Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome

AIM： To compare the efficacy and safety of collagen matrix implant [Ologen（OLO） implant] versus mitomycin C（MMC） with subscleral trabeculectomy（SST） for the surgical treatment of congenital glaucoma（CG） in SturgeWeber Syndrome（SWS）.METHODS： A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group（MMC Group） included 10 eyes that were subjected to SST with MMC. The second group（OLO Group） included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant（OLO implant）. Postoperative evaluation included intraocular pressure（IOP） level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS： The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups（57.9% and 56.3%）. At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes（60%）, blebitis in only one eye（10%） treated with topical antibiotics, shallow anterior chamber in two eyes（20%）.CONCLUSION： This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

Deep sclerectomy-trabeculectomy with mitomycin C in treating glaucoma:postoperative long-term results

AIM:To determine the long-term postoperative outcomes of deep sclerectomy-trabeculectomy(DST)with mitomycin C(MMC)in the treatment of glaucoma.METHODS:Patients who underwent DST with MMC between 2010 and 2017 were included in this retrospective observational study.Complete success was defined as postoperative intraocular pressure(IOP)≤21 mm Hg or 30%reduction of IOP from baseline without any topical IOP-lowering agent,and qualified success defined as IOP≤21 mm Hg or 30%reduction of IOP from baseline with/without single topical agent.We evaluated the surgical success rates and complication rates of this procedure,as well as described the IOP profiles,best corrected visual acuity(BCVA)profiles and mean deviations(MD)of Humphrey visual field(HVF)24-2 performance at each follow-up time point.Mixed linear regression models were constructed to determine estimated predictive values of demographic data,use of topical IOPlowering agents,baseline and postoperative IOP and optical profiles(e.g.,BCVA and MD).RESULTS:Totally 98 eyes(mean postoperative followup 67.5mo)showed mean IOP reduction at every followup interval.Both median BCVA and MD of visual fields were maintained throughout the follow-up intervals when comparing to baseline.The number of IOP-lowering medications decreased from 2.8±0.8 to 0.3±0.7(P=0.068).Totally 84(85.7%)eyes achieved complete success at final follow-up.Transient hyphaema and transient choroidal effusion developed in 15 eyes(15.3%)and 11 eyes(11.2%)respectively.Other complications included shallow anterior chamber in 5 eyes(5.1%),bleb leak in 4 eyes(4.1%),bleb revision in 7 eyes(7.1%),bleb needling in 9 eyes(9.2%)and repeat trabeculectomy in 1 eye(1.0%).There was no endophthalmitis,blebitis or macular oedema.There was no significant correlation between postoperative IOP control and postoperative BCVA.CONCLUSION:DST with MMC demonstrates effective and sustained long-term outcomes in the treatment of glaucoma with no major complication.

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.

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.

Safety and efficacy of photodynamic therapy using BCECF-AM compared to mitomycin C in controlling post-operative fibrosis in a rabbit model of subscleral trabeculectomy

AIM： To evaluate the safety and efficacy of cellular photoablation using BCECF-AM [2, T-bis-（2-carboxyethyl） -5-（and-6）-carboxyfluorescein, acetoxymethyl ester mixed isomersl as a method to control postoperative fibrosis in subscleral trabeculectomy （SST） compared to mitomycin C （MMC） in a rabbit model. METHODS： A comparative prospective case-control animal study was conducted. Fourteen rabbits were subjected to SST with intraoperaUve use of wound modulating agents （MMC or BCECF-AM） of the right eye （study groups I and II respectively） and SST without use of intraoperative wound modulating agents for the left eye （control group II）. Two rabbits 4 eyes were considered as control group I with no surgical intervention. BCECF-AM was injected subconjunctivally 30min before surgery followed by intraoperative illumination with diffuse blue light for 10min. Antifibrotic efficacy was established by clinical response and histological examination. Clinical response was assessed by measuring intraocular pressure （lOP） at day 1, 3, 5, 7, 14, 21 postoperatively, Success was defined by 〉20.0% reduction in lOP from the preoperative values without anti-glaucoma medications. RESULTS： The mean percentage of reduction was 35.0% in the study group I with only one eye （14.3%） had 12.5% reduction. The mean percentage of reduction was 28.0% in the study group U with two eyes （28.6%） in study group II had 14.2% reduction each. Regarding the control group II, the mean percentage of reduction was 14.3% with 64.3% eyes had 〈20.0% reduction. There was a highly statistically significant difference between each of the study groups （right eyes） and the corresponding control group II （left eyes） as regards the mean postoperative lOP values started from day 5 in both study groups and this highly significant difference remained so till the end of the follow up period. Histologically, MMC treated blebs showed thinning of conjunctival epithelium with marked reduction of the goblet cells relative to control. Marked sub-epithelial edema was seen along with variable collagen dispersion. Mild cellularity was noted in sub-epithelial tissue. BCECF-AM treated blebs showed normal conjunctival epithelial thickness with abundant goblet cells. Mild sub- epithelial edema was noted along with moderate collagen dispersion. No histological abnormality was noted in the ciliary body or the cornea in any of the studied groups. CONCLUSION： Cellular photoablation using BCECF-AM is a safe and effective wound modulating agent to control postoperative fibrosis in trabeculectomy. However MMC considered as a more potent adjuvant to trabeculectomy than BCECF-AM in promoting IOP reduction.

Short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy for failed Ahmed glaucoma valve

AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy(ERC) after Ahmed glaucoma valve(AGV) failure.METHODS: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval.The number of anti-glaucoma medications(AGMs),intraocular pressure(IOP) and best corrected visual acuity(BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d.Intra-and postoperative complications were also recorded.Positive outcome was defined as IOP≤21 mm Hg with or without AGMs.RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range(IQR) 61.3-80] were included.Pseudoexfoliative glaucoma(n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo(IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0(IQR 3.0-4.0)to 2.0(IQR 1.5-3), the median IOP decreased from 26 mm Hg(IQR 22-29) to 16.5 mm Hg(IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1,3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes(36%), which were resolved spontaneously during the first week following ERC.CONCLUSION: ERC has a high success rate for shortterm management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.

Intraoperative Use of Mitomycin in Trabeculectomy

Mitomycin (0. 2 mg/ml) was applied intraoperatively to 26 glaucomatous patients (33 eyes) during conventional trabeculectomy procedure. Most of them were considered to be at high risk of surgical failure. The conjunctival flap was fornix-based in 9 patients (11 eyes). The success rate was 84. 8% without any serious side effect.

Risk factors for flat anterior chamber after glaucoma filtration surgery

AIM： To investigate the incidence rate and risk factors for grade Ⅲ flat anterior chamber（FAC） after glaucoma filtration surgery based on 5-year data.METHODS： Patients who underwent glaucoma filtration surgery in Daping hospital from January 2009 to December 2013 were enrolled in this retrospective study. The incidence of grade Ⅲ FAC following glaucoma filtration surgery was determined. Regression analysis was performed to investigate the influence of glaucoma type, surgical approach, age, and preoperative intraocular pressure（IOP） on the risk of postoperative FAC.RESULTS： A total of 2179 eyes receiving anti-glaucoma surgery were included. Ninety-one eyes suffered from postoperative FAC, with an overall incidence rate of 4.18%. Of 471 eyes with primary open angle glaucoma（POAG）, grade Ⅲ FAC occurred in only 3 eyes（0.64%）. Primary angleclosure glaucoma（PACG） was diagnosed in 1076 eyes, 39（3.62%） of which developed grade Ⅲ FAC, including 12 eyes（12/300, 4%） with acute PACG（aP ACG） and 27 eyes（27/776, 3.48%） with chronic PACG（c PACG）. Six of 259 eyes（2.32%） with secondary glaucoma, 28 of 186 eyes（15.05%） with neovasular glaucoma, 1 of 66 eyes（1.52%） with congenital glaucoma, and 14 of 115 eyes（12.17%） with remnant glaucoma suffered from grade Ⅲ FAC. Of 6 eyes with mixed glaucoma, none developed grade Ⅲ FAC after surgery. When stratified by surgical approach, 24 of 766 eyes（3.13%） undergoing trabeculectomy, 21 of 924 eyes（2.27%） treated by trabeculectomy plus mitomycin C（MMC）, 18 of 109 eyes（16.51%） undergoing Ahmed glaucoma valve implantation, 23 of 201 eyes（11.44%） managed by Ahmed implantation plus MMC, and 5 of 133 eyes（3.76%） treated by Ahmed implantation plus lens extraction or vitrectomy developed grade Ⅲ FAC. Logistic regression analysis revealed that factors including neovasular glaucoma, remnant glaucoma, glaucoma valve implantation, glaucoma valve implantation＋MMC, glaucoma valve implantation＋vitrectomy, age〉60 y, and IOP at admission 〉50 mm Hg were significantly associated with an increased risk for grade Ⅲ FAC.CONCLUSION： The overall incidence of grade Ⅲ FAC after glaucoma filtration surgery is 4.18%. Patients with neovasular glaucoma and remnant glaucoma are at a higher risk of developing FAC. Ahmed glaucoma valve implantation is associated with a higher risk for grade Ⅲ FAC compared with trabeculectomy. No significant correlation was observed between the use of MMC in glaucoma filtration surgery and the risk of postoperative FAC. Higher IOP at admission（〉50 mm Hg） and old age（〉60 y） are risk factors for grade Ⅲ FAC.

Novel CYP1B1 mutations and a possible prognostic use for surgical management of congenital glaucoma

AIM: To identify CYP1B1 gene mutations and evaluate their possible role as a prognostic factor for success rates in the surgical management of Egyptian congenital glaucoma patients.METHODS: Totally 42 eyes of 29 primary congenital glaucoma patients were operated on with combined trabeculotomy/trabeculectomy with mitomycin-C and followed up at 1 d, 1 wk, 1, 6 and 12 mo postoperatively. Genomic DNA was extracted from peripheral blood leukocytes. Coding regions of CYP1B1 gene were amplified using 13 pairs of primers, screened for mutations using single-strand conformation polymorphism followed by sequencing of both strands. Efficacy of the operation was graded as either a success [maintaining intraocular pressure(IOP) less than 21 mm Hg with or without antiglaucoma medication], or a failure(IOP more than 21 mm Hg with topical antiglaucoma medications). RESULTS: Seven novel mutations out of a total of 15 different mutations were found in the CYP1B1 genes of 14 patients(48.2%). The presence of CYP1B1 gene mutations did not correlate with the failure of the surgery(P=0.156, odds ratio=3.611, 95%CI, 0.56 to 22.89); while the positive consanguinity strongly correlated with failure of the initial procedure(P=0.016, odds ratio=11.25, 95%CI, 1.57 to 80.30). However, the Kaplan-Meier survival analysis revealed a significantly lower time of IOP control in the subgroup with mutations in CYP1B1 versus the congenital primary glaucoma group without mutations(log rank test, P=0.015).CONCLUSION: Seven new CYP1B1 mutations are identified in Egyptian patients. Patients harboring confirmed mutations suffered from early failure of the initial surgery. CYP1B1 mutations could be considered as a prognostic factor for surgery in primary congenital glaucoma.

A Study of Toxic Effect of Mitomycin C on Cultured Bovine Trabecular Meshwork Cells

Purpose:To explore the toxicity of Mitomycin C(MMC)on trabecular meshwork cells.Methods:Bovine trabecular meshwork cells were cultured in vitro and exposed to MMC of different concentrations,The cellular morphology,ultrastructure,mortality and phagocytosis was studied with light microscopy,transmission electron microscopy and methods of Wright's stain ,etc.Results:It was found that the toxic effect of MMC on the cells was in a dose-dependent mode,1×10^-2and1×10^-3mg/mlofMMC caused a large part of cells dead,1×10^-4and1×10^-5mg/mlof the drug had remarkable killing effect on the cells,1×10^-6mg/ml of MMC had still a mild toxicity,while1×10^-7mg/ml of MMChad not any influence on cellular morphology,mortality,and phagocytosis,etc.The safe concentration o n bovine trabecular meshwork cells was1×10^7mg/ml and the LD50 was between1×10^-3and1×10^-4mg/ml.Conclusions:Refering to previous data,we conclude that conventional clinical-application of MMC might do harm to trabecular meshwork cells.Eye Science2000;16:38-42.

XEN引流管植入联合丝裂霉素C治疗开角型青光眼

目的:探讨XEN引流管植入联合丝裂霉素C(MMC)治疗开角型青光眼(OAG)的临床疗效和安全性。方法:回顾性纳入OAG患者37例37眼,按初始接受抗青光眼手术治疗与否分为初次青光眼手术组17例17眼,多次青光眼手术组20例20眼,记录各随访时间点眼压、降眼压药物种类及并发症,术后随访时间大于1 a。结果:术后1 a,初次与多次青光眼手术组眼压分别从术前27.56±9.94、28.43±14.18 mmHg降至15.16±3.65、17.18±5.83 mmHg,分别下降55.01%和60.43%(t=4.863,P<0.001;t=3.255,P=0.004)。术后不同时间点两组眼压均较术前降低,时间有差异(F_(时间)=6.876,P_(时间)<0.001),组间及交互均无差异(F_(组间)=0.242,P_(组间)=0.626;F_(时间×组间)=0.959,P_(时间×组间)=0.458)。两组手术完全成功率分别为47%、45%,条件成功率为76%、75%(Z=-0.115,P=0.909),完全成功与条件成功累积生存率分析均无差异(χ^(2)=0.042,P=0.838;χ^(2)=0.004,P=0.949)。术后1 a随访时两组降眼压药物均由术前的3(2,3)种减少为1(0,2)种(Z=-3.289、-3.796,均P<0.001),组间无差异(Z=-0.581,P=0.561)。术后短期并发症以低眼压为主,前房出血次之,远期并发症以滤过泡包裹为主,除外引流管暴露及脱落各1眼,无其他严重并发症发生。结论:XEN引流管植入联合MMC治疗初次与多次青光眼手术OAG患眼均安全有效,但多次青光眼手术组滤过泡包裹发生率高。

Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-blockstyrene) surgical device for the treatment of primary open-angle glaucoma: a review

Trabeculectomy remains the‘gold standard’intraocular pressure(IOP)-lowering procedure for moderate-to-severe glaucoma;however,this approach is associated with the need for substantial post-operative management.Microinvasive glaucoma surgery(MIGS)procedures aim to reduce the need for intra-and post-operative management and provide a less invasive means of lowering IOP.Generally,MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma,highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma.The PRESERFLO®MicroShunt(formerly known as InnFocus MicroShunt)is an 8.5 mm-long(outer diameter 350μm;internal lumen diameter 70μm)glaucoma drainage device made from a highly biocompatible,bioinert material called poly(styrene-block-isobutylene-blockstyrene),or SIBS.The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided,but large enough to avoid being blocked by sloughed cells or pigment.The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule.The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive(relative to incisional surgery)surgical procedure,enabling precise control of placement without the need for gonioscopy,suture tension control,or suture lysis.The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure.The MicroShunt received ConformitéEuropéenne(CE)marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery.Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed;a Phase 3 multicenter,randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway.In preliminary studies,the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation,with an acceptable safety profile.This article summarizes current literature on the unique properties of the MicroShunt,the preliminary efficacy and safety findings,and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.

Cyclosporine A-loaded drug delivery systems inhibit scar formation after glaucoma surgery in rabbits

To the Editor:Glaucoma is the primary cause of irreversible blindness. Surgery is the main treatment option if intraocular pressure (IOP) cannot be controlled with medications. Local fibroblast proliferation and collagen deposition cause stenosis of drainage channels and scar formation in the filtration area, which are the main causes of unsuccessful antiglaucoma surgery. Application of mitomycin C during surgery is one of the most widely performed clinical interventions aimed at modifying the wound healing process. However, recent reports suggest that there is scope to further improve the outcomes of mitomycin C application in surgery.

MMC的PTMC-F127-PTMC温敏型水凝胶缓释剂对兔小梁切除术后滤过泡瘢痕化的调控作用

背景 难治性青光眼患者抗青光眼术中单次应用丝裂霉素C（MMC）并不能满足术后抗滤过区瘢痕化的需求.构建MMC载药缓释系统可维持术区MMC的有效药物浓度和持续抗瘢痕化作用,同时减少药物对眼组织的不良反应,对青光眼滤过术后瘢痕化的调控具有重要意义. 目的 探讨使用聚三亚甲基碳酸酯（PTMC）-F127-PTMC温敏型水凝胶作为MMC的药物载体对兔眼小梁切除术后瘢痕的抑制作用. 方法 将10 ～ 14周龄的新西兰白兔60只行小梁切除术,然后按随机数字表法分成单纯小梁切除术组,术后注射含0.05、0.10、0.20 g/L MMC的PTMC-F127-PTMC组以及空白PTMC-F127-PTMC组,均注射0.1ml.于术后第3天、第7天随机选取0.05、0.10、0.20 g/L MMC的PTMC-F127-PTMC组实验兔各2只眼,用30 G针头从角膜缘进针,取0.1 ml房水送至广州市分析测试中心进行高效液相色谱法-质谱联用分析（HPLC-MS）检测房水内MMC质量浓度;于术后第1、3、5、7、10、14、28天用卡尺测量滤过泡的宽度和长度,半定量估测滤过泡的高度以及用Tonopen眼压计测量实验眼眼压,术前和术后28 d用角膜内皮计数仪进行角膜内皮细胞计数;上述检查后处死动物并摘除眼球,制备眼球组织切片进行苏木精-伊红染色,光学显微镜下检查眼球组织的组织病理学改变.结果 PTMC-F127-PTMC水凝胶在体外可缓释MMC达20 d以上.术后单纯小梁切除术组,空白PTMC-F127-PTMC组,0.05、0.10、0.20 g/L MMC缓释组兔眼滤过泡平均生存时间分别为（5.3±0.4）、（5.5±0.4）、（12.2±1.0）、（25.1±0.9）、（26.7±0.7）d,各组间差异有统计学意义（F=123.200,P=0.000）.0.05g/LMMC PTMC-F127-PTMC组的滤过泡生存时间长于单纯小梁切除术组和空白PTMC-F127-PTMC组（均P=0.000）.0.10 g/L MMC和0.20 g/L MMC的PTMC-F127-PTMC组滤过泡的生存时间长于其余各组,差异均有统计意义（均P=0.000）,此两组术后眼压降低趋势与其余各组的差异有统计意义（F=53 010.000,P＜0.01）,但两组之间差异无统计意义（P＞0.05）.各组间术后28 d角膜内皮数目的改变差异均无统计意义（P＞0.05）,各组房水内均未检测到MMC.组织病理学检查发现,3个MMC缓释组炎症反应及纤维化程度比单纯小梁切除术组和空白PTMC-F127-PTMC组轻,而抑制增生作用更强. 结论 PTMC-F127-PTMC水凝胶可作为缓释载体,负载并缓释不同质量浓度的MMC.MMC缓释组能够在较低毒性作用下有效延长滤过泡的生存时间,调控兔眼小梁手术后的瘢痕化.

小梁切除术分别联合Ologen植入与丝裂霉素C治疗青光眼的有效性和安全性对比分析

目的对比分析小梁切除术分别联合Ologen植入与丝裂霉素C(mitomycin C,MMC)治疗青光眼的有效性和安全性。方法利用计算机检索Medline、EMBASE、Web of Science、Cochrane Central of Controlled Trials、Google Scholar等数据库,检索时间均从建库至2014年1月,并追溯纳入文献的参考文献。将获得的临床对照研究,通过纳入和排除标准限定,经质量评价后,采用Rev Man5.0软件进行Meta分析。结果纳入6篇临床对照研究(小梁切除术联合Ologen植入组114例,小梁切除术联合MMC组123例),质量评分均大于16分,为高质量文献。Meta分析结果显示,Ologen植入组术后患者眼压减低,但眼压降低百分率与MMC治疗组相比无明显差异。两组在青光眼药物种数治疗减少、手术成功率及术后并发症发生率等方面亦无明显差异。结论小梁切除术联合Ologen植入治疗青光眼在长期眼压控制成功率方面与小梁切除术联合MMC治疗效果相当,在避免MMC治疗引发的术后并发症方面无明显优势。

丝裂霉素C在小梁切除术治疗青光眼中的应用

目的评价丝裂霉素C在复合式小梁切除术治疗青光眼中的作用。方法选择2008年1月-2010年1月在我院眼科行MMC联合小梁切除术36例45眼和小梁切除术33例40眼的两组患者,年龄和性别基本匹配,进行回顾性比较分析。结果 MMC组出院时成功率97.8%,术后3、6、12个月成功率分别为93.3%、90.5%、82.5%。对照组出院时成功率95.0%,术后3、6、12个月成功率分别为71.8%、69.2%、67.6%。经过χ2检验,两组成功率比较差异有统计学意义(P<0.05)。结论小梁切除术联合丝裂霉素C能安全、有效地治疗青光眼。

小梁切除术中应用丝裂霉素C加可调整缝线

目的评价丝裂霉素C联合可调整缝线在小梁切除术中的作用。方法原发性开角型青光眼(POAG)或原发性闭角型青光眼(PACG)98例(124眼)。其中实验组45例(56眼),对照组53例(68眼),实验组采用丝裂霉素C联合可调整缝线小梁切除术,对照组采用单纯小梁切除术并对手术疗效、手术并发症及住院时间进行对照分析。结果两组术后眼压控制理想;术后浅前房、低眼压、前房出血、脉络膜脱离的发生率实验组均明显低于对照组,差异有硅著性(P<0.05);平均住院时间实验组明显低于对照组,差异有显著性(P<0.05)。结论丝裂霉素C联合可调整缝线的应用使小梁切除术的疗效更为确切,并可增加手术安全性,减少术后并发症。

青光眼小梁切除术中应用羊膜与丝裂霉素C的对比研究

目的:探讨羊膜和丝裂霉素C用于小梁切除术的临床疗效。方法:采用随机对照的方法,将28例(48只眼)青光眼患者分为羊膜组和丝裂霉素C组各24只眼,每组按年龄再细分为A、B两个小组。前者施行标准小梁切除术联合巩膜瓣下羊膜植入术,后者在术中一次性应用丝裂霉素C,浓度为0.2～0.4mg/ml,2～4min。随访6个月。结果:两组的手术完全成功率和条件成功率均高于标准小梁切除术,两组之间的成功率差异无显著性(P>0.05)。羊膜引起的并发症主要有术后浅前房,丝裂霉素C引起的并发症有薄壁滤过泡、术后浅前房、滤过泡渗漏、持续性低眼压、低眼压性黄斑病变等。结论:在小梁切除术中应用羊膜与丝裂霉素C,均能提高手术成功率,长期保留功能性滤过泡,恰当应用,可降低手术并发症。

丝裂霉素C及可调整缝线在小梁切除术中的应用

目的 观察丝裂霉素C联合可调整缝线在青光眼小梁切除术中应用的效果。方法 我院近3年来小梁切除术98例,术中采用巩膜瓣下放置含丝裂霉素C棉片2～5分钟,然后迅速以平衡盐溶液冲洗,切除2mm×3mm包括小梁在内的深层角巩膜缘组织,并做虹膜根部切除,用10-0尼龙线间断缝合巩膜瓣2～4针后,再于巩膜瓣一侧或两侧作1条或2条型巩膜瓣缝合。形成前房。术后2周、3月、1年及1.5年检查视力、眼压、前房、滤过泡等情况。结果 术后眼压控制良好,Ⅰ、Ⅱ度浅前房发生率低,滤过泡形成良好,43％视力保持不变或改善,炎症反应轻,并发症少。结论 丝裂霉素C可提高小梁切除术后眼压控制率,联合可调整缝线,可有效控制术后滤过水平,减少术后并发症,提高成功率。

丝裂霉素C结膜下注射联合针刺分离瘢痕性滤过泡疗效观察

目的:观察丝裂霉素C结膜下注射联合针刺分离对青光眼滤过性手术后瘢痕性滤过泡修复的临床效果。方法:对行滤过性手术后滤过泡瘢痕化的32例(32眼)进行滤过泡旁结膜下注射丝裂霉素C并进行针刺分离,观察分离前后视力、眼压、滤过泡形态和角膜内皮细胞计数等,结果进行统计学分析。结果:随访观察3～18(平均8.9±4.5)mo,针刺后3mo平均眼压由(30.6±6.2)mmHg降至(16.7±5.2)mmHg,总成功率为84%;随访≥6mo,眼压由治疗前(31.2±7.2)mmHg降至(17.8±5.8)mmHg,总成功率为84%;治疗前后眼压比较差异有非常显著性;随访6mo以上功能性滤过泡形成率为76%;角膜内皮细胞计数治疗前后差异无显著性。并发症有前房延缓形成3眼和前房少量积血3眼,3d后均自行恢复。结论:丝裂霉素C结膜下注射联合针刺分离对瘢痕性滤过泡的功能修复是一种安全有效的方法。