难治性青光眼小梁切除术中应用生物羊膜与丝裂霉素C的对比研究

目的:探讨生物羊膜与MMC应用于青光眼小梁切除术中治疗难治性青光眼的临床疗效。方法:采用随机对照的方法,将临床收治的40例(57眼)难治性青光眼患者分为羊膜组32眼和丝裂霉素组25眼,前者施行小梁切除术联合巩膜瓣下生物羊膜植入术,后者在术中一次性应用MMC,浓度为0.2～0.4g/L,时间2～4min,随访1a,比较两种手术方式的临床疗效。结果:术后与术前相比:两组眼压均明显降低(P值均<0.01);术后1～2wk内MMC组视力下降者占45%,而羊膜组视力下降者仅占10%,两组间差异有显著性(P<0.05)。术后并发症:羊膜组眼部的副作用小,引起的并发症主要有术后浅前房;MMC引起的眼部并发症主要有薄壁滤过泡、滤过泡渗漏、低眼压性脉络膜脱离。结论:生物羊膜应用于难治性青光眼小梁切除术可有效地防止滤过泡的瘢痕组织形成,且并发症较应用MMC少,是治疗难治性青光眼安全、有效的手术方法。

A comparative study between biotic amniotic membrane and mitomycin C applied in refractory glaucoma trabeculectomy

·AIM:To explore the clinical effects of trabeculectomy with biotic amniotic membrane(amniotic membrane transplantation,AMT)or mitomycin C(MMC)in the treatment of refractory glaucoma..METHODS:In a randomized control clinical trial,57 eyes of 40 patients with refractory glaucoma underwent trabeculectomy with AMT(32 eyes)or MMC(25 eyes).The former were performed trabeculectomy with AMT under the scleral flap;the latter were intraoperatively administered with MMC,0.2-0.4mg/mL via a sponge for 2-4 minutes.The follow-up was 1 year,and the effects of two kinds of surgery were compared..RESULTS:The postoperative conditions were compared with those before the surgery.The intraocular pressure(IOP)of both groups significantly declined(P<0.01).The decrease of visual acuity occurred in 45% of MMC group,whereas only 10% in AMT group during posto-perative 1 to 2 weeks.There was significant difference between two groups(P<0.05).The postoperative complications induced by AMT were mild,mainly invol-ving the shallow anterior chamber,while the compli-cations of MMC group include thin wall filtering bleb,bleb leaking,choroidal detachment due to ocular hypotension,and so on..CONCLUSION:Application of AMT in trabeculectomy can prevent the filtering bleb from scar formation and the complication was less than that of MMC.It is a safe and effective method for treatment of refractory glaucoma..