al-Hazmi A, Zwaan J, Awad A, al-Mesfer S, Mullaney P B, Wheeler D T
Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
Ophthalmology. 1998 Oct;105(10):1915-20. doi: 10.1016/S0161-6420(98)91041-7.
To examine the safety of mitomycin C (MMC) use in pediatric glaucoma surgery.
Retrospective interventional case series.
One hundred eighty pediatric glaucoma patients younger than 7 years of age (254 eyes) who underwent glaucoma surgery and were followed for at least 1 year participated.
Surgeries consisted of trabeculectomy or combined trabeculotomy-trabeculectomy with adjunctive use of MMC.
Control of intraocular pressure (IOP) and occurrence of complications were measured. An IOP below 21 mmHg without any additional medical or surgical treatment was considered a success.
Primary congenital glaucoma was present in 98% of the patients. Sixty percent had a trabeculectomy, and 40% had a trabeculotomy-trabeculectomy. The combined surgery was performed mostly in infants up to 1 year of age. Complications were cystic bleb (19), bleb leak (4), retinal detachment (3), flat anterior chamber (3), cataract (2), and endophthalmitis (1). Children younger than 2 years of age had fewer complications but higher failure rates. The combined procedure in infants up to 2 years of age was moderately more successful (57%) than trabeculectomy alone (39%). Minimal complications seen in this group were more likely related to young age than to the type of surgery. Complications increased with time after surgery, with most occurring 2 years or more after surgery.
Success of MMC-augmented glaucoma filtering surgery increased with age, as did the complication rate. Serious complications were uncommon in the authors' group of pediatric patients up to now. However, complications related to bleb thinning increased with time after surgery, and additional problems can be anticipated with longer follow-up.
探讨丝裂霉素C（MMC）在小儿青光眼手术中的安全性。
回顾性干预病例系列研究。
180例7岁以下接受青光眼手术并随访至少1年的小儿青光眼患者（254只眼）。
手术包括小梁切除术或小梁切开术联合小梁切除术，并辅助使用MMC。
测量眼压（IOP）的控制情况及并发症的发生情况。眼压低于21 mmHg且无需额外药物或手术治疗被视为成功。
98%的患者为原发性先天性青光眼。60%的患者接受了小梁切除术，40%的患者接受了小梁切开术联合小梁切除术。联合手术主要在1岁以下婴儿中进行。并发症包括囊性滤过泡（19例）、滤过泡渗漏（4例）、视网膜脱离（3例）、无前房（3例）、白内障（2例）和眼内炎（1例）。2岁以下儿童并发症较少，但失败率较高。2岁以下婴儿的联合手术成功率（57%）略高于单纯小梁切除术（39%）。该组中观察到的轻微并发症更可能与年龄小有关，而非手术类型。并发症随术后时间增加，大多数发生在术后2年或更长时间。
MMC增强的青光眼滤过手术成功率随年龄增加，并发症发生率也如此。到目前为止，在作者的小儿患者组中严重并发症并不常见。然而，与滤过泡变薄相关的并发症随术后时间增加，随着随访时间延长可能会出现更多问题。
