Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield, UK.
J Glaucoma. 2011 Jan;20(1):21-7. doi: 10.1097/IJG.0b013e3181ccb926.
To report the long-term outcomes of deep sclerectomy (DS) with intraoperative mitomycin C in eyes with no previous ocular surgery.
One hundred ninety-four eyes of 160 consecutive patients who had primary phakic DS between August 2001 and April 2005 were included from a database on all glaucoma surgery in our department. The mean follow-up was 48±15 months (median, 49 mo).
The probability of a final intraocular pressure (IOP) of less than 19, 16, and 13 mm Hg without medications or needle revisions at 1 year was 85% (80% to 90%, 95% confidence intervals), 83% (78% to 88%), and 68% (62% to 75%). At 3 years was 78% (73% to 85%), 76% (60% to 82%), and 60% (53% to 67%), respectively. The probability of performing Nd:YAG laser goniopuncture (LGP) was 66% (59% to 74%) 3 years after DS. Further glaucoma surgery was undertaken in 16 eyes (8.2%). Intraoperative perforations occurred in 28 eyes (14.4%). Iris synechiae or incarceration in the goniopuncture were observed in 54 (27.8%) during follow-up and were associated with an acute symptomatic rise in IOP in 6 eyes (3.1%). Hypotony with maculopathy was seen after LGP and needling in 3 eyes (1.5%). Blebitis developed in 2 eyes (1%) after LGP and endophthalmitis in 1 eye (0.5%), which had an intraoperative perforation.
Mitomycin C-enhanced primary DS effectively reduces IOP in primary phakic open-angle glaucoma. Most eyes required LGP to maintain IOP control. However, complications associated with partial-thickness procedures, like bleb-related infections and hypotonic maculopathy were observed.
报告术中应用丝裂霉素 C 的深层巩膜切除术（DS）在无既往眼部手术的眼中的长期疗效。
从我们科室所有青光眼手术数据库中选取 2001 年 8 月至 2005 年 4 月间行初次单纯 PHACODS 的 160 例连续患者的 194 只眼。平均随访 48±15 个月（中位数，49mo）。
1 年时，无需药物或针拨治疗，最终眼压（IOP）<19、16、13mmHg 的概率分别为 85%（80%90%，95%置信区间）、83%（78%88%）和 68%（62%75%）。3 年时，相应概率分别为 78%（73%85%）、76%（60%82%）和 60%（53%67%）。DS 后 3 年行 Nd：YAG 激光前房角切开术（LGP）的概率为 66%（59%~74%）。16 只眼（8.2%）行进一步青光眼手术。术中发生穿孔 28 只眼（14.4%）。随访中观察到 54 只眼（27.8%）虹膜周边黏连或嵌顿，其中 6 只眼（3.1%）发生急性症状性眼压升高。LGP 和针刺后 3 只眼（1.5%）出现黄斑病变伴低眼压，LGP 后 2 只眼（1%）发生针道炎，1 只眼（0.5%）发生眼内炎，均与术中穿孔有关。
丝裂霉素 C 增强的初次 PHACODS 可有效降低原发性开角型青光眼的眼内压。大多数眼需要 LGP 来维持眼压控制。然而，仍观察到与部分厚度手术相关的并发症，如与滤泡相关的感染和低眼压性黄斑病变。
