculectomy.