Shin D H, Hughes B A, Song M S, Kim C, Yang K J, Shah M I, Juzych M S, Obertynski T
Kresge Eye Institute, Wayne State University School of Medicine, Detroit 48201-1423, USA.
Ophthalmology. 1996 Nov;103(11):1925-33. doi: 10.1016/s0161-6420(96)30406-5.
The prerequisite for selective use of adjunctive mitomycin C (MMC) in primary glaucoma triple procedure (PGTP) is a better understanding of the prognostic factors. Therefore, the authors carried out the current study on the outcome of PGTP with and without adjunctive MMC to determine the prognostic factors for filtration failure of PGTP.
The study patients consisted of 174 consecutive primary open-angle glaucoma (POAG) patients undergoing PGTP. They were assigned randomly to either no adjunctive MMC (93 eyes of 93 patients) or adjunctive subconjunctival MMC (81 eyes of 81 patients) during the PGTP. After surgery, the patients were examined at regular intervals for visual acuity, intraocular pressure (IOP) control, medical therapy requirements, and complications. Filtration failure was determined according to two different criteria: (1) a less stringent set of criteria (criterion I) and (2) a more stringent set of criteria (criterion II).
There were no statistically significant differences between the groups with and without adjunctive MMC with respect to postoperative IOP, number of medications, and visual acuity outcome during mean follow-up (+/- standard deviation) of 25.1 +/- 5.5 months (P > 0.05 for each). However, there were prognostic factors for filtration failure in the control group but not in the MMC group. Black race, diabetes mellitus, preoperative IOP greater than or equal to 20 mmHg, and number of preoperative medications greater than two were found to be significant prognostic factors for filtration failure by criterion I. Black race, preoperative IOP greater than or equal to 20 mmHg and number of preoperative medications greater than 1 were significant prognostic factors for filtration failure by criterion II.
There was no statistically significant difference in the overall outcome of PGTP between control and MMC groups of nonselected patients with primary open-angle glaucoma. Black race, diabetes mellitus (by criterion I only), preoperative IOP greater than or equal to 20 mmHg, and number of preoperative medications greater than 2 (by criterion I) or greater than 1 (by criterion II) were found to be significant independent prognostic factors for filtration failure of PGTP without adjunctive MMC but no with adjunctive MMC. The use of adjunctive subconjunctival MMC in PGTP may have to be selective, primarily in those patients with primary open-angle glaucoma with one or more of the prognostic factors for filtration failure.
在原发性青光眼三联手术（PGTP）中选择性使用辅助性丝裂霉素C（MMC）的前提是更好地了解预后因素。因此，作者开展了这项关于有或无辅助性MMC的PGTP结果的研究，以确定PGTP滤过失败的预后因素。
研究患者包括174例连续接受PGTP的原发性开角型青光眼（POAG）患者。在PGTP期间，他们被随机分为不使用辅助性MMC组（93例患者的93只眼）或结膜下注射辅助性MMC组（81例患者的81只眼）。术后定期检查患者的视力、眼压（IOP）控制情况、药物治疗需求及并发症。滤过失败根据两种不同标准确定：（1）一组较宽松的标准（标准I）和（2）一组更严格的标准（标准II）。
在平均随访25.1±5.5个月期间，辅助性MMC组和非辅助性MMC组在术后眼压、用药数量和视力结果方面无统计学显著差异（每项P>0.05）。然而，对照组存在滤过失败的预后因素，而MMC组不存在。根据标准I，黑人种族、糖尿病、术前眼压大于或等于20 mmHg以及术前用药数量大于两种被发现是滤过失败的显著预后因素。根据标准II，黑人种族、术前眼压大于或等于20 mmHg以及术前用药数量大于1是滤过失败的显著预后因素。
在未选择的原发性开角型青光眼患者中，对照组和MMC组在PGTP的总体结果上无统计学显著差异。黑人种族、糖尿病（仅根据标准I）、术前眼压大于或等于20 mmHg以及术前用药数量大于2（根据标准I）或大于1（根据标准II）被发现是无辅助性MMC的PGTP滤过失败的显著独立预后因素，但有辅助性MMC时则不是。在PGTP中使用结膜下注射辅助性MMC可能必须是选择性的，主要针对那些具有一个或多个滤过失败预后因素的原发性开角型青光眼患者。
