Giudiceandrea Andrea, Toro Maria Emanuela, Scupola Andrea, Caporossi Aldo, Nociti Viviana, Mirabella Massimiliano, Salgarello Tommaso
Ophthalmology Division - Department of Head and Neck Surgery of Catholic University of "Sacro Cuore", Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
Catholic University of "Sacro Cuore", Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy.
Ophthalmol Ther. 2018 Dec;7(2):431-436. doi: 10.1007/s40123-018-0133-y. Epub 2018 Jun 7.
The purpose of this case series was to report the potential role of cyclophosphamide (CY) on bleb survival and to evaluate the safety of the trabeculectomy procedure under immunosuppressant systemic therapy.
Five eyes of five patients with unresponsive to intraocular pressure (IOP) lowering medication, progressive glaucoma, underwent mytomicin C (MMC) augmented phaco-trabeculectomy, performed by the same surgeon, A.G., during the period from May 2015 to January 2016. All patients were treated with low doses of systemic CY at the time of surgery, to control their relapsing progressive multiple sclerosis (MS) form.
During a mean follow-up period of 20.6 ± 8.1 months, for cases of "complete success" (when the IOP was < 15 mmHg without glaucoma therapy) were observed, while one case was classified as a "qualified success" since the IOP was ≤ 15 mmHg with β-blocker drops. There were no bleb infections, nor bleb-related complications.
This study reports the safety of performing the filtration surgical procedure under immunosuppressant systemic therapy and provides a possible explication of CY anti-fibrotic mechanism and its possible role on bleb survival. Our findings may suggest new perspectives of study in this field.
本病例系列的目的是报告环磷酰胺（CY）对滤过泡存活的潜在作用，并评估免疫抑制剂全身治疗下小梁切除术的安全性。
2015年5月至2016年1月期间，由同一位外科医生A.G.对5例眼压降低药物治疗无效的进行性青光眼患者的5只眼睛进行了丝裂霉素C（MMC）强化白内障超声乳化小梁切除术。所有患者在手术时均接受低剂量全身CY治疗，以控制其复发的进行性多发性硬化症（MS）。
在平均20.6±8.1个月的随访期内，观察到“完全成功”的病例（即未接受青光眼治疗时眼压<15 mmHg），而1例被归类为“合格成功”，因为使用β受体阻滞剂滴眼液后眼压≤15 mmHg。未发生滤过泡感染，也没有与滤过泡相关的并发症。
本研究报告了在免疫抑制剂全身治疗下进行滤过性手术的安全性，并对CY的抗纤维化机制及其对滤过泡存活的可能作用提供了一种可能的解释。我们的研究结果可能为该领域的研究提供新的视角。
