Collignon-Brach J
Centre Hospitalier Universitaire, Service d'Ophtalmologie, Université de Liège.
Bull Soc Belge Ophtalmol. 1993;247(1):79-86.
Glaucoma filtering surgery fails because of scarring of the filtering bleb. Fibroblasts proliferation from the episclera and Tenon capsule play an important role in the scarring process. The use of antimetabolites in glaucoma filtering surgery have a beneficial effect on the lowering of intraocular pressure especially in eye at poor surgery prognosis. They inhibit the fibroblasts proliferation and subsequent scarring of filtering bleb. 5 fluorouracil improves chance of success with filtering surgery but the necessity of multiple subconjunctival injections has many disadvantages including discomfort for the patient and ocular surface problems such as corneal defect and conjunctival wound leak. Mitomycin C with its focal applications limits the toxic effects to tissue directly exposed to the drug. A single intra-operative application leads to a more hypotensive effect with less corneal complications which are two major advantages of this treatment (Kitazawa and al.): Success rate at one year without medical treatment: 88% with MMC-40% with 5 FU. Different tissue culture studies as well as clinical studies demonstrate that the antiproliferative effect of MMC is 100 times more powerful than 5 fluorouracil. Mitomycin C might probably interfere with other steps in the wound healing process. Mitomycin C seems to be a better treatment than 5 fluorouracil. Nevertheless long term randomized prospective human studies are necessary to confirm it.
青光眼滤过手术失败是因为滤过泡瘢痕形成。来自巩膜表层和Tenon囊的成纤维细胞增殖在瘢痕形成过程中起重要作用。在青光眼滤过手术中使用抗代谢药物对降低眼压有有益作用，尤其是在手术预后较差的眼中。它们抑制成纤维细胞增殖以及滤过泡随后的瘢痕形成。5-氟尿嘧啶提高了滤过手术成功的几率，但多次结膜下注射的必要性有许多缺点，包括给患者带来不适以及眼部表面问题，如角膜缺损和结膜伤口渗漏。丝裂霉素C局部应用可将毒性作用局限于直接接触药物的组织。术中单次应用可产生更强的降压效果，且角膜并发症更少，这是该治疗的两个主要优点（北泽等人）：未经药物治疗一年的成功率：丝裂霉素C为88%，5-氟尿嘧啶为40%。不同的组织培养研究以及临床研究表明，丝裂霉素C的抗增殖作用比5-氟尿嘧啶强100倍。丝裂霉素C可能会干扰伤口愈合过程中的其他步骤。丝裂霉素C似乎是比5-氟尿嘧啶更好的治疗方法。然而，需要长期随机前瞻性人体研究来证实这一点。
