Szymanski A
Silesian School of Medicine, Department of Ophthalmology, Katowice, Poland.
Int Ophthalmol. 1996;20(1-3):89-94. doi: 10.1007/BF00212952.
The purpose of this study is to evaluate the effect of trephination with free scleral auto-implant plug exposed to Mitomycin-C out of the eye, in surgical treatment of primary open-angle glaucoma (POAG), in comparison with efficacy of trabeculectomy with MMC (32 eyes with POAG of patients, younger than 55 years-group 1). Trephination with scleral auto-implant plug with MMC was done on 35 eyes of patients, younger than 55 years, with POAG (group 2). The postoperative follow-up was 28.52 +/- 8.78 months.
A limbal 1.0 mm diameter trephination is made beneath the limbus-based conjunctival flap, a small iridectomy is performed. From the external layers of the trephine button one third of the corneoscleral thickness, in the form of a thin disc, is excised. The scleral disc, a free auto-implant, is dipped into liquid containing MMC with concentration 0.2 mg/ml for 5 minutes, outside the eye. Afterwards the scleral disc soaked with MMC is carefully irrigated with 150 ml of BSS and placed in the external part of the trephine fistula in primary position and stabilized with two interrupted 10-0 nylon sutures. The operation is ended as a typical trabeculectomy. The final success rate in terms of IOP (IOP < 14 mmHg) was 100%, without or with antiglaucoma medication, in both groups, but the number of postoperative complications was significantly lower in group 2. Trephination with free scleral auto-implant plug soaked with MMC may represent a viable alternative to trabeculectomy with MMC; the scleral plug may be taken out of the eye and exposed to antimetabolite outside the eye to minimize toxicity.
本研究的目的是评估在原发性开角型青光眼（POAG）的手术治疗中，将暴露于丝裂霉素-C（MMC）的游离巩膜自体植入塞在眼外进行环钻术的效果，并与使用MMC的小梁切除术的疗效进行比较（32例年龄小于55岁的POAG患者，第1组）。对35例年龄小于55岁的POAG患者的眼睛进行了带MMC的巩膜自体植入塞环钻术（第2组）。术后随访时间为28.52±8.78个月。
在以角膜缘为基底的结膜瓣下进行直径1.0mm的角膜缘环钻术，行一小的虹膜切除术。从环钻钮的外层切除角膜巩膜厚度三分之一的薄盘状组织。将作为游离自体植入物的巩膜盘在眼外浸入含浓度为0.2mg/ml MMC的液体中5分钟。之后，用150ml平衡盐溶液仔细冲洗浸有MMC的巩膜盘，并将其置于环钻瘘管的外部原位，用两根间断的10-0尼龙缝线固定。手术以典型的小梁切除术结束。两组在眼压方面（眼压<14mmHg）的最终成功率均为100%，无论是否使用抗青光眼药物，但第2组术后并发症的数量明显更低。用浸有MMC的游离巩膜自体植入塞进行环钻术可能是使用MMC的小梁切除术的一种可行替代方法；巩膜塞可从眼中取出并在眼外暴露于抗代谢物以将毒性降至最低。
