Shin D H, Kim Y Y, Sheth N, Ren J, Shah M, Kim C, Yang K J
Kresge Eye Institute, Wayne State University School of Medicine, Detroit, Michigan 48201-1423, USA.
Ophthalmology. 1998 Apr;105(4):740-5. doi: 10.1016/S0161-6420(98)94032-5.
This study aimed to investigate whether previously failed glaucoma filtration surgery is a risk factor for filtration failure of subsequent trabeculectomy combined with cataract surgery and to determine the role of adjunctive mitomycin C (MMC) in the secondary glaucoma triple procedure (SGTP) as compared to primary glaucoma triple procedure (PGTP).
A prospective, controlled study that was randomized with respect to assignment to adjunctive MMC and a case-control design with respect to comparisons between SGTP and PGTP was studied.
The SGTP group consisted of 49 eyes of 49 consecutive patients with primary open-angle glaucoma with a history of glaucoma filtration surgery requiring glaucoma medical therapy and in need of cataract surgery, randomized to adjunctive MMC (SGTP MMC subgroup of 21 eyes) and no adjunctive MMC (SGTP control subgroup of 28 eyes). The PGTP group consisted of 49 PGTP cases closely matched to the SGTP cases with respect to age, race, gender, MMC use, C:D ratio, and systemic diseases.
Trabeculectomy combined with phacoemulsification and a small incision (5 x 6 mm), all polymethylmethacrylate posterior chamber intraocular lens implantation with or without adjunctive MMC (0.5 mg/ml for 1 minute), was performed.
Surgery failure was defined as the need of an additional intraocular procedure or the need of more than one medication to achieve intraocular pressure control to the target level. Intragroup and intergroup comparisons were made with respect to filtration outcome among the SGTP and PGTP patients.
Without adjunctive MMC, filtration success was significantly less in SGTP than in PGTP (P = 0.03). Adjunctive MMC significantly increased the success rate of SGTP (P = 0.02) but not that of PGTP (P = 0.89) over the average follow-up period of 2 years.
Previously failed glaucoma filtration surgery is a significant risk factor for the filtration failure of combined surgery. Intraoperative use of adjunctive MMC significantly improves the filtration success rate of SGTP.
本研究旨在调查既往青光眼滤过手术失败是否是后续小梁切除术联合白内障手术滤过失败的危险因素，并确定与原发性青光眼三联手术（PGTP）相比，辅助丝裂霉素C（MMC）在继发性青光眼三联手术（SGTP）中的作用。
一项前瞻性对照研究，在辅助MMC的分配方面进行随机分组，并对SGTP和PGTP之间的比较采用病例对照设计。
SGTP组由49例连续的原发性开角型青光眼患者的49只眼组成，这些患者有青光眼滤过手术史，需要青光眼药物治疗且需要白内障手术，随机分为辅助MMC组（SGTP MMC亚组，21只眼）和无辅助MMC组（SGTP对照组，28只眼）。PGTP组由49例PGTP病例组成，在年龄、种族、性别、MMC使用、C:D比值和全身疾病方面与SGTP病例密切匹配。
进行小梁切除术联合超声乳化和小切口（5×6mm），所有患者均植入聚甲基丙烯酸甲酯后房型人工晶状体，有或无辅助MMC（0.5mg/ml，持续1分钟）。
手术失败定义为需要额外的眼内手术或需要使用不止一种药物来将眼压控制到目标水平。对SGTP和PGTP患者的滤过结果进行组内和组间比较。
在无辅助MMC的情况下，SGTP的滤过成功率显著低于PGTP（P = 0.03）。在平均2年的随访期内，辅助MMC显著提高了SGTP的成功率（P = 0.02），但未提高PGTP的成功率（P = 0.89）。
既往青光眼滤过手术失败是联合手术滤过失败的重要危险因素。术中使用辅助MMC可显著提高SGTP的滤过成功率。
