Suominen Sakari, Harju Mika, Kurvinen Leena, Vesti Eija
Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
Acta Ophthalmol. 2014 Nov;92(7):701-6. doi: 10.1111/aos.12305. Epub 2013 Dec 21.
To compare the outcome of deep sclerectomy (DS) with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).
We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; mean ± SD; 64 ± 7 years) who underwent DS with a collagen implant. Patients were randomized to the MMC and non-MMC groups. Subconjunctival MMC (0.4 mg/ml for 3 min) was used intraoperatively in 15 of 37 eyes. We defined total success as 25% reduction in intraocular pressure (IOP) without medication. Follow-up time was 12 months.
The mean preoperative IOP was significantly reduced from 15.2 ± 2.8 mmHg to 9.3 ± 2.7 (p < 0.001) in the MMC group after 12-month follow-up and from 15.1 ± 2.9 mmHg to 11.8 ± 2.0 (p < 0.001) in the non-MMC group. At 12 months, the mean IOP was significantly lower in the MMC group (p = 0.003) compared with the non-MMC group. Total success was achieved in 10 of 15 eyes (67%) in MMC group and in nine of 22 eyes (41%) in non-MMC group (p = 0.12). The number of glaucoma medications was decreased from 2.2 ± 0.8 to 0.5 ± 1.2 in MMC group (p = 0.001) and from 2.6 ± 1.0 to 0.5 ± 0.7 in non-MMC group (p < 0.001). Goniopuncture was performed in seven eyes (47%) in the MMC group, compared with 16 eyes (73%) in the non-MMC group (p = 0.13). IOP < 10 mmHg was achieved in seven of 15 eyes in the MMC group and in two of 22 in the non-MMC group (p = 0.009). Complication rate was low, and no difference between groups was evident.
Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG. Intraoperative use of MMC results in lower postoperative IOP 12-month postoperatively without increased rate of complications.
比较在正常眼压性青光眼（NTG）患者中，行与不行丝裂霉素-C（MMC）的深层巩膜切除术（DS）的效果。
我们前瞻性分析了37例连续的NTG患者（年龄；平均±标准差；64±7岁）的37只眼，这些患者接受了带胶原植入物的DS。患者被随机分为MMC组和非MMC组。37眼中的15眼术中使用了结膜下MMC（0.4mg/ml，持续3分钟）。我们将眼压在不用药情况下降低25%定义为完全成功。随访时间为12个月。
12个月随访后，MMC组平均术前眼压从15.2±2.8mmHg显著降至9.3±2.7（p<0.001），非MMC组从15.1±2.9mmHg降至11.8±2.0（p<0.001）。12个月时，MMC组平均眼压显著低于非MMC组（p=0.003）。MMC组15眼中有10眼（67%）取得完全成功，非MMC组22眼中有9眼（41%）取得完全成功（p=0.12）。MMC组青光眼用药数量从2.2±0.8降至0.5±1.2（p=0.001），非MMC组从2.6±1.0降至0.5±0.7（p<0.001）。MMC组7眼（47%）进行了前房角穿刺，非MMC组为16眼（73%）（p=0.13）。MMC组15眼中有7眼眼压<10mmHg，非MMC组22眼中有2眼眼压<10mmHg（p=0.009）。并发症发生率低，两组之间无明显差异。
深层巩膜切除术在降低NTG患者眼压方面似乎有效且安全。术中使用MMC可使术后12个月眼压降低，且不增加并发症发生率。
