Broadway D C, Grierson I, Stürmer J, Hitchings R A
Moorfields Eye Hospital, London, England.
Arch Ophthalmol. 1996 Mar;114(3):262-7. doi: 10.1001/archopht.1996.01100130258004.
To determine whether the adverse effects of antiglaucoma medications could be reversed before filtration surgery, potentially reducing the risk of subsequent failure.
One month before surgery, 30 patients who were receiving multiple antiglaucoma medications underwent an inferior bulbar conjunctival biopsy, ceased using sympathomimetic drops, and began treatment with topical corticosteroid, (1% fluorometholone four times daily). At the time of surgery two conjunctival biopsy specimens were obtained, one from the operation site (superior bulbar region), and one from the inferior bulbar region. The biopsy specimens were quantitatively analyzed by light microscopy. In addition, the outcome of first trabeculectomy for 16 of these patients was compared with that of 16 matched patients who had not undergone an altered preoperative regimen of topical therapy.
During a 1-month period a notable decrease occurred in the number of fibroblasts and inflammatory cells throughout the conjunctiva. Inferior bulbar conjunctiva was found to be representative of superior bulbar conjunctiva with respect to these changes. Furthermore, evidence comparing the matched patients suggested that the altered preoperative regimen may have improved the success rate of trabeculectomy.
The preoperative regimen used reversed the adverse conjunctival effect of topical medication. The regimen may be of clinical benefit in improving the success rate of trabeculectomy.
确定抗青光眼药物的不良反应在滤过手术前是否可以逆转，从而有可能降低后续手术失败的风险。
手术前一个月，30名正在使用多种抗青光眼药物的患者接受了下穹窿结膜活检，停用拟交感神经滴眼液，并开始使用局部皮质类固醇治疗（1%氟米龙，每日4次）。手术时获取两份结膜活检标本，一份取自手术部位（上穹窿区域），另一份取自下穹窿区域。通过光学显微镜对活检标本进行定量分析。此外，将其中16名患者首次小梁切除术的结果与16名未改变术前局部治疗方案的匹配患者的结果进行比较。
在1个月的时间里，整个结膜中的成纤维细胞和炎症细胞数量显著减少。发现下穹窿结膜在这些变化方面可代表上穹窿结膜。此外，对匹配患者的比较证据表明，改变术前治疗方案可能提高了小梁切除术的成功率。
所采用的术前治疗方案逆转了局部用药对结膜的不良影响。该方案可能对提高小梁切除术的成功率具有临床益处。
