Baumgartner J-M, Ngondi C E, Bovet J, Chiou A G
OnO, Ophthalmology Network Organisation, clinique de l'œil SA, avenue Bois-de-la-Chapelle 15, 1213 Onex, Genève, Suisse.
J Fr Ophtalmol. 2012 Nov;35(9):705-15. doi: 10.1016/j.jfo.2012.01.003. Epub 2012 Aug 24.
The multiple complications observed with trabeculectomy encouraged the re-emergence of non penetrating glaucoma surgery (NPGS) in the 1980's. Since then, several modifications have been developed in order to improve success rates and safety. We describe a new variation of deep sclerectomy (DS) in which we include an autologous corneal stromal implant soaked in mitomycin C and sutured to the scleral bed. Next, we compare intraocular pressure (IOP) at 2 years in three groups: I: DS; II: DS with autologous implant soaked in mitomycin C; III: conventional trabeculectomy.
All surgeries were performed by the same surgeon. There were 40, 22 and 15 eyes with medically uncontrolled primary open angle glaucoma (POAG) in groups I, II and III, respectively. All patients underwent the usual pre- and postoperative exams over 24 months. Selected patients underwent Visante OCT (Optical Coherence Tomography) (Carl Zeiss, Meditec, Inc. Germany) examination of their anterior segments.
Age and sex distribution in all three groups showed no statistical difference. Mean preoperative IOP was 24 ± 11 mmHg, 26 ± 14 mmHg and 25 ± 9 mmHg in group I, II and III, respectively (P>0.8). Mean postoperative IOP was 14 ± 3 mmHg, 10 ± 3 mmHg and 13 ± 4 mmHg (P=0.05) at six months; 16 ± 4 mmHg, 13 ± 3 mmHg and 11 ± 4 mmHg (P=0.02) at 12 months; and 15 ± 4 mmHg, 12 ± 3 mmHg and 14 ± 4 mmHg (P=0.2) at 24 months. Mean number of eye medications dropped from 1.85, 2.18 to 1.92 (P>0.05) preoperatively in group I, II, and III, respectively, to and 0.25, 0.05 to 0.18 (P=0.02) at 24 months. Patients with a visible implant under the bleb at 24 months had a better outcome.
DS with autologous implant significantly reduced IOP at 12 and 24 months. The results seem better than those obtained with collagen implants, most likely due to the persistence of the corneal implant under the bleb at 2 years. Its non-resorption and the minimal fibrosis at the level of the scleral bed may be related to the fact that it is an autologous material which has been soaked with mitomycin C.
DS with autologous implant soaked in mitomycin C, an inexpensive technique, demonstrates medium-term efficacy in the surgical management of POAG. Our results suggest that our technique may enhance both success rate and efficacy in lowering IOP. Further long-term studies are needed.
小梁切除术观察到的多种并发症促使非穿透性青光眼手术（NPGS）在20世纪80年代重新出现。从那时起，为了提高成功率和安全性，人们进行了多种改进。我们描述了一种深层巩膜切除术（DS）的新变体，其中我们将浸泡在丝裂霉素C中的自体角膜基质植入物包含在内并缝合到巩膜床。接下来，我们比较三组患者2年时的眼压（IOP）：I组：DS；II组：浸泡在丝裂霉素C中的自体植入物的DS；III组：传统小梁切除术。
所有手术均由同一位外科医生进行。I组、II组和III组分别有40只、22只和15只药物治疗无法控制的原发性开角型青光眼（POAG）患者的眼睛。所有患者在24个月内接受了常规的术前和术后检查。部分患者接受了Visante OCT（光学相干断层扫描）（德国卡尔蔡司医疗技术公司）眼前节检查。
三组患者的年龄和性别分布无统计学差异。I组、II组和III组术前平均眼压分别为24±11 mmHg、26±14 mmHg和25±9 mmHg（P>0.8）。术后6个月时平均眼压分别为14±3 mmHg、10±3 mmHg和13±4 mmHg（P = 0.05）；12个月时分别为16±4 mmHg、13±3 mmHg和11±4 mmHg（P = 0.02）；24个月时分别为15±4 mmHg、12±3 mmHg和14±4 mmHg（P = 0.2）。I组、II组和III组术前平均眼药数量分别从1.85、2.18降至1.92（P>0.05），24个月时分别降至0.25、0.05至0.18（P = 0.02）。24个月时在滤过泡下可见植入物的患者预后较好。
带自体植入物的DS在12个月和24个月时显著降低了眼压。结果似乎优于胶原植入物，这很可能是由于2年时角膜植入物在滤过泡下持续存在。其不吸收以及巩膜床水平的最小纤维化可能与它是一种浸泡过丝裂霉素C的自体材料这一事实有关。
浸泡在丝裂霉素C中的自体植入物的DS是一种廉价技术，在POAG手术治疗中显示出中期疗效。我们的结果表明我们的技术可能提高降低眼压的成功率和疗效。需要进一步的长期研究。
