Jacobi P C, Dietlein T S, Krieglstein G K
University Eye Hospital of Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 1998 Sep;236(9):652-7. doi: 10.1007/s004170050137.
The purpose of this study was to determine the efficacy of initial mitomycin C (MMC)-augmented trabeculectomy for uncomplicated glaucoma in young patients.
A retrospective chart review was performed on all glaucoma patients aged between 15 and 40 years without previous surgery that underwent initial trabeculectomy with MMC between 1988 and 1995 at the University Eye Hospital of Cologne. Success (survival) was defined as an intraocular pressure (IOP) of 21 mmHg or lower, with (qualified success) or without (complete success) glaucoma medications. The results were compared with a case-matched control group that did not receive antiproliferative therapy.
Eleven eyes of 11 patients fulfilled the inclusion criteria of initial MMC-augmented trabeculectomy. Using cumulative life-table analysis the success rate was 91% at 1 year and 73% at 5 years for the control group. For the MMC group the success rate was 91% at 1 year and 5 years, respectively. At final visit, mean IOP was significantly (P < 0.001) lower for the MMC group (13.3 +/- 3.9 mmHg) than for controls (18.0 +/- 1.3 mmHg). Significant differences were also found in the complication rate: complications associated with excessive aqueous overfiltration, such as shallow anterior chamber (36%), choroidal detachment (45%) and persistent hypotony (27%), featured particularly in the MMC group. Conversely, scarring of the filtering bleb (18%) and Tenon's cysts (18%) were observed exclusively in control eyes.
The present results suggest that initial MMC trabeculectomy for uncomplicated glaucoma in young patients significantly reduces IOP and number of adjunctive medications, postoperatively, albeit at the price of a high incidence of hypotony.
本研究旨在确定初始丝裂霉素C（MMC）辅助小梁切除术治疗年轻患者单纯性青光眼的疗效。
对1988年至1995年在科隆大学眼科医院接受初次MMC辅助小梁切除术的所有年龄在15至40岁且未接受过手术的青光眼患者进行回顾性病历审查。成功（存活）定义为眼压（IOP）为21 mmHg或更低，使用（合格成功）或不使用（完全成功）青光眼药物。将结果与未接受抗增殖治疗的病例匹配对照组进行比较。
11例患者的11只眼符合初次MMC辅助小梁切除术的纳入标准。使用累积生命表分析，对照组1年成功率为91%，5年成功率为73%。MMC组1年和5年成功率分别为91%。在最后一次随访时，MMC组的平均眼压（13.3±3.9 mmHg）显著低于对照组（18.0±1.3 mmHg）（P<0.001）。并发症发生率也存在显著差异：MMC组尤其以与房水过度滤过相关的并发症为特征，如浅前房（36%）、脉络膜脱离（45%）和持续性低眼压（27%）。相反，仅在对照眼中观察到滤过泡瘢痕形成（18%）和Tenon囊肿（18%）。
目前的结果表明，初始MMC小梁切除术治疗年轻患者单纯性青光眼可显著降低术后眼压和辅助药物的使用数量，尽管代价是低眼压发生率较高。
