Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy

AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: retrospective review

AIM: To evaluate the outcomes of trabeculectomy with large area mitomycin-C(MMC) application as a first line treatment in advanced glaucoma. ·METHODS: The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy(initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy(primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure(IOP) values,visual acuities,mean deviations,morphology and function of the blebs,necessity for anti-glaucomatous medications and surgical complications were reported. ·RESULTS: There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg(27-68mmHg) and 29.0±4.4mmHg(21-41mmHg),respectively(P=0.001). Average preoperative mean deviations(MD) in Groups 1 and 2 were 17.4±2.8dB(13.3-23dB) and 17.9± 2.4dB(13.7-23.2dB),respectively(P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2(P =0.005). No cystic bleb formation was observed in Group 1,whereas 4 patients from Group 2(10.8%) developed cystic bleb(P =0.040). No visually devastating complication has occurred in both Groups. ·CONCLUSION: Initial trabeculectomy with large areaMMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.

小梁切除术中丝裂霉素C和透明质酸钠的应用

目的:探讨丝裂霉素C(MMC)和透明质酸钠(Healon)在小梁切除术中的作用。方法:随机将61例65眼分成治疗组31例34眼和对照组30例31眼。治疗组术中使用MMC和Healon,而对照组常规行小梁切除术,术中不使用MMC和Healon。结果:治疗组术后2wk眼压≤21mmHg的34眼,而对照组≤21mmHg的25眼,>21mmHg的6眼(P>0.01);两组差异有显著性。术后浅前房治疗组和对照组分别是3眼和10眼(P<0.05);差异有显著性。术后Ⅸ型滤过泡,治疗组和对照组分别为1眼和6眼(P<0.05);差异有显著性。结论:MMC和Healon应用于小梁切除术,明显降低术后并发症,提高手术成功率,是可靠有效可行的方法。

青光眼应用改良小梁切除术联合丝裂霉素C方案治疗的可行性及预后分析

目的:探讨改良小梁切除术联合丝裂霉素C治疗青光眼的效果。方法:纳入2011年6月-2016年3月90例青光眼患者,以数字表法分组,对照组给予单一改良小梁切除术治疗,观察组则给予改良小梁切除术联合丝裂霉素C治疗。比较两组青光眼控制率;功能性滤过泡以及非功能性滤过泡形成的情况;干预前后患者眼压、视力水平、视野缺损程度、生活质量;浅前房、前房出血等并发症发生率。结果:观察组青光眼控制率95.56%,高于对照组的68.89%,差异有统计学意义(P<0.05);观察组功能性滤过泡及非功能性滤过泡形成情况优于对照组,差异有统计学意义(P<0.05);干预前两组眼压、视力水平、视野缺损程度、生活质量相近,差异无统计学意义(P>0.05);干预后观察组眼压、视力水平、视野缺损程度、生活质量均优于对照组,差异有统计学意义(P<0.05)。观察组浅前房、前房出血等并发症发生率2.22%,低于对照组的17.77%,差异有统计学意义(P<0.05)。结论:改良小梁切除术联合丝裂霉素C治疗青光眼的应用效果确切,可有效改善视力和视野,降低眼压,改善患者生活质量,并发症少,值得推广应用。

鼻内窥镜下泪道浚通联合硅胶管植入治疗泪道阻塞的临床观察

目的:观察鼻内窥镜下泪道浚通联合硅胶管逆行植入和丝裂霉素C(MMC)应用治疗泪道阻塞的手术疗效。方法:鼻内窥镜下利用泪道浚通联合类Y形硅胶管规范泪道逆行植入和MMC应用,留置Y形管3mo,跟踪观察并统计其中106例106眼的治疗结果。结果:鼻内窥镜下泪道浚通后MMC应用,置留、拔管操作特别简单容易,创伤甚微。全部治疗在门诊完成,期间患者正常生活、工作、学习。3a以上随访治疗结果:有效以上率96.2%(102眼);显效以上率92.5%(98眼);治愈率84.9%(90眼);无效3.8%(4眼)。结论:鼻内窥镜下泪道浚通联合硅胶管逆行植入和MMC应用技术是治疗泪道阻塞的首选与补充方法,损伤小,成功率高,并发症少,手术费用低。

经上皮准分子激光角膜切削术中应用丝裂霉素C作用的观察

目的观察在经上皮准分子激光光学屈光性角膜切削术（TPRK）中应用丝裂霉素c（MMC）的作用。方法回顾性非随机对照研究。分析TPRK61例（122眼）的临床资料。所有患者分为两组：A组，30例（60眼）术中将浸有0．02％MMC的海绵片覆盖于角膜切削区20～40S。B组，31例（62眼）术中未用MMC。术后定期随访观察6个月。结果术后眼部刺激症状B组较轻，两组差异有统计学意义（t=7．582，P=0．000）；术后3d、10d角膜上皮修复更快，两组角膜上皮愈合情况差异有统计学意义（P=0．002、0．007）。随访3d、10d、1及3个月达术前最佳矫正视力（BCVA）两组差异无统计学意义（χ2=0．439，P=0．508; χ2=2．367，P=0．124；X2=0．370，P=0．543；χ2=0．919，P=0．338）。术后6个月角膜haze发生率两组差异无统计学意义（χ2=0．726，P=0．190）。结论TPRK术中不用MMC可减轻术后眼部刺激症状，角膜上皮修复较快，而且对视力恢复及角膜haze发生无影响。

地塞米松在复合式小梁切除术中应用的临床研究

目的评价地塞米松联合丝裂霉素在青光眼滤过术中的临床效果。方法 A组：小梁切除术应用0.5 mL的0.4 mg/mL丝裂霉素加0.5 mL（2.5 mg）地塞米松;B组：小梁切除术应用0.5 mL的0.4 mg/mL丝裂霉素＋0.5 mL生理盐水。观察两组术后眼压、视力、结膜充血、滤过泡及并发症等。每组80只眼、男性、年龄40-60岁、原发性闭角型青光眼、随访12个月。结果术后A组眼压控制显著优于B组,但差异无统计学意义（P〉0.05）,视力改善无明显差别（P〉0.05）,功能性滤过泡成功率高,结膜充血反应较轻,术后应用抗瘢痕增生药量减少。结论青光眼滤过术中应用地塞米松可减轻术后眼部充血及炎症反应,在临床实用中,取得良好的效果。