Bettin Paolo, Di Matteo Federico, Rabiolo Alessandro, Fiori Marina, Ciampi Carlo, Bandello Francesco
Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
J Glaucoma. 2016 Jun;25(6):e625-9. doi: 10.1097/IJG.0000000000000309.
To evaluate the long-term efficacy and safety of deep sclerectomy (DS) augmented with mitomycin C (MMC) and injectable cross-linked hyaluronic acid implant (Healaflow) in medically refractory glaucoma patients.
Our study included 96 eyes of 83 consecutive patients with open-angle glaucoma undergoing MMC-DS with injectable cross-linked hyaluronic acid implant. Mean follow-up was 28.6±20.0 months. Variables analyzed were: intraocular pressure (IOP), best-corrected visual acuity, mean number of antiglaucomatous drugs, execution of postoperative maneuvres (goniopuncture, bleb needling, and laser lysis of scleral flap sutures). Tonometric success was defined by 2 different thresholds, specifically IOP≤21 mm Hg (criterion A) and ≤15 mm Hg (criterion B). The procedure was defined as a qualified success if reached with medication and as a complete success if reached without.
For criterion A, qualified and complete success rates were 96% and 94%, respectively, at 12 months, 95% and 92% at 24 months, and 92% and 89% at 36 months. For criterion B, qualified and complete success rates were 75% and 75%, respectively, at 12 months, 62% and 60% at 24 months, and 59% and 58% at 36 months. Goniopuncture was performed in 56 eyes (58%), bleb needling with 5-fluorouracil injection in 4 eyes (5.1%), and laser release of scleral flap sutures in 4 eyes (4%). Six eyes required additional filtering surgery.
DS with Healaflow and MMC seems to be an effective and safe technique to lower IOP in patients affected by open-angle glaucoma, with few postoperative complications.
评估丝裂霉素C（MMC）联合可注射交联透明质酸植入物（Healaflow）辅助的深层巩膜切除术（DS）在药物治疗无效的青光眼患者中的长期疗效和安全性。
我们的研究纳入了83例连续的开角型青光眼患者的96只眼，这些患者接受了MMC-DS联合可注射交联透明质酸植入物治疗。平均随访时间为28.6±20.0个月。分析的变量包括：眼压（IOP）、最佳矫正视力、抗青光眼药物的平均使用数量、术后操作（前房穿刺、滤过泡针刺及巩膜瓣缝线激光松解）。眼压测量成功通过两种不同阈值定义，具体为IOP≤21 mmHg（标准A）和≤15 mmHg（标准B）。该手术在使用药物情况下达到上述标准则定义为合格成功，未使用药物情况下达到则定义为完全成功。
对于标准A，12个月时合格成功率和完全成功率分别为96%和94%，24个月时为95%和92%，36个月时为92%和89%。对于标准B，12个月时合格成功率和完全成功率分别为75%和75%，24个月时为62%和60%，36个月时为59%和58%。56只眼（58%）进行了前房穿刺，4只眼（5.1%）进行了滤过泡针刺联合5-氟尿嘧啶注射，4只眼（4%）进行了巩膜瓣缝线激光松解。6只眼需要额外的滤过性手术。
MMC联合Healaflow的DS似乎是一种有效且安全的降低开角型青光眼患者眼压的技术，术后并发症较少。
