S Khouri Albert, Huang Grace, Y Huang Linda
Associate Professor, Department of Ophthalmology, Rutgers University, Newark New Jersey, USA.
Resident Physician, Department of Ophthalmology, Icahn School of Medicine Mount Sinai, New York, USA.
J Curr Glaucoma Pract. 2017 Sep-Dec;11(3):101-106. doi: 10.5005/jp-journals-10028-1233. Epub 2017 Oct 27.
To determine the safety and efficacy of intraoperative injection of mitomycin C (MMC) against conventional sponge-applied MMC during trabeculectomy.
This study was a retrospective, comparative case series. Thirty eyes with primary open-angle glaucoma underwent consecutive trabeculectomies with MMC injection (injection group), and thirty eyes with sponge-applied MMC were as controls (sponge group). Data were collected preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Demographic data, applanation intraocular pressure (IOP), best-corrected visual acuity (VA), number of glaucoma medications, postoperative interventions, postoperative complications, and number of visits within 3 months were recorded. In order to stratify data, proportion of eyes achieving >30% IOP reduction from baseline with or without glaucoma medications was calculated and defined as surgical success.
Mean IOP reduction at 1 year was significant in both the injection and sponge groups from baseline (46.8 and 37.8% respectively). The injection group had overall lower postoperative IOP and comparable complete treatment success, defined as achieving >30% IOP reduction without glaucoma medications (p = 0.941). The number of postoperative visits within 3 months and the proportion of eyes needing 5-fluorouracil (5-FU) intervention were significantly lower in the injection group (p = 0.03, p = 0.04 respectively).
Injection of MMC was as safe and effective as sponge application with comparable estimated complete treatment success, less need for visits within 3 months, and 5-FU intervention.
Surgeons may consider intraopera-tive injection of MMC in appropriate patient cohorts given comparable safety and efficacy and several advantages over traditional sponge application. Further study in a prospective, larger, long-term manner is necessary to assess this modality. Khouri AS, Huang G, Huang LY. Intraoperative Injection Sponge-applied Mitomycin C during Trabeculectomy: One-year Study. J Curr Glaucoma Pract 2017;11(3):101-106.
确定小梁切除术中术中注射丝裂霉素C（MMC）相较于传统海绵敷用MMC的安全性和有效性。
本研究为回顾性、比较性病例系列研究。30例原发性开角型青光眼患者连续接受MMC注射小梁切除术（注射组），30例接受海绵敷用MMC的患者作为对照组（海绵组）。术前及术后1天、1周、1个月、3个月、6个月和1年收集数据。记录人口统计学数据、压平眼压（IOP）、最佳矫正视力（VA）、青光眼用药数量、术后干预措施、术后并发症以及3个月内的就诊次数。为了对数据进行分层，计算并定义眼压从基线降低>30%且使用或未使用青光眼药物的眼的比例为手术成功。
注射组和海绵组1年时平均眼压较基线均显著降低（分别为46.8%和37.8%）。注射组术后眼压总体较低，且完全治疗成功率相当，定义为眼压降低>30%且未使用青光眼药物（p = 0.941）。注射组3个月内的术后就诊次数及需要5-氟尿嘧啶（5-FU）干预的眼的比例显著更低（分别为p = 0.03，p = 0.04）。
注射MMC与海绵敷用一样安全有效，估计完全治疗成功率相当，3个月内就诊需求及5-FU干预更少。
鉴于安全性和有效性相当且相较于传统海绵敷用有若干优势，外科医生在合适的患者群体中可考虑术中注射MMC。有必要进行前瞻性、更大规模、长期的进一步研究来评估这种方式。Khouri AS，Huang G，Huang LY。小梁切除术中术中注射与海绵敷用丝裂霉素C：一年研究。《当代青光眼实践杂志》2017；11(3)：101 - 106。
