Mandal A K, Walton D S, John T, Jayagandan A
VST Centre for Glaucoma Care, L. V. Prasad Eye Institute, Hyderabad, India.
Ophthalmology. 1997 Jun;104(6):996-1001; discussion 1002-3. doi: 10.1016/s0161-6420(97)30195-x.
The purpose of the study is to determine the safety and efficacy of mitomycin C-augmented trabeculectomy in children with developmental glaucoma treated previously by conventional procedures.
Retrospective review of all cases of developmental glaucoma with previously failed conventional procedures that underwent mitomycin C-augmented trabeculectomy between January 1992 and December 1994.
A total of 19 eyes of 13 patients were included in the study. Nineteen eyes included primary congenital glaucoma (15 eyes) with documented failure of primary trabeculotomy, Axenfeld-Reiger syndrome (2 eyes) and aniridia (2 eyes).
Mitomycin C-augmented (0.4 mg/ml for 3 minutes) trabeculectomy was the chosen intervention.
Preoperative and postoperative intraocular pressures (IOPs), visual acuities, success rate, bleb characteristics, time of surgical failure, and complications were the main outcome measures.
The mean IOP was reduced from a preoperative level of 33.74 +/- 10.70 mmHg to 11.89 +/- 1.33 mmHg (P < 0.0001) with the percentage reduction in IOP being 64.75. The mean follow-up was 19.52 +/- 2.65 months. Visual acuity was maintained in all the cases after surgery. Complete success as defined in the authors' study was achieved in 18 eyes (94.74%). Only one patient was classified as a qualified success. The bleb was characterized by its large elevated, avascular, transparent appearance in all the eyes. The only significant complication was retinal detachment in an eye with buphthalmos, aphakia, and large axial length. However, the retina was reattached successfully by retinal reattachment surgery, and visual acuity improved to the preoperative level of 20/200. It was not possible to determine the cause of retinal detachment or to assess the possible role of mitomycin C in this complication.
Mitomycin C-augmented trabeculectomy is a viable option in eyes with failed conventional trabeculotomy surgery.
本研究旨在确定丝裂霉素C辅助小梁切除术治疗既往接受过传统手术的发育性青光眼患儿的安全性和有效性。
回顾性分析1992年1月至1994年12月期间所有既往传统手术失败后接受丝裂霉素C辅助小梁切除术的发育性青光眼病例。
本研究共纳入13例患者的19只眼。19只眼中包括原发性先天性青光眼（15只眼）且有原发性小梁切开术失败的记录、Axenfeld-Rieger综合征（2只眼）和无虹膜症（2只眼）。
选择丝裂霉素C辅助（0.4mg/ml，持续3分钟）小梁切除术作为干预措施。
术前和术后眼压（IOP）、视力、成功率、滤过泡特征、手术失败时间及并发症为主要观察指标。
平均眼压从术前的33.74±10.70mmHg降至11.89±1.33mmHg（P<0.0001），眼压降低百分比为64.75%。平均随访时间为19.52±2.65个月。术后所有病例视力均得以维持。根据作者研究定义的完全成功在18只眼中实现（94.74%）。仅1例患者被分类为合格成功。所有眼中滤过泡的特征为大的、隆起的、无血管的、透明外观。唯一显著的并发症是一只患有牛眼、无晶状体和眼轴过长的眼睛发生视网膜脱离。然而，通过视网膜复位手术视网膜成功复位，视力提高到术前20/200的水平。无法确定视网膜脱离的原因或评估丝裂霉素C在该并发症中的可能作用。
丝裂霉素C辅助小梁切除术是传统小梁切开术手术失败的眼中一种可行的选择。
