Pakravan Mohammad, Miraftabi Arezoo, Yazdani Shahin, Koohestani Nasim, Yaseri Mehdi
Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Ophthalmic Vis Res. 2011 Apr;6(2):78-86.
To compare the efficacy and safety of topical mitomycin-C (MMC) drops with that of subconjunctival 5-fluorouracil (5-FU) injections for management of early bleb failure after trabeculectomy or combined phacoemulsification and trabeculectomy with posterior chamber intraocular lens implantation (PT+PCIOL).
In a randomized comparative study, 37 eyes of 37 patients with impending early bleb failure received MMC 0.02% eye drops for 2 or 4 weeks (19 eyes) or subconjunctival 5-FU injections, 5 mg per dose (18 eyes). Complete success was defined as 5 < IOP ≤ 18 mmHg without medications.
Baseline characteristics were comparable between the study groups. However, there were more cases of combined PT+PCIOL in the MMC group [11 (57.9%) eyes versus 3 (16.7%) eyes, P = 0.017]. Mean preoperative IOP was 20.5±8.85 mmHg in the MMC group and 25.82±11.35 mmHg in the 5-FU group (P = 0.129), which was decreased to 13.2±6.1 and 10.6±4.8 mmHg respectively after 12 months (P = 0.159). There was no significant difference between the study groups in terms of bleb extent (P = 0.170), height (P = 0.178) or vascularity (P = 0.366). At the end of the study, complete success was achieved in 13 eyes (68.4%) in the MMC group and 14 eyes (77.8%) in the 5-FU group (P = 0.714). The survival of success at 8 months (median follow-up) was 89.5% and 86.5% in the MMC and 5-FU groups respectively; the number of glaucoma medications (P = 0.707) and best-corrected visual acuity (P = 0.550) were also comparable. Complication rates were similar in the study groups (P = 0.140).
Topical MMC 0.02% has comparable safety and efficacy to subconjunctival 5-FU injections for management of early bleb failure. Topical MMC 0.02% drops are more convenient and can be initiated first, while 5-FU injections may be reserved for eyes with an insufficient response to topical MMC.
比较局部应用丝裂霉素C（MMC）滴眼液与结膜下注射5-氟尿嘧啶（5-FU）治疗小梁切除术后或白内障超声乳化联合小梁切除术及后房型人工晶状体植入术（PT+PCIOL）后早期滤过泡失败的疗效和安全性。
在一项随机对照研究中，37例即将发生早期滤过泡失败的患者的37只眼，19只眼接受0.02%MMC滴眼液治疗2或4周，18只眼接受结膜下注射5-FU，每剂5mg。完全成功定义为不用药时眼压5＜IOP≤18mmHg。
研究组间基线特征具有可比性。然而，MMC组中PT+PCIOL联合手术的病例更多[11只眼（57.9%）对3只眼（16.7%），P = 0.017]。MMC组术前平均眼压为20.5±8.85mmHg，5-FU组为25.82±11.35mmHg（P = 0.129），12个月后分别降至13.2±6.1和10.6±4.8mmHg（P = 0.159）。研究组间滤过泡范围（P = 0.170）、高度（P = 0.178）或血管化程度（P = 0.366）无显著差异。研究结束时，MMC组13只眼（68.4%）达到完全成功，5-FU组14只眼（77.8%）达到完全成功（P = 0.714）。MMC组和5-FU组在8个月（中位随访时间）时成功的存活率分别为89.5%和86.5%；青光眼药物使用数量（P = 0.707）和最佳矫正视力（P = 0.550）也具有可比性。研究组间并发症发生率相似（P = 0.140）。
0.02%局部应用MMC与结膜下注射5-FU治疗早期滤过泡失败的安全性和疗效相当。0.02%MMC滴眼液更方便，可首先使用，而5-FU注射可用于对局部应用MMC反应不足的眼。
