Carlson D W, Alward W L, Barad J P, Zimmerman M B, Carney B L
Department of Ophthalmology, Wilford Hall Medical Center, Lackland AFB, USA.
Ophthalmology. 1997 Apr;104(4):719-24. doi: 10.1016/s0161-6420(97)30246-2.
The purpose of the study is to determine whether the intraoperative application of subconjunctival mitomycin C (MMC), during combined phacoemulsification and trabeculectomy, is an effective means of improving filtration, defined as overall lower intraocular pressure (IOP) and less antiglaucoma medication use.
Twenty-nine patients with a visually significant cataract and glaucoma were randomized, in a double-masked fashion, to receive intraoperative MMC (0.5 mg/ml) or placebo.
Follow-up ranged from 6 to 30 months (mean, 20 months). Postoperative visual acuity at 1 year was 20/40 or better in 14 of 15 eyes operated on in the placebo group and 13 of 14 eyes operated on in the MMC group. Intraocular pressure at 8 months averaged 15.2 +/- 1.5 mmHg in the placebo-treated eyes versus 12.3 +/- 1.6 mmHg in the MMC-treated eyes. At 12 months, IOPs averaged 16.2 +/- 1.5 mmHg in the placebo-treated eyes versus 12.6 +/- 1.0 mmHg in the MMC-treated eyes. On average, the MMC group had postoperative IOP levels 3.0 mmHg lower than did the placebo group (P = 0.04) throughout the study. In the placebo group, laser suture lysis was required in a greater number of patients (80% versus 43%) and to a greater extent (mean = 2.0 versus 0.7 suture lysed) (P < 0.05). At 12 months, 5 of the 15 patients in the placebo group required an average of 1.8 medications for IOP control, whereas 0 of the 14 patients in the MMC group needed IOP-lowering medications. A late endophthalmitis developed through an intact bleb in one patient in the MMC group; otherwise, complications were minimal in each group.
These results suggest that intraoperative MMC application, during combined phacoemulsification and trabeculectomy surgery, does improve early filtration as shown by overall lower IOPs and less antiglaucoma medication use.
本研究的目的是确定在白内障超声乳化吸除联合小梁切除术术中结膜下应用丝裂霉素C（MMC）是否是改善滤过的有效方法，滤过改善定义为总体眼内压（IOP）降低和抗青光眼药物使用减少。
29例患有明显视力障碍的白内障和青光眼患者以双盲方式随机分组，分别接受术中MMC（0.5mg/ml）或安慰剂。
随访时间为6至30个月（平均20个月）。安慰剂组15只手术眼中有14只、MMC组14只手术眼中有13只在术后1年的视力达到20/40或更好。安慰剂治疗组的眼睛在8个月时平均眼压为15.2±1.5mmHg，而MMC治疗组的眼睛为12.3±1.6mmHg。在12个月时，安慰剂治疗组的眼睛平均眼压为16.2±1.5mmHg，而MMC治疗组的眼睛为12.6±1.0mmHg。在整个研究过程中，MMC组术后眼压水平平均比安慰剂组低3.0mmHg（P = 0.04）。在安慰剂组中，更多患者（80%对43%）需要进行激光缝线松解，且松解程度更大（平均松解2.0根对0.7根缝线）（P < 0.05）。在12个月时，安慰剂组15例患者中有5例平均需要1.8种药物来控制眼压，而MMC组14例患者中没有需要降眼压药物的。MMC组有1例患者通过完整的滤过泡发生了晚期眼内炎；除此之外，每组的并发症都很少。
这些结果表明，在白内障超声乳化吸除联合小梁切除术中应用术中MMC，确实能改善早期滤过，表现为总体眼压降低和抗青光眼药物使用减少。
