丝裂霉素C辅助深层巩膜切除术

Deep sclerectomy augmented with mitomycin C.

作者信息

Anand N, Atherley C

机构信息

Department of Ophthalmology, Calderdale & Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield HD3 3EA, UK.

出版信息

Eye (Lond). 2005 Apr;19(4):442-50. doi: 10.1038/sj.eye.6701403.

DOI:10.1038/sj.eye.6701403

PMID:15746961

Abstract

AIMS

To investigate the comparative efficacy and safety of deep sclerectomy with and without intraoperative mitomycin C (MMC) application for lowering the intraocular pressure (IOP).

METHODS

A total of 71 eyes of 71 consecutive patients who had routine deep sclerectomy (DS), nonaugmented (DS-noMMC) or with mitomycin C (DS-MMC) augmentation (0.2 mg/ml for 2 min) and follow-up of 4 months or more were identified from an ongoing prospective database on glaucoma surgery. Indications for MMC use were the presence of risk factors for subconjunctival scarring and low target IOPs. MMC 0.2 mg/ml was applied in the sub-Tenons space for 2 min.

RESULTS

There were 19 eyes in the DS-noMMC group and 52 eyes in the DS-MMC group. In 11 eyes (15.5%), the procedure was complicated by intraoperative perforation of the trabeculo-Descemet's window. Eyes in the DS-MMC group had significantly lower IOPs (MANOVA, P = 0.04). Kaplan-Meier survival curve analysis showed that the probability of maintaining IOP below target IOP level, below 18 mmHg and below 14 mmHg at 1 year was 51, 67, and 35% for the DS-noMMC group and 80, 86, and 74% for the DS-MMC group. The survival rates of the DS-MMC group were not statistically significant (P = 0.06) when the success criterion was maintaining an IOP less than 18 mmHg but were significant for the other criteria, namely IOP less than target levels (P = 0.03) and less than 14 mmHg (P = 0.03). Nd:YAG goniopuncture to lower IOP to target levels was done more frequently in the DS-noMMC group (13 eyes, 81%) than the DS-MMC group (20 eyes, 45%) and this difference was significant (P = 0.03). The prevalence of avascular areas within filtration blebs and transconjunctival oozing of aqueous was significantly higher in the DS-MMC group (P < 0.01).

CONCLUSIONS

The use of intraoperative MMC during deep sclerectomy has a significant effect on the postoperative IOP and increases the probability of achieving target IOPs. However, our current technique of MMC application is associated with a higher incidence of avascular blebs and transconjunctival oozing.

摘要

目的

研究在不应用和应用术中丝裂霉素C（MMC）的情况下，深层巩膜切除术降低眼压（IOP）的疗效和安全性比较。

方法

从一个正在进行的青光眼手术前瞻性数据库中，确定了71例连续患者的71只眼睛，这些患者接受了常规深层巩膜切除术（DS），其中未增强组（DS-noMMC）或丝裂霉素C增强组（DS-MMC，0.2mg/ml，持续2分钟），并进行了4个月或更长时间的随访。应用MMC的指征为存在结膜下瘢痕形成风险因素和低目标眼压。将0.2mg/ml的MMC应用于Tenon囊下2分钟。

结果

DS-noMMC组有19只眼，DS-MMC组有52只眼。11只眼（15.5%）手术中出现小梁-Descemet膜窗穿孔并发症。DS-MMC组的眼压显著更低（多变量方差分析，P = 0.04）。Kaplan-Meier生存曲线分析显示，DS-noMMC组在1年时将眼压维持在目标眼压水平以下、低于18mmHg和低于14mmHg的概率分别为51%、67%和35%，DS-MMC组分别为80%、86%和74%。当成功标准为眼压维持低于18mmHg时，DS-MMC组的生存率无统计学意义（P = 0.06），但对于其他标准，即眼压低于目标水平（P = 0.03）和低于14mmHg（P = 0.03）有统计学意义。DS-noMMC组（13只眼，81%）比DS-MMC组（20只眼，45%）更频繁地进行Nd:YAG房角穿刺以将眼压降至目标水平，且这种差异有统计学意义（P = 0.03）。DS-MMC组滤过泡内无血管区域的发生率和房水经结膜渗漏的发生率显著更高（P < 0.01）。