抗代谢药物与包裹性囊状滤过泡

为了探讨抗代谢药物对青光眼小梁切除术后包裹性囊状滤过泡形成的影响，本文分别对５０眼术中应用丝裂霉素Ｃ（ＭＭＣ）和４０眼术后结膜下注射５—氟尿嘧啶（５－Ｆｕ）的难治性青光眼进行分析。术后６个月，ＭＭＣ组手术成功率８６％；５－Ｆｕ组成功率８２．５％。包裹性囊状滤过泡的发生率，ＭＭＣ组１６％；５－Ｆｕ组１０％。结果表明，上述药物能明显减少滤过泡的瘢痕化，但不能减少包裹性囊状滤过泡的发生。男性、青少年性青光眼和以角膜缘为基底的结膜瓣发生率较高。     

5－氟尿嘧啶不同用药方式辅助青光眼滤过手术的实验研究

术后结膜下注射５－氟尿嘧啶（５－Ｆｕ）能提高难治性青光眼滤过手术的成功率。为降低结角膜毒性，减少频繁用药，用随机盲法对照实验对５－Ｆｕ不同用药方式进行了比较研究。术中在滤过部位使用高浓度５－Ｆｕ（４０ｍｇ／ｍｌ）比术后用药更能提高手术成功率，临床上未见明显的眼毒副作用。光镜检查术中５－Ｆｕ用药组可见潜在的滤腔。电镜检查两组５－Ｆｕ用药组均可见减少变细、紊乱排列的胶原纤维。     

难治性青光眼滤过术中一次性应用MMC和5—Fu的疗效观察

近几年来国内外已开始应用ＭＭＣ和５Ｆｕ于抗青光眼滤过术中抗瘢痕形成，且二者均能提高手术成功率。为了进一步观察ＭＭＣ和５Ｆｕ对复杂难治性青光眼的临床疗效，我们分别采用术中一次应用ＭＭＣ和５Ｆｕ的方法对４０例（４８眼）难治性青光眼患者进行了临床观察...     

重组γ-干扰素作用人Tenons囊成纤维细胞体外研究

目的体外研究人重组γ－干扰素对人Ｔｅｎｏｎｓ囊成纤维细胞作用。方法以人Ｔｅｎｏｎｓ囊成纤维细胞作为实验对象,分别加入０．１～１０~６Ｕ／ｍｌ人重组γ－干扰素（ＩＦＮ－γ）、０．００１～１０ｍｇ／Ｌ丝裂霉素（ＭＭＣ）、０．１～１０３ｍｇ／Ｌ ５－氟尿嘧啶（５－Ｆｕ）孵育４８ｈ,然后以ＭＴＴ法进行检测。结果高浓度和低浓度ＩＦＮ－γ实验组ＯＤ值较对照组升高（Ｐ＜０．０５）,中间浓度 ＩＦＮ－γ实验组 ＯＤ值较对照组低（Ｐ＜０． ０５）。 ＩＦＮ－γ的抑制率较 ＭＭＣ及５－Ｆｕ低（Ｐ＜０． ００５）。结论 ＩＦＮ－γ对体外培养的人Ｔｅｎｏｎｓ囊成纤维细胞具有促增殖及抑制增殖双向调控作用,其抗增殖作用较ＭＭＣ及５－Ｆｕ弱。     

5—氟尿嘧啶多相脂质体对实验性青光眼滤过术瘢痕形成的影响

目的 为研究５－氟尿嘧啶（５－Ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）多相脂质体和５－Ｆｕ预防滤过术瘢痕形成的作用。方法 对２０只新西兰长耳兔双眼行小梁切除术。术后将兔分为２组，每组１０只，每组按随机规定一眼为用药眼，对侧眼为对照眼。第１组：用药眼术后每日结膜下注射５－Ｆｕ（水针剂）０．２ｍｌ（５ｍｇ），对照眼结膜下注射等量生理盐水。第２组：用药眼术后每隔３日结膜下注射５－Ｆｕ多相脂质体０．２ｍｌ（５     

5—氟尿嘧啶不同用药方式辅助青光眼滤过手术的实验研究

术后结膜下注射５－氟尿嘧啶能提高难治性青光眼滤过手术的成功率。为降低结角膜毒性，减少频繁用药，用随机盲法对照实验对５－Ｆｕ不同用药方式进行了比较研究。术中在滤过部位使用高浓度５－Ｆｕ比术后用药能提高手术成功率，临床上未见明显的眼毒副作用。光镜检查术中５－Ｆｕ用药组可见潜在的滤腔。电镜检查两组５－Ｆｕ用药组均可见减少变细、紊乱排列的胶原纤维。     

青光眼滤过性手术中一次应用5－FU的近期效果

青光眼滤过性手术中一次应用５－ＦＵ的近期效果［英］／ＬａｎｉｇａｎＬ…ＢｒＪＯｐｈｔｈａｌｍｏｌ．－１９９４，７８（１）．－３３～３７青光眼滤过术后结膜下多次注射５－ＦＵ（５－氟尿嘧啶）较烦琐且易引起角膜上皮缺损；而术中一次应用丝裂霉素Ｃ（ＭＭＣ）有...     

次全视网膜冷凝联合抗代谢物治疗新生血管性青光眼

目的：探讨新生血管性青光眼尤其晚期病例的治疗方法，方法：将４０例新生血管性表示我眼随机分为次全视网膜冷凝（ＳＲＣ）组２３例（２３只眼），单纯用ＳＲＣ或联合抗青光眼手术，对照组１７例（１７只眼）行抗青光眼手术，两组术后均局部应用５－Ｆｕ和地塞米松，术后随访１月～５年，平均６个月。结果：ＳＲＣ组的治疗成功率（７３．９％＿高于对照组（４１．２％），差异有显著性（Ｐ〈０．０５）。结论：单纯次全视网膜冷凝术     

5—氟尿嘧啶高分子缓释剂在兔眼滤过术后抗瘢痕形成的研究

目的研究５－氟尿嘧啶（５－ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）缓释剂在兔眼滤过术后抗瘢痕形成的疗效及毒性。方法对２３只家兔双眼行巩膜后唇咬切术，术后次日第１组结膜下注射２．５％５－Ｆｕ缓释剂１０ｍｇ，第２组结膜下注射２．５％５－Ｆｕ注射液１０ｍｇ。术后第１周隔日用药１次，连续３次；第２周隔２日用药１次，连续３次。第３组用同法注射等体积的空白缓释剂。结果空白缓释剂组的滤过泡在术后７天内失败，５－Ｆｕ注射液组的滤过泡在术后２０～３０天失败，５－Ｆｕ缓释剂组的滤过泡持续至实验全程。术后７～３０天，５－Ｆｕ缓释剂组巩膜瘘道的阻塞率为６．７％，５－Ｆｕ注射液组为４１．７％，空白缓释剂组为１００．０％。５－Ｆｕ缓释剂组３只眼，５－Ｆｕ注射液组８只眼及空白缓释剂组２只眼出现角膜上皮缺损。结论本研究结果显示，５－Ｆｕ缓释剂可有效防止滤过泡瘢痕化及巩膜瘘道阻塞，提高兔眼滤过术的成功率，并降低５－Ｆｕ注射液的毒性，有临床应用价值。     

t—PA和5—Fu多相脂质体联合应用对兔青光眼滤过术后瘢痕形成的影响

研究组织纤溶酶原激活剂（ｔｉｓｓｕｅ ｐｌａｓｍｉｎｏｇｅｎ ａｃｔｉｖａｔｏｒ，ｔ－ＰＡ）联合５－氟尿嘧啶（５－Ｆｌｕｏｒｏｕｒａｃｉｌ，５－Ｆｕ）多相脂质体抑制青光眼滤后瘢痕形成的作用。方法将１６只健康成年新西兰长耳兔随机分成４组，每组１只，均行双眼小梁切除术。第１组：为对照组，手术结束时双眼前房内各注射生理盐水０．１ｍｌ，共４次。术后不用抑制瘢痕形成的药物。第２组；手术结束时双眼前房内注射ｔ     

Comparative study of dacryocystorhinostomy with and without intraoperative application of Mitomycin C

Aims and objectives

To compare the outcome of dacryocystorhinostomy surgery with and without the intraoperative use of Mitomycin C.

Methods

Our study is a prospective comparative case study in which 50 patients of primary acquired nasolacrimal duct obstruction were divided on the basis of random sampling into the conventional dacryocystorhinostomy group and the Mitomycin C group in which Mitomycin C 0.2 mg/ml was used intraoperatively. Patients were followed on 1st postoperative day, 1st, 3rd, 6th weeks, 3rd and 6th months. Patient symptoms and satisfaction were noted. Patency of lacrimal passage was assessed by lacrimal syringing and tear meniscus height was recorded on each follow-up.

Results

At the end of 6 months of follow-up, 96% of patients were asymptomatic in the Mitomycin C group whereas 80% patients in the conventional group were asymptomatic. On lacrimal syringing 24 (96%) eyes had patent passage in the Mitomycin C group where as only 1 (4%) patient had complete block with regurgitation of mucopurulent fluid. In the conventional group 20 (80%) eyes had patent passage, 4 (16%) eyes had complete block with regurgitation of mucopurulent fluid and 1 (4%) eye had partially patent passage on lacrimal syringing. Out of 25 eyes, 24 had normal tear meniscus height, and 1 had high tear meniscus height in the Mitomycin C group in comparison to the conventional group in which out of 25 eyes 20 eyes had normal, 1 had moderate and 4 eyes had high tear meniscus height. Intraoperative and postoperative complications in both the groups were identical.

Conclusion

Although the difference between the two groups was not statistically significant, a distinctly higher success was achieved in patients undergoing dacryocystorhinostomy with intra operative Mitomycin C as compared to conventional dacryocystorhinostomy.     

Mitomycin C as adjunct therapy in correcting punctal stenosis

PURPOSE: To assess the efficacy of intraoperative mitomycin C in improving the success rate of the posterior punctectomy procedure. METHODS: The charts of all patients who underwent posterior punctectomy between the years 1997 and 2000 were reviewed. The procedure was done without mitomycin C (n = 26 eyes, group A) until the end of 1998 and with mitomycin C (n = 25 eyes, group B) starting in 1999. The Kaplan-Meier curve was used for statistical evaluation. RESULTS: In group A, 5 of 26 (19.2%) eyes had complete anatomic obstruction and scarring of their puncta after surgery, compared with 0 of 25 (0.0%) eyes in group B. The difference was statistically significant (P<0.02). No significant complications were observed. CONCLUSIONS: Mitomycin C appears to be a safe and effective adjunct therapy in correcting punctal stenosis.     

丝裂霉素C提高人工鼻泪管治疗慢性泪囊炎疗效的意义

目的探讨丝裂霉素C（MMC）对提高人工鼻泪管植入术治疗慢性泪囊炎疗效的意义。方法89例（98眼）慢性泪囊炎分为治疗组和对照组。对照组采用人工鼻泪管植入术,而治疗组在人工鼻泪管植入术中及术后7d使用0．02％MMC0．5mL注入泪道。结果术后随访10～12个月,治疗组36眼中有35IliON道冲洗通畅,对照组62眼中有53眼泪道冲洗通畅,差异有统计学意义（P=0．004）。结论在人工鼻泪管植入术中、术后应用MMC是一种能提高远期疗效的安全、有效的辅助措施。     

Subconjunctival injection of low-dose Mitomycin-C for treatment of failing human trabeculectomies

Purpose: To evaluate the safety and efficacy of a low-dose Mitomycin C injected subconjunctivally after a guarded filtration operation in humans. Methods: Fourteen patients with failing filters received an injection of 0.01 mg Mitomycin C (0.25 ml of 0.04 mg/ml solution) into the filtering bleb. Eyes with end stage glaucoma of patients with healthy or successfully operated fellow eye were selected for the treatment. In 6 of the cases 2 to 5 days later a needle revision of the bleb was performed. Results: In 12 of the treated eyes (86%) we found a lowering of the IOP with a mean of 8.08 mmHg (range, 4 to 13 mmHg) and a development of a typical wide, pale, avascular filtering bleb. Complications, such as conjunctival, scierai or corneal necrosis, wound dehiscence, bleb leaks, hypotony or any clinically detectable signs of toxic damage of the anterior segment of the eye were not observed. Conclusion: Subconjunctival injection of low-dose Mitomycin C in the early postoperative period may offer a useful option for improving the outcome in some cases of failing trabeculectomies. This alternative method of application seems to enhance the effect of a subsequent needle revision. With the concentration used we did not find any undesirable complications after a follow-up of 1 to 9 months.Abbreviations 5-FU 5-Fluorouracil - HM hand movements - IOP intraocular pressure - MMC Mitomycin-C - PL perception of light - TE trabeculectomy - VA visual acuity     

曲安奈德联合5-氟尿嘧啶治疗外伤性白内障术后人工晶状体前膜的疗效观察

目的:探讨曲安奈德联合5-氟尿嘧啶(5-Fu)治疗外伤性白内障术后人工晶状体前膜形成的疗效。方法:选择外伤性白内障术后并发人工晶状体前膜形成的患者,治疗组为52例52只眼,采用5-Fu和曲安奈德联合结膜下注射治疗;对照组为48例49只眼,采用地塞米松结膜下注射治疗,对比观察人工晶状体前膜的吸收情况和并发症。结果:治疗组人工晶状体前膜完全吸收率为90.38%;对照组完全吸收率为75.51%,两组患者视力均有不同程度提高。治疗组有6只眼发生角膜上皮点状脱落。结论:曲安奈德联合5-Fu治疗外伤性白内障术后人工晶状体前膜形成有较好的效果,并发症发生率低。     

小梁切除联合MMC治疗陈旧性虹膜睫状体炎合并青光眼

目的:探讨陈旧性虹膜睫状体炎合并青光眼的有效治疗方法。方法:将38例52眼陈旧性虹膜睫状体炎合并青光眼的患者随机分成两组,A组(17例24眼)激光周边虹膜切除术,B组(21例28眼)小梁切除联合丝裂霉素C应用术。结果:A组成功4眼,成功率为17%,B组成功26眼,成功率为93%,差异有显著统计学意义(P<0.01)。结论:小梁切除联合丝裂霉素C是治疗陈旧性虹膜睫状体炎合并青光眼的有效治疗方法。     

角膜缘干细胞移植术中结膜瓣的宽与窄对原发性翼状胬肉的疗效比较

目的:对比下方角膜缘干细胞窄结膜瓣与宽结膜瓣移植联合丝裂霉素C治疗原发性翼状胬肉的长期效果与复发率.方法:采用回顾性研究,共纳入146例(193眼)原发性翼状胬肉患者.其中91例采用下方角膜缘干细胞窄结膜瓣移植联合丝裂霉素C治疗(NI-LCAT组),102例采用下方角膜缘干细胞宽结膜瓣移植联合丝裂霉素C治疗(WI-LCAT组).随访对比两组复发率、供体区、植片植床情况与相应并发症.结果:NI-LCAT组与WI-LCAT组复发率分别为3.3％与4.9％,两者差异无统计学意义.两组植片植床情况未见明显差别.两组供体区最常见并发症均为轻中度结膜瘢痕(NI-LCAT组18.6％,WI-LCAT组13.2％).其他并发症包括结膜下上皮囊肿与受体区肉芽肿发生率在两组间差异无统计学意义.Kaplan-Meier生存分析显示两组间累积手术成功率差异无统计学意义.结论:下方角膜缘干细胞窄结膜瓣与宽结膜瓣移植联合丝裂霉素C治疗原发性翼状胬肉复发率相似.相比宽结膜瓣组,窄结膜瓣组对结膜供体区创伤较小,对保留上下方结膜更为有效.     

丝裂霉素C在小梁咬切器辅助下泪点息肉切除术中的应用

目的　探讨在小梁咬切器辅助下泪点息肉切除术中应用丝裂霉素C的疗效。方法　选取2009年1月至2012年6月在中国人民解放军第三二二医院诊治的118例下泪点息肉患者为研究对象，将研究对象进行分组:观察组62例62眼（丝裂霉素C联合小梁咬切器辅助下泪点息肉切除术）和对照组56例56眼（小梁咬切器辅助下泪点息肉切除术）。随访2 a观察并比较两组泪点息肉治疗后的临床效果及息肉复发情况。结果　术后早期观察组发生泪小点水肿17眼、角膜荧光素点染4眼，对照组发生泪小点水肿15眼、角膜荧光素点染3眼，两组并发症发生率比较差异无统计学意义（P＞0.05）；两组均未发生其他严重并发症。术后随访观察2 a，观察组有效率（治愈率+好转率）为96.77%，对照组有效率为87.50%，2组差异无统计学意义（P＞0.05）。观察组泪点息肉复发率为4.84%，对照组为19.64%，差异有统计学意义（P＜0.05）。结论　丝裂霉素C能有效降低泪点息肉复发，提高手术成功率，值得在临床上推广。     

Needling revision of failed filtering blebs after trabeculectomy: a retrospective study

PURPOSE: To determine the efficacy and safety of needling revision of failed filtering blebs. METHODS: We reviewed retrospectively 26 eyes that had undergone needling revision for a failed trabeculectomy. The needling revisions were performed either with adjunctive use of Mitomycin C, 5-Fluorouracil or without antimetabolites. The procedure was usually performed as a clinic procedure, using a 27-gauge needle. RESULTS: The mean follow-up time was 14.5 +/- 11.3 months (range 6.0-48.0 months). Intraocular pressure (IOP) decreased from 28.8 +/- 6.8 mmHg (range 19.0-40.0 mmHg) to 15.3 +/- 5.2 mmHg (range 7.0-35.0 mmHg). Twelve eyes (46.2%) achieved success, defined as IOP < or = 18 mmHg without medication; 11 eyes (42.3%) achieved qualified success, defined as IOP < or = 18 mmHg with antiglaucomatous medication, and three of 26 eyes (11.5%) were classified as failures. The success rate after the initial needling was 64% at 6 months and the same after 1 year and 2 years. The success rate after one or more needlings was 96% at 6 months and 77% at 1 year and 2 years. Complications developed in six of the 26 eyes (23.1%). These involved transient corneal epithelial defects in three eyes (11.5%), temporary conjunctival wound leak in two eyes (7.7%), and development of bullous keratopathy in one high risk eye (3.8%). CONCLUSION: Our results are comparable to the results of other studies. Needling revision appears to be a useful tool in the management of glaucoma.     

5—氟尿嘧啶与丝裂霉素C在青光眼滤过术中的合理应用

目的 探讨青光眼滤过手术抗代谢药物丝裂霉素C（MCC）与5－氟尿嘧啶（5－Fu）的合理应用。方法 对108只需手术的青光眼随机分成3组。5－Fu组术后球结下注射5－Fu6－8次,MMC组术中一次性给予质量浓度为0.2mg/ml的MMC,对照组则不用任何药物,观察各组术后的疗效及并发症。结果 随访3－34个月（平均28．2月）,5－Fu和MMC组手术成功率明显高于对照组,P＜0．05。术后并发症5－Fu组角膜上皮点状损害18只眼（45％）,MMC组低眼压2例（6．7％）,与对照组比有显著差异（P＜0．05）。结论 5－Fu与MMC能提高青光眼手术的成功率,但有一定的毒副作用。临床上应根据病人的年龄、病情及青光眼类型选择用药。