Turáçli M E, Gündüz K, Aktan G, Sencer H
Department of Ophthalmology, Faculty of Medicine, University of Ankara, Turkey.
Int Ophthalmol. 1995;19(6):337-46. doi: 10.1007/BF00130852.
A prospective and randomized clinical trial was conducted to investigate the pressure-lowering effect of mitomycin C-aided trabeculectomy in the Turkish population. The scleral tissues excised during the operation were examined by light and electron microscopy. The study population consisted of 26 patients undergoing mitomycin C-aided trabeculectomy and another 26 patients subjected to trabeculectomy without mitomycin C serving as controls. The treatment groups consisted of primary open-angle and closed-angle glaucomas, congenital glaucomas, various types of secondary glaucomas and prior failed trabeculectomies. The decrease in IOP was more marked (P < 0.01) and the number of additional medications needed post-operatively was less in the mitomycin C group (P < 0.01). There were no serious complications except for transient hypotony in one mitomycin-treated eye. Transmission electron microscopic examinations showed differences between the control and mitomycin applied trabecular blocks. At the scleral dissection plane where mitomycin was applied, collagen fibrils were frayed with a loss of proteoglycan cross-links. Fibroblasts demonstrated pyknotic nuclei and loss of cell processes. In the control group, active fibroblasts and regular collagen structure were observed at this level. The middle and inner scleral layers were generally unaffected except for minor changes in some of the mitomycin-treated eyes. Our study showed mitomycin C to be safe and effective as adjunct to trabeculectomy in both primary open-angle, primary angle-closure, various secondary glaucomas and prior failed trabeculectomies. Transmission electron microscopic examinations of excised blocks showed disruption in collagen organization and cytopathic effects to fibroblasts. Mitomycin seemed to affect the proteoglycan cross-links between collagen fibrils after its application.
开展了一项前瞻性随机临床试验，以研究丝裂霉素C辅助小梁切除术在土耳其人群中的降压效果。对手术中切除的巩膜组织进行光镜和电镜检查。研究人群包括26例行丝裂霉素C辅助小梁切除术的患者以及另外26例接受未使用丝裂霉素C的小梁切除术作为对照的患者。治疗组包括原发性开角型和闭角型青光眼、先天性青光眼、各种类型的继发性青光眼以及既往小梁切除术失败的患者。丝裂霉素C组的眼压降低更为显著（P<0.01），术后所需额外药物的数量更少（P<0.01）。除一只接受丝裂霉素治疗的眼睛出现短暂性低眼压外，未发生严重并发症。透射电镜检查显示对照小梁组织块和应用丝裂霉素的小梁组织块之间存在差异。在应用丝裂霉素的巩膜剥离平面，胶原纤维磨损，蛋白聚糖交联缺失。成纤维细胞显示核固缩和细胞突起丧失。在对照组，在此层面观察到活跃的成纤维细胞和规则的胶原结构。除部分接受丝裂霉素治疗的眼睛有轻微变化外，巩膜中层和内层一般未受影响。我们的研究表明，在原发性开角型青光眼、原发性闭角型青光眼、各种继发性青光眼以及既往小梁切除术失败的病例中，丝裂霉素C作为小梁切除术的辅助用药是安全有效的。对切除组织块的透射电镜检查显示胶原组织破坏和成纤维细胞的细胞病变效应。丝裂霉素应用后似乎影响了胶原纤维之间的蛋白聚糖交联。
