Ramakrishnan R, Michon J, Robin A L, Krishnadas R
Aravind Eye Hospital, Madurai, India.
Ophthalmology. 1993 Nov;100(11):1619-23. doi: 10.1016/s0161-6420(93)31427-2.
Glaucoma is a major cause of blindness in developing nations. Medical and laser therapy have limitations in this environment. Filtration surgery alone often fails in young, darkly pigmented, individuals. The authors, therefore, evaluated the safety and efficacy of filtration surgery, using topical mitomycin C, in patients undergoing trabeculectomy in India.
A short-term pilot study used mitomycin C at the time of trabeculectomy in a population of southern Indians with various forms of glaucoma. A single 5-minute intraoperative application of 0.4 mg/ml mitomycin C was given to 76 consecutive patients requiring filtration surgery for the control of intraocular pressure (IOP). All patients were admitted for 6 days and were seen at 6-week intervals for a minimum of 18 weeks.
The mean preoperative IOP was 35.3 +/- 9.6 mmHg. Postoperative IOP control was attained in 93.4% of patients as defined by an IOP of 20 mmHg or less without additional glaucoma medications (or an IOP reduction > 25% if the preoperative IOP was < or = 20 mmHg). No corneal epithelial defects or wound leaks were seen. The major complications were cataract formation and a decreased visual acuity in ten (13%) eyes.
Mitomycin C-aided trabeculectomy was highly successful in controlling IOP in this darkly pigmented population and may become an important adjunct in the treatment of glaucoma in developing countries.
青光眼是发展中国家失明的主要原因。在这种环境下，药物和激光治疗存在局限性。单纯的滤过性手术在年轻、色素沉着深的个体中常常失败。因此，作者评估了在印度接受小梁切除术的患者中使用局部丝裂霉素C进行滤过性手术的安全性和有效性。
一项短期试点研究在患有各种形式青光眼的印度南部人群中，于小梁切除术时使用丝裂霉素C。对76例连续需要滤过性手术以控制眼压（IOP）的患者，术中单次5分钟应用0.4mg/ml丝裂霉素C。所有患者住院6天，每6周复诊一次，至少随访18周。
术前平均眼压为35.3±9.6mmHg。93.4%的患者术后眼压得到控制，定义为眼压在20mmHg或更低且无需额外的青光眼药物治疗（如果术前眼压≤20mmHg，则眼压降低>25%）。未见角膜上皮缺损或伤口渗漏。主要并发症是白内障形成，10只眼（13%）视力下降。
丝裂霉素C辅助小梁切除术在控制该色素沉着深的人群的眼压方面非常成功，可能成为发展中国家青光眼治疗的重要辅助手段。
