论文部分内容阅读
目的:探讨小梁切除术中应用丝裂霉素(MMC),术后联合应用5-氟尿嘧啶(5-fluorouracil,5-Fu)治疗青光眼的临床疗效。方法:将42例(49眼)青光眼患者随机分为2组:一组为治疗组23眼,给小梁切除术中应用MMC,术后联合应用5-Fu结膜下注射治疗;另一组为对照组26眼,只给予小梁切除术中应用MMC,术后不联合应用5-Fu治疗;术后随访半年到两年,观察治疗前后患眼的视力、眼压、滤过泡情况以及低眼压浅前房和角膜损害等指标,对手术成功率及并发症进行比较。结果:治疗组视力提高5眼(21.7%),视力未提高16眼(69.6%),视力下降2眼(8.7%),术前平均眼压(42.57±4.51)mmHg,术后平均眼压(11.46±3.45)mmHg,发生低眼压和浅前房5眼(21.7%),角膜上皮损4眼(17.4%),前房出血1眼(4.3%),结膜下出血4眼(17.4%);功能滤过泡20眼(87.0%),非功能滤过泡3眼(13.0%);对照组视力提高4眼(15.4%),未提高19眼(73.1%),视力下降3眼(11.5%),术前平均眼压(43.23±5.12)mmHg,术后平均眼压(13.35±4.63)mmHg,发生低眼压和浅前房4眼(15.4%),角膜上皮损害1眼(3.8%),前房出血0眼,结膜下出血1眼(3.8%),功能滤过泡17眼(65.4%),非功能滤过泡眼9眼(34.6%)。结论:MMC和5-Fu作为青光眼滤过术辅助用药都可以减少、预防术后滤过泡的粘连包裹引起的青光眼复发,二者联合应用可以起到协同作用,提高手术成功率;但术后联合应用5-Fu能加重低眼压浅前房的发生,同时对角膜的损害也相应加大,如果合并全身服用血管扩张剂可致结膜下或前房出血等并发症的发生;所以应正确、合理地使用MMC和5-Fu,注意用药的时机、药量和浓度。
Objective: To investigate the clinical efficacy of mitomycin C (MMC) in trabeculectomy combined with 5-fluorouracil (5-Fu) in the treatment of glaucoma. Methods: Forty-two patients (49 eyes) with glaucoma were randomly divided into 2 groups: one was treated group (23 eyes), MMC was given to trabeculectomy, 5-Fu subconjunctival injection was used after operation, and the other was The control group, 26 eyes, only given trabeculectomy MMC, not combined with 5-Fu postoperative treatment; follow-up for six months to two years, before and after treatment in patients with visual acuity, intraocular pressure, filtration bleb conditions and low Intraocular pressure shallow anterior chamber and corneal damage and other indicators, the success rate of surgery and complications were compared. Results: In the treatment group, visual acuity was improved in 5 eyes (21.7%), visual acuity was not increased in 16 eyes (69.6%), visual acuity was decreased in 2 eyes (8.7%), mean intraocular pressure was (42.57 ± 4.51) mmHg, mean IOP 11.46 ± 3.45) mmHg. There were 5 eyes (21.7%) with low intraocular pressure and shallow anterior chamber, 4 eyes (17.4%) with corneal epithelial lesions, 1 eyes with anterior chamber hemorrhage (4.3%) and 4 eyes with subconjunctival hemorrhage (87.0%), 3 eyes (13.0%) of non-functional filtering bleb, 4 eyes (15.4%), 19 eyes (73.1%), 3 eyes (11.5 eyes) %), Preoperative average IOP (43.23 ± 5.12) mmHg, postoperative IOP (13.35 ± 4.63) mmHg, hypotony and shallow anterior chamber in 4 eyes (15.4%), corneal epithelial lesion in 1 eye ), 0 anterior chamber hemorrhage, 1 eye subconjunctival hemorrhage (3.8%), 17 functional filtration bleb (65.4%) and 9 non-functional filtering bleb (34.6%). CONCLUSION: Both MMC and 5-Fu can reduce the amount of adjuvant treatment of glaucoma filtration surgery and prevent the recurrence of glaucoma caused by postoperative filtration bleb adhesions. The combination of MMC and 5-Fu can improve the success rate of surgery. Joint application of 5-Fu can aggravate the occurrence of shallow anterior chamber hypocular pressure, while the damage to the cornea also increased, if combined with systemic vasodilator can cause subconjunctival or anterior chamber bleeding and other complications; it should be correct , The rational use of MMC and 5-Fu, pay attention to the timing of the drug, dosage and concentration.