Lee D, Shin D H, Birt C M, Kim C, Kupin T H, Olivier M M, Khatana A K, Reed S Y
Kresge Eye Institute, Wayne State University, Detroit, Michigan 48201-1423, USA.
Ophthalmology. 1997 Dec;104(12):2126-35. doi: 10.1016/s0161-6420(97)30050-5.
The purpose of the study is to assess the effect of adjunctive intraoperative mitomycin C (MMC) in Molteno drainage device implantation for patients with recalcitrant glaucomas.
Forty-nine eyes of 49 patients who underwent one-stage, single-plate Molteno device implantation with adjunctive intraoperative MMC (0.5 mg/ml) for 3 to 5 minutes (MMC group) were compared to a historic control group of 51 eyes of 51 patients (control group) who received one-stage, single-plate Molteno device implantation without MMC. Success (survival) was defined as an intraocular pressure (IOP) between 6 and 21 mmHg, inclusive, with (qualified success) or without (complete success) glaucoma medications and with no additional glaucoma surgery, phthisis, implant removal, or loss of light perception.
Preoperative conditions were similar between the two groups. There was no significant difference in surgical survival rate between the two groups (P = 0.13, log-rank test). There also were no significant differences in the postoperative IOP levels and numbers of antiglaucoma medications between the two groups at all times (P > 0.05). Visual acuity was improved or remained within one line of preoperative visual acuity in 76.1% of the MMC group and 78.7% of the control group at 1 year after surgery (P = 0.76, chi-square test). Complications and reoperation for complications were similar in both groups (P > 0.05, chi-square test) except for the incidence of early postoperative hypotony and the total number of eyes with complications not requiring reoperation, which were more common in the MMC group (P = 0.027, 0.005, respectively, chi-square test). The most common complications included hypotony with or without a flat anterior chamber or choroidal detachment, followed by hyphema and tube plugging.
Molteno device implantation with adjunctive intraoperative MMC in patients with complicated glaucoma may not offer a better chance of surgical success compared with Molteno implantation without MMC.
本研究旨在评估术中辅助使用丝裂霉素C（MMC）在顽固性青光眼患者Molteno引流装置植入术中的效果。
将49例患者的49只眼作为MMC组，这些患者接受了一期单盘Molteno装置植入，并在术中辅助使用MMC（0.5mg/ml）3至5分钟；将51例患者的51只眼作为历史对照组（对照组），这些患者接受了一期单盘Molteno装置植入但未使用MMC。成功（存活）定义为眼压（IOP）在6至21mmHg之间（包括6和21mmHg），使用（合格成功）或不使用（完全成功）青光眼药物，且未进行额外的青光眼手术、眼球痨、植入物取出或无光感。
两组术前情况相似。两组手术存活率无显著差异（P = 0.13，对数秩检验）。两组术后各时间点的眼压水平和抗青光眼药物使用数量也无显著差异（P > 0.05）。术后1年，MMC组76.1%的患者视力提高或保持在术前视力的一行以内，对照组为78.7%（P = 0.76，卡方检验）。两组并发症及并发症再手术情况相似（P > 0.05，卡方检验），但术后早期低眼压发生率及无需再手术的并发症眼总数在MMC组更常见（分别为P = 0.027、0.005，卡方检验）。最常见的并发症包括伴有或不伴有无前房或脉络膜脱离的低眼压，其次是前房积血和引流管堵塞。
与未使用MMC的Molteno植入术相比，在复杂性青光眼患者中术中辅助使用MMC进行Molteno装置植入术可能不会带来更好的手术成功机会。
