Aktas Zeynep, Korkmaz Safak, Hasanreisoglu Murat, Onol Merih, Hasanreisoglu Berati
Department of Ophthalmology, Gazi University Medical Faculty, Ankara 06500, Turkey.
Department of Ophthalmology, Duzce Ataturk State Hospital, Düzce, 81010, Turkey.
Int J Ophthalmol. 2014 Feb 18;7(1):104-9. doi: 10.3980/j.issn.2222-3959.2014.01.19. eCollection 2014.
To evaluate the outcomes of trabeculectomy with large area mitomycin-C (MMC) application as a first line treatment in advanced glaucoma.
The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy (initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy (primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure (IOP) values, visual acuities, mean deviations, morphology and function of the blebs, necessity for anti-glaucomatous medications and surgical complications were reported.
There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg (27-68mmHg) and 29.0±4.4mmHg (21-41mmHg), respectively (P=0.001). Average preoperative mean deviations (MD) in Groups 1 and 2 were 17.4±2.8dB (13.3-23dB) and 17.9±2.4 dB (13.7-23.2dB), respectively (P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2 (P=0.005). No cystic bleb formation was observed in Group 1, whereas 4 patients from Group 2 (10.8 %) developed cystic bleb (P=0.040). No visually devastating complication has occurred in both Groups.
Initial trabeculectomy with large area MMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.
评估大面积应用丝裂霉素C（MMC）的小梁切除术作为晚期青光眼一线治疗的效果。
回顾性分析55例接受小梁切除术且有严重视野缺损患者的病历。患者被分为一线治疗组，即早期小梁切除术（初始小梁切除术 - 第1组）或长期药物治疗后行小梁切除术（原发性小梁切除术 - 第2组）。小梁切除术采用大面积MMC应用。报告眼压（IOP）值、视力、平均偏差、滤过泡的形态和功能、抗青光眼药物的必要性及手术并发症。
第1组有18例患者20只眼，第2组有37例患者37只眼。第1组和第2组术前平均IOP分别为40.2±10.0mmHg（27 - 68mmHg）和29.0±4.4mmHg（21 - 41mmHg）（P = 0.001）。第1组和第2组术前平均偏差（MD）分别为17.4±2.8dB（13.3 - 23dB）和17.9±2.4dB（13.7 - 23.2dB）（P = 0.441）。两组术后IOP均显著降低且具有可比性。第2组平均用药数量显著更高（P = 0.005）。第1组未观察到囊性滤过泡形成，而第2组有4例患者（10.8%）出现囊性滤过泡（P = 0.040）。两组均未发生严重视力损害并发症。
大面积应用MMC的初始小梁切除术可应用于晚期青光眼患者，并发症发生率较低。长期局部应用抗青光眼药物似乎会增加囊性滤过泡形成的风险。
