Department of Ophthalmology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Department of Ophthalmology, Turku University Hospital, University of Turku, Turku, Finland.
Acta Ophthalmol. 2018 Mar;96(2):154-160. doi: 10.1111/aos.13529. Epub 2017 Aug 21.
To study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).
We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits.
A total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p = 0.002) and 10 (5-13) mmHg (p < 0.001). The overall (groups combined) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p = 0.48 and p = 0.25). Goniopuncture was performed in 87% and 100% of eyes in the MMC and non-MMC groups (p = 0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p = 0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma.
In NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications.
研究伴有或不伴有丝裂霉素 C（MMC）的深层巩膜切除术治疗正常眼压性青光眼（NTG）的长期疗效。
我们前瞻性地分析了连续的随机接受手术治疗的患者，这些患者被分为接受 MMC 治疗（MMC 组）和不接受 MMC 治疗（非 MMC 组）。如果手术后无需药物治疗即可将术前眼压（IOP）水平降低 25%，则手术被认为是完全成功的；如果需要药物治疗才能达到相同的限制，则手术被认为是合格成功。
共纳入 37 例患者，其中 MMC 组 15 例，非 MMC 组 22 例。中位（范围）随访时间为 7.9（1.0-9.0）年，有 3 例（8%）患者失访。MMC 组和非 MMC 组的术前 IOP 分别为 15（11-21）mmHg 和 15（10-19）mmHg。在最后 6-9 年的随访中，IOP 显著降低至 9（2-13）mmHg（p=0.002）和 10（5-13）mmHg（p<0.001）。总体（两组合并）完全和合格成功率分别为 50%和 71%，两组之间无显著差异（p=0.48 和 p=0.25）。在 MMC 组和非 MMC 组中，分别有 87%和 100%的眼行房角穿刺术（p=0.14）。MMC 组行 MMC 注射针穿刺 0（0-1）次，而非 MMC 组行 0.5（0-4）次（p=0.056）。我们未发现任何虹膜炎、浅前房、低眼压性黄斑病变、脉络膜渗漏、迟发性滤泡漏、滤泡炎、眼内炎或恶性青光眼的病例。
在 NTG 中，深层巩膜切除术可实现长期显著的眼压降低，且发生威胁视力的并发症的风险较低。
