Scott I U, Greenfield D S, Schiffman J, Nicolela M T, Rueda J C, Tsai J C, Palmberg P F
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Fla 33101-6880, USA.
Arch Ophthalmol. 1998 Mar;116(3):286-91. doi: 10.1001/archopht.116.3.286.
To investigate the efficacy and safety of adjunctive mitomycin when used during a primary trabeculectomy within a series of 89 consecutive patients at 1 and 2 years postoperatively.
A cohort study of all patients who underwent primary trabeculectomy, performed by one of us (P.F.P.), between April 1, 1991, and December 31, 1994. Patients received topical mitomycin in conjunction with a corneal safety valve incision. A trabeculectomy was considered "successful" if it resulted in an intraocular pressure (IOP) of 21 mm Hg or lower and a 30% or greater reduction in the IOP at and after 1 year of follow-up, with or without medications and without a reoperation for an elevated IOP. Survival analysis was used to calculate success rates.
The 1- and 2-year success rates were 85.4% and 77.9%, respectively. The mean IOP was reduced from 26.3 to 11.3 mm Hg at 1 year (n=68) and to 11.9 mm Hg at 2 years (n=56), with 60 (88.2%) of 68 patients off medication at 1 year and 47 (83.9%) of 56 patients off medication at 2 years. Trabeculectomy success rates were significantly lower in black compared with nonblack patients (76.2% vs 87.5% at 1 year, P=.03). Trabeculectomy failure occurred throughout the follow-up period. Endophthalmitis occurred in 2 (2.2%) of the patients, and hypotonia requiring revision occurred in 4 (4.5%) of the patients.
Primary trabeculectomy with the use of intraoperative mitomycin lowered the IOP by 30% or more in 78% (at 2 years) to 86% (at 1 year) of the cases and is associated with a marked reduction in the percentage of patients who require glaucoma medication. Success rates must be evaluated in light of such risks as endophthalmitis and hypotony.
在一组连续89例患者中，研究原发性小梁切除术期间辅助使用丝裂霉素在术后1年和2年时的疗效及安全性。
对1991年4月1日至1994年12月31日期间由我们其中一人（P.F.P.）实施原发性小梁切除术的所有患者进行队列研究。患者在角膜安全瓣切口的同时接受局部丝裂霉素治疗。如果小梁切除术导致眼压（IOP）降至21 mmHg或更低，且在随访1年及以后眼压降低30%或更多，无论是否使用药物且无需因眼压升高再次手术，则该小梁切除术被视为“成功”。采用生存分析来计算成功率。
1年和2年的成功率分别为85.4%和77.9%。眼压在1年时（n = 68）从26.3 mmHg降至11.3 mmHg，在2年时（n = 56）降至11.9 mmHg，68例患者中有60例（88.2%）在1年时停用药物，56例患者中有47例（83.9%）在2年时停用药物。与非黑人患者相比，黑人患者的小梁切除术成功率显著较低（1年时为76.2%对87.5%，P = 0.03）。小梁切除术失败发生在整个随访期间。2例（2.2%）患者发生眼内炎，4例（4.5%）患者发生需要修复的低眼压。
术中使用丝裂霉素的原发性小梁切除术在78%（2年时）至86%（1年时）的病例中使眼压降低3０%或更多，并且与需要青光眼药物治疗的患者百分比显著降低相关。必须根据眼内炎和低眼压等风险来评估成功率。
