Quist Michael S, Brown Ninita, Bicket Amanda K, Herndon Leon W
Department of Ophthalmology, Duke University, Durham, NC.
J Glaucoma. 2018 Feb;27(2):148-156. doi: 10.1097/IJG.0000000000000830.
Traditionally, during trabeculectomy, Mitomycin-C (MMC) is applied to the tissues using surgical sponges. However, alternate modes of application exist. This study assessed the success rates, complication rates, final intraocular pressure (IOP), and bleb characteristics between patients receiving subtenon MMC application by sponge versus irrigation.
A total of 100 patients with glaucoma were enrolled and each was randomized to 1 of the 2 treatment groups. Patients underwent trabeculectomy with Ex-PRESS shunt and MMC placement and were followed for 6 months. Complication rates assessed included bleb failure, bleb leaks, bleb encapsulation, and hypotony, amongst others. Additional factors evaluated included bleb morphology, glaucoma drop usage, Fluorouracil (5-FU) application, bleb revision, and subsequent glaucoma surgery.
The irrigation method provided greater IOP lowering effects (P=0.03); correspondingly the irrigation group had higher rates of hypotony (P=0.03) but with no significant consequences. Patients who had trabeculectomy/Ex-PRESS alone had greater IOP reduction than those who had concurrent cataract surgery (P<0.001). The sponge group had higher rates of 5-FU use (P=0.007) and higher reoperation rates (P=0.02) when compared with the irrigation group. Success was defined as achieving 4 mm Hg≤IOP≤15 mm Hg without any anatomical bleb failure or subsequent glaucoma surgery. The overall success rate was 87%.
Application of subtenon MMC by irrigation seems to provide improved short-term outcomes compared with application with sponges. With a similar safety profile, the irrigation method provides better IOP control, and decreases the need for further clinical/surgical intervention in the short-term after trabeculectomy. Longer-term studies will be useful in analyzing if these differences persist with time.
传统上，小梁切除术期间，丝裂霉素-C（MMC）通过手术海绵应用于组织。然而，存在其他应用方式。本研究评估了通过海绵与冲洗进行球结膜下MMC应用的患者之间的成功率、并发症发生率、最终眼压（IOP）和滤过泡特征。
共纳入100例青光眼患者，将其随机分为2个治疗组中的1组。患者接受Ex-PRESS分流小梁切除术及MMC植入，并随访6个月。评估的并发症发生率包括滤过泡失败、滤过泡渗漏、滤过泡包裹和低眼压等。评估的其他因素包括滤过泡形态、青光眼滴眼液使用情况、氟尿嘧啶（5-FU）应用、滤过泡修复及后续青光眼手术。
冲洗法降低眼压效果更佳（P = 0.03）；相应地，冲洗组低眼压发生率更高（P = 0.03），但无显著不良后果。单纯接受小梁切除术/Ex-PRESS的患者眼压降低幅度大于同时接受白内障手术的患者（P<0.001）。与冲洗组相比，海绵组5-FU使用率更高（P = 0.007），再次手术率更高（P = 0.02）。成功定义为眼压达到4 mmHg≤IOP≤15 mmHg，且无任何解剖学滤过泡失败或后续青光眼手术。总体成功率为87%。
与通过海绵应用相比，通过冲洗进行球结膜下MMC应用似乎能改善短期预后。在安全性相似的情况下，冲洗法能更好地控制眼压，并减少小梁切除术后短期内进一步临床/手术干预的需求。长期研究将有助于分析这些差异是否随时间持续存在。
