Comparison of low-dose intraoperative mitomycin-C vs 5-fluorouracil in primary glaucoma surgery: a pilot study

BACKGROUND AND OBJECTIVE: This study was undertaken to compare the efficacy and safety of low-dose intraoperative application of mitomycin-C (MMC) with that of 5-fluorouracil (5-FU) in primary trabeculectomy. PATIENTS AND METHODS: A non-randomized prospective study was performed between August 1994 and November 1995. Thirty-two eyes of 16 consecutive patients who underwent trabeculectomy for uncontrolled glaucoma of various causes form the study group. The mean age was 46.8 +/- 9.9 years. The first eye received MMC (0.2, 0.4 mg/ml), fellow eye received 5-FU (50 mg/ml), for 1 minute intraoperatively. Bleb characteristics and intraocular pressure (IOP) control were analyzed. Success of surgery based on IOP control was measured by 3 different criteria: IOP less than 21 mm Hg; IOP less than 21 mm Hg with more than 30% reduction; and IOP less than 16 mm Hg with more than 30% reduction. RESULTS: Mean preoperative IOP was 31.4 +/-12.7 mm Hg in MMC group and 27.8+/- 8.8 mm Hg in 5-FU group. Mean follow-up in MMC group was 16.12 +/- 8.17 months; in 5-FU group 13.37 +/- 8.19 months. At last follow-up all 5-FU blebs were nonischemic, while 4 eyes in the MMC group showed nonischemic blebs, and 12 eyes had ischemic blebs. There was no statistically significant difference between MMC group and 5-FU group success rates with all 3 criteria. Success rates were: IOP less than 21 mm Hg; 100% in both groups; IOP less than 21 mm Hg with more than 30% reduction; MMC group 93.8%, 5-FU group 75%; less than 16 mm Hg with more than 30% reduction; MMC group 87.5%, 5-FU group 68.8%. CONCLUSIONS: Low-dose intraoperative MMC and 5-FU can provide control of IOP in primary trabeculectomy, 5-FU group showed more non-ischemic blebs.     

Neodymium: YAG and argon laser iridotomy. Long-term follow-up in a prospective, randomized clinical trial

Neodymium:YAG (Nd:YAG) and argon laser iridotomies were compared in a prospective, randomized clinical trial of 43 patients with bilateral chronic pupillary-block glaucoma. All patients had one eye randomly assigned to argon and the fellow eye assigned to Nd:YAG laser treatment. Follow-up ranged from 20 to 42 months. Iridotomy closure was not observed in Nd:YAG-treated eyes, but nine (21%) argon iridotomies required retreatment. Visual loss due to progression of laser-induced lens or corneal damage was not observed in any eye. Nine (21%) argon-treated eyes and eight (19%) Nd:YAG-treated eyes required laser trabeculoplasty for further intraocular pressure (IOP) lowering after iridotomy. Five (12%) argon-treated and two (5%) Nd:YAG-treated eyes required intraocular filtration surgery for long-term IOP control, but this difference was not statistically significant. There were no significant long-term differences between these treatment modalities.     

丝裂霉素C结膜下注射联合针刺分离瘢痕性滤过泡疗效观察

目的:观察丝裂霉素C结膜下注射联合针刺分离对青光眼滤过性手术后瘢痕性滤过泡修复的临床效果。方法:对行滤过性手术后滤过泡瘢痕化的32例(32眼)进行滤过泡旁结膜下注射丝裂霉素C并进行针刺分离,观察分离前后视力、眼压、滤过泡形态和角膜内皮细胞计数等,结果进行统计学分析。结果:随访观察3～18(平均8.9±4.5)mo,针刺后3mo平均眼压由(30.6±6.2)mmHg降至(16.7±5.2)mmHg,总成功率为84%;随访≥6mo,眼压由治疗前(31.2±7.2)mmHg降至(17.8±5.8)mmHg,总成功率为84%;治疗前后眼压比较差异有非常显著性;随访6mo以上功能性滤过泡形成率为76%;角膜内皮细胞计数治疗前后差异无显著性。并发症有前房延缓形成3眼和前房少量积血3眼,3d后均自行恢复。结论:丝裂霉素C结膜下注射联合针刺分离对瘢痕性滤过泡的功能修复是一种安全有效的方法。     

青光眼小梁切除术联合羊膜移植的临床应用

目的观察小梁切除术联合羊膜移植术治疗青光眼的临床效果。方法选择需行滤过手术的58例（58只眼）青光眼患者,随机分为小梁切除术组（对照组）29例（29只眼）和小粱切除联合羊膜移植术组（实验组）29例（29只眼）。所有患者随访12个月,分析比较两组术后的降眼压效果、滤过泡形成情况及并发症。结果术后12个月时实验组平均眼压（14.7±3.6）mm Hg,对照组平均眼压（16.4±5.0）mm Hg,两组之间的平均眼压差异无统计学意义（P=0.143）;实验组手术成功率（93.1%）,对照组手术成功率（82.8%）,差异无统计学意义（校正检验P=0.420）;功能性滤过泡实验组（89.7%）较对照组（65.5%）多,差异有统计学意义（P=0.028）;术后浅前房发生率实验组（13.8%）明显低于对照组（37.9%）,差异有统计学意义（P=0.036）。结论小梁切除术联合羊膜移植可以有效的治疗青光眼,成功率高。     

The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up

PURPOSE: To compare the intermediate-term efficacy of 5-fluorouracil (5-FU) and Mitomycin C (MMC) as adjunctive antimetabolites in neovascular glaucoma (NVG) filtration surgery. METHODS: Forty consecutive eyes of 40 patients with NVG refractory to medical therapy were randomized to receive antimetabolite-augmented trabeculectomy. Eighteen eyes received postoperative 5-FU (5-FU group) and 22 eyes received intraoperative, low-dose (0.2 mg/ml) MMC for 2 mins (MMC group). The main outcome measure was intraocular pressure (IOP). Surgical success was defined as IOP < 21 mmHg with topical treatment (qualified success) or without topical treatment (complete success). Surgical failure was defined as IOP > or = 21 mmHg, despite postoperative topical treatment, and by postoperative blindness. RESULTS: The mean follow-up period was 35.8 +/- 22.6 months in the 5-FU group and 18.6 +/- 17.2 months in the MMC group. This difference was not significant. Mean IOP decreased from 40.4 +/- 10.3 mmHg to 14.7 +/- 3.4 mmHg (p < 0.0001) in the 5-FU group and from 42 +/- 11.3 mmHg to 22.9 +/- 13.3 mmHg (p = 0.0006) in the MMC group; however, the difference between the 5-FU and MMC groups was not significant at any point. The success rate in the 5-FU group was 55.5% (44.4% complete, 11.1% qualified), compared with 54.5% (9.1% complete, 45.4% qualified) in the MMC group. This difference was not significant. CONCLUSIONS: The percentage of patients who achieved postoperative IOP < 21 mmHg was similar in both groups, although a larger proportion of patients treated with MMC-augmented trabeculectomy required topical treatment in comparison with the 5-FU group.     

滤过手术中丝裂霉素C不同用法的疗效分析

目的 比较青光眼滤过手术中丝裂霉素C（MMC）结膜瓣下与巩膜瓣下两种应用方法的降压效果和并发症的发生情况。方法 132眼接受滤过手术的原发性青光眼随机分为对照组和MMC组，再将应用MMC（0．4mg／ml，3min）的66眼分成结膜瓣下（MMC-A）组和巩膜瓣下（MMC-B）组。观察1年内3组患者手术后的眼压、视力和手术并发症。结果 MMC组与对照组相比眼压下降差异有统计学意义（P〈0．05），功能性滤过泡形成率71．21％，手术成功率达75．76％，而两组手术并发症无显著性差异。MMC两组病人的降压效果和并发症的差异无统计学意义。结论 MMC作为滤过性手术辅助药物，可增加手术成功率，而且无严重并发症。MMC放置在结膜瓣下和巩膜瓣下效果相似，但放置在结膜瓣下可能会减少对眼内组织的毒性。     

Intraoperative mitomycin versus postoperative 5-fluorouracil in high-risk glaucoma filtering surgery.

In a randomized clinical trial, the authors compared the use of postoperative subconjunctival injections of 5-fluorouracil (5-FU) in 19 eyes with a single intraoperative application of subconjunctival mitomycin (MMC) at the filtering site in 20 eyes at high risk for failure of glaucoma filtering surgery. Six months after surgery, intraocular pressures averaged 10.9 +/- 5.3 mmHg (mean +/- standard deviation) in the MMC-treated eyes versus 14.2 +/- 5.5 mmHg in the 5-FU-treated eyes (P = 0.08) and were less than or equal to 12 mmHg in 60.0% of MMC-treated eyes and 21.1% of 5-FU-treated eyes (P = 0.03). Mitomycin-treated eyes were receiving an average of 0.3 +/- 0.5 medications for intraocular pressure control, and 5-FU-treated eyes were receiving an average of 1.1 +/- 1.1 medications (P = 0.01). Drug-induced corneal epithelial defects were seen in nine 5-FU-treated eyes and in no MMC-treated eyes (P = 0.0004). These results suggest that intraoperative MMC may be a viable alternative to postoperative 5-FU, with lower overall intraocular pressures, decreased dependence on postoperative ocular antihypertensive medications, and decreased corneal toxicity.     

Efficacy and safety of adjunctive mitomycin C during Ahmed Glaucoma Valve implantation: a prospective randomized clinical trial

PURPOSE: To evaluate the efficacy and safety of intraoperative mitomycin C (MMC) in eyes undergoing Ahmed Glaucoma Valve implantation. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Sixty patients with refractory glaucoma. INTERVENTION: Sixty eyes of 60 patients with refractory glaucoma were randomized to receive intraoperative MMC (0.5 mg/ml for 5 minutes) (n = 34) or balanced salt solution (n = 26) during Ahmed Glaucoma Valve implantation. MAIN OUTCOME MEASURES: Surgical success was defined according to 2 different criteria: (1) postoperative intraocular pressure (IOP) between 6 and 21 mmHg, with or without antiglaucoma medications, and (2) IOP reduction of at least 30% relative to preoperative values. Eyes requiring additional glaucoma surgery, developing phthisis, or showing loss of light perception were classified as failures. Success rates in both groups were compared using Kaplan-Meier survival curves and the log rank test. Other outcome measures were mean IOP, number of glaucoma medications, and complications. RESULTS: After a mean follow-up of 12.3 months, Kaplan-Meier survival analysis showed a probability of success of 59% at 18 months for the MMC group and 61% for the control group when the first criterion for success was used (IOP between 6 and 21 mmHg). When an IOP reduction of at least 30% was used as the criterion to define success, the Kaplan-Meier survival analysis demonstrated a probability of success at 18 months of 62% for the MMC group and 67% for the control group. There were no significant differences in survival rates between the 2 groups with either criterion (P = 0.75 and P = 0.37, respectively). After 15 days postoperatively, the mean IOP did not significantly differ for both MMC and control eyes. Mean numbers of postoperative antiglaucoma medications were similar in MMC-treated eyes and controls. There was no significant difference between the incidences of postoperative complications in both groups. CONCLUSION: Mitomycin C did not increase the short- or intermediate-term success rates of Ahmed Glaucoma Valve implantation.     

Mitomycin C and 5-fluorouracil antimetabolite therapy for pediatric glaucoma filtration surgery

PURPOSE: To evaluate the efficacy and safety of augmented trabeculectomy with 5-fluorouracil (5-FU) and mitomycin C (MMC) compared to 5-FU only for the treatment of pediatric glaucoma. PATIENTS AND METHODS: In a prospective randomized clinical trial, 8 children (12 eyes) with pediatric glaucoma, either congenital or secondary to: lens aspiration, Sturge-Weber syndrome, or steroids underwent augmented trabeculectomy. Six patients (8 eyes) underwent augmented trabeculectomy with 5-FU plus MMC and 2 patients (4 eyes) underwent augmented trabeculectomy with 5-FU only. MAIN OUTCOME MEASURES: Between-group comparison of postoperative parameters: change in intraocular pressure (IOP), dependence on antiglaucoma medication, number of 5-FU injections, cup-disc ratio, corneal diameter, drug-induced complications. RESULTS: In the 5-FU/MMC group, 7/8 eyes showed good control of postoperative IOP (9-16 mm Hg), which was independent of antiglaucoma therapy; only 2 injections of 5-FU were needed. By contrast, in the 5-FU group, no control of the postoperative IOP (21-23 mm Hg) was achieved in 4/4 eyes, and these patients remained dependent on antiglaucoma medication; up to 6 injections of 5-FU were used. There was no deterioration in the cup-disc ratio or the corneal diameter in either group. Results were maintained on follow-up (23-27 months). No significant drug-induced complications were noted. CONCLUSION: Augmented trabeculectomy with adjunctive 5-FU/MMC may be an option for the control of pediatric glaucoma in patients with a poor surgical prognosis.     

A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy

PURPOSE: To compare the safety and efficacy of intraoperative 5-fluorouracil (5-FU) or Intraoperative mitomycin C (MMC) in eyes undergoing primary trabeculectomy.DESIGN: Prospective double-masked randomized clinical trial.METHODS: One hundred fifteen eyes of 103 patients with uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy or laser were prospectively randomized in a double-masked fashion to one of two treatment groups in a single institution setting. Subject's eyes underwent primary trabeculectomy with either topical 5-FU (50 mg/ml for 5 minutes) or topical MMC (0.2 mg/ml for 2 minutes). Primary outcome measures included the number of eyes achieving target pressures of 21, 18, 15, and 12 mm Hg at 6 and 12 months postoperatively. Secondary outcome measures included IOP, best-corrected visual acuity, complications, and interventions.RESULTS: Of the 115 eyes, 57 received 5-FU while 58 received MMC. A target IOP of 21 mm Hg at 6 months was achieved in 53 of 56 (95%) eyes in the 5-FU group and 54 of 57 (95%) eyes in the MMC group (P = 1.00). At 12 months, 45 of 48 (94%) eyes in the 5-FU group met a target IOP of 21 mm Hg while 48 of 54 (89%) eyes in the MMC group did (P =.49). The most common complications in each group were persistent choroidal effusions and bleb leak.CONCLUSION: Our study suggests that intraoperative topical 5-FU is at least as effective as intraoperative topical MMC in reducing IOP of eyes undergoing primary trabeculectomy.     

Deep sclerectomy augmented with mitomycin C

AIMS: To investigate the comparative efficacy and safety of deep sclerectomy with and without intraoperative mitomycin C (MMC) application for lowering the intraocular pressure (IOP). METHODS: A total of 71 eyes of 71 consecutive patients who had routine deep sclerectomy (DS), nonaugmented (DS-noMMC) or with mitomycin C (DS-MMC) augmentation (0.2 mg/ml for 2 min) and follow-up of 4 months or more were identified from an ongoing prospective database on glaucoma surgery. Indications for MMC use were the presence of risk factors for subconjunctival scarring and low target IOPs. MMC 0.2 mg/ml was applied in the sub-Tenons space for 2 min. RESULTS: There were 19 eyes in the DS-noMMC group and 52 eyes in the DS-MMC group. In 11 eyes (15.5%), the procedure was complicated by intraoperative perforation of the trabeculo-Descemet's window. Eyes in the DS-MMC group had significantly lower IOPs (MANOVA, P = 0.04). Kaplan-Meier survival curve analysis showed that the probability of maintaining IOP below target IOP level, below 18 mmHg and below 14 mmHg at 1 year was 51, 67, and 35% for the DS-noMMC group and 80, 86, and 74% for the DS-MMC group. The survival rates of the DS-MMC group were not statistically significant (P = 0.06) when the success criterion was maintaining an IOP less than 18 mmHg but were significant for the other criteria, namely IOP less than target levels (P = 0.03) and less than 14 mmHg (P = 0.03). Nd:YAG goniopuncture to lower IOP to target levels was done more frequently in the DS-noMMC group (13 eyes, 81%) than the DS-MMC group (20 eyes, 45%) and this difference was significant (P = 0.03). The prevalence of avascular areas within filtration blebs and transconjunctival oozing of aqueous was significantly higher in the DS-MMC group (P < 0.01). CONCLUSIONS: The use of intraoperative MMC during deep sclerectomy has a significant effect on the postoperative IOP and increases the probability of achieving target IOPs. However, our current technique of MMC application is associated with a higher incidence of avascular blebs and transconjunctival oozing.     

丝裂霉素C不同放置方法对滤过手术疗效影响的研究

目的：比较青光眼滤过手术中丝裂霉素C放置在结膜瓣下与巩膜瓣下这 两种不同方法的降眼压效果和合并症的发生情况，以便从中筛选出一种较佳的方法。方法：将67只接受滤过性手术并在术中应用丝裂霉素C的原发性青光眼随机分为两组，A组丝裂霉素C放置于结膜瓣下，B组丝裂霉素C同时放置于巩膜面上和巩膜瓣下。二组丝裂霉素C浓度和放置时间相同。观察二组病人手术前、后的眼压，视力和手术后的并发症。全部病人观察12个月。结果：（1）A、B二组病人均有明显的降眼压效果；（2）A、B二组间的降眼压效果没有明显差异；（3）A、B二组病人的手术并发症没有明显差异。结论：鉴于二种不同的放置方法对滤过手术都具有相同的良好降压效果，且在降压作用和手术并发症的发生率方面二者却没有明显的差异，因此笔者认为滤过手术中丝裂霉素C放置在结膜瓣下可能会减少它对眼内的穿透力，从而降低药物对眼内组织的毒性影响。     

Long-term filtration and visual field outcomes after primary glaucoma triple procedure with and without mitomycin-C

OBJECTIVE: To evaluate the long-term effectiveness of glaucoma management in patients undergoing primary glaucoma triple procedure (PGTP) with and without adjunctive subconjunctival mitomycin-C (MMC). DESIGN: Case-controlled study. PARTICIPANTS: Of the 203 eyes of 203 primary open-angle glaucoma (POAG) patients who had undergone PGTP and in whom reliable Humphrey visual fields had been obtained both before and after surgery at 13.5 +/- 8.9 and 27.9 +/- 8.9 months, 124 of the 144 eyes that received MMC during surgery were matched to the other 59 eyes that did not with respect to cup-to-disc ratio and risk factors for filtration failure in addition to other variables. MAIN OUTCOME MEASURES: Both preoperative and postoperative intraocular pressure (IOP), Humphrey visual fields and their global indices, number of glaucoma medications, and best-corrected visual acuity (BCVA). RESULTS: There were no significant differences in demographics between the two groups (P > 0.05 for each). Whereas both the control and the MMC groups attained significant decreases of mean IOP (18.5 +/- 5.7 mmHg-;15.6 +/- 4.6 mmHg, P = 0.0014; 19.3 +/- 7.0 mmHg-13.7 +/- 4.9 mmHg, P = 0.0001) and mean number of medications (2.1 +/- 1.3-1.3 +/- 1.3, P = 0.0001; 2.3 +/- 1.2-1.0 +/- 1.3, P = 0.0001) at 36 months after surgery, the MMC group had significantly lower mean IOP than the control group at all postoperative visits (P < 0.05 for each). The MMC group also tended to have less medical dependency after surgery than the control group. There was no significant difference in postoperative BCVA between the two groups. Patients in both groups had mean visual acuity of 20/30 or better. There was a significant worsening of corrected pattern standard deviation (CPSD) in the control group (3.97 +/- 3.18-5.17 +/- 3.36, P = 0.001) compared with no significant change in the MMC group (5.07 +/- 4.11-5.23 +/- 3.36, P = 0.93). The mean deviation did not change significantly in either group. CONCLUSIONS: The long-term glaucoma management in POAG patients with cataract undergoing PGTP indicates a successful outcome in final IOP, medical dependency, and BCVA. Furthermore, the MMC group had better IOP control and stable visual fields (CPSD), whereas the control group had a significant worsening of CPSD.     

针拨联合丝裂霉素C结膜下注射治疗抗青光眼术后失败滤过泡

目的:观察利用针拨联合丝裂霉素C结膜下注射治疗抗青光眼术后失败滤过泡的效果。方法:对抗青光眼小梁手术后3~22wk失败滤过泡34例(35眼)用针拨联合丝裂霉素C滤过泡旁注射,并随访6mo以上,观察滤过泡重新形成和眼压下降情况。结果:成功29例(29眼),手术前平均眼压为23.74±6.2mmHg,手术后眼压平均为13±4.3mmHg。其中3例(3眼)重复针拨、注射。随访期结束后统计针拨前后眼压具有显著性差异,Kaplan-Meier生存分析2a滤过泡成功率82.9%±6.4%。针拨术中有4眼前房出血,2眼低眼压,未见丝裂霉素的其它毒性反应。结论:针拨联合丝裂霉素C结膜下注射可以重新建立功能性滤过泡,有效地控制眼压,减少青光眼患者再次手术的痛苦。它是挽救抗青光眼术后失败滤过泡的一种良好的方法,具有毒性小、安全可重复的特点。     

Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results

PURPOSE: To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery. METHODS: Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)or=20% drop in IOP or a reduction of at least two medications. RESULTS: Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery. CONCLUSION: NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.     

Mitomycin‐C‐augmented deep sclerectomy in patients with primary open‐angle glaucoma and exfoliation glaucoma: a 1‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in patients with primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG). Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Results: Preoperatively, the mean IOPs were 23.1 ± 5.8 and 25.4 ± 8.3 mmHg, and 13.8 ± 6.1 and 11.2 ± 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. Conclusion: DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.     

Long term results and complications of trabeculectomy augmented with low dose mitomycin C in patients at risk for filtration failure

AIM: To determine the results and complications up to 5 years after trabeculectomy with 0.02% mitomycin C (MMC) in glaucoma patients at risk for failure of filtration surgery. METHODS: A consecutive series of 21 eyes from 20 patients who underwent trabeculectomy with MMC 0.02%, with an exposure time of 2 minutes, was retrospectively analysed and the results were compared with previously published data. RESULTS: The mean preoperative intraocular pressure (IOP) was 28 mm Hg on an average of 2.8 glaucoma medications, and the mean postoperative IOP after 3 years was 14 mm Hg on an average of 0.4 medications. Three years after trabeculectomy, 17 of 21 (80.9%) eyes had an IOP of less than 21 mm Hg without medical treatment. Using Kaplan-Meier life table analysis the 5 year probability of an IOP less than 21 mm Hg without medication was 67% and with medication was 90%. Two patients required further glaucoma surgery during the first postoperative year, and another developed hypotonous maculopathy which was reversed after bleb revision. Seven patients developed visually significant cataract as a late consequence of the surgery. There were no bleb related infections. CONCLUSION: In the long term MMC 0.02% used for 2 minutes intraoperatively is an effective adjunctive treatment in glaucoma patients at risk for bleb failure and in this dose is associated with few complications.     

非穿透小梁手术中应用丝裂霉素C的疗效

目的　评价非穿透小梁手术中应用丝裂霉素C治疗原发性开角型青光眼的临床疗效。方法　对 18例 (2 5只眼 )原发性开角型青光眼患者行非穿透小梁手术 ,术中联合应用丝裂霉素C。术后随访 6～ 2 8个月 ,平均 16个月。结果　患者术前平均眼压 (2 7 93± 7 6 2 )mmHg(1mmHg =0 133kPa) ;术后 3个月 ,平均眼压降至 (14 6 2± 3 5 3)mmHg ;差异有显著意义 (t=11 82 ,P <0 0 0 1)。术后2 5只眼均形成明显的弥散滤过泡。术后 3个月 ,2 1只眼有功能性滤过泡 ,4只眼功能性滤过泡消失。术后前房反应轻 ,1只眼发生前房出血 ;4只眼术中发现小梁网处有小穿孔 ,但无虹膜膨出 ,术后前房角镜检查均可见小穿孔 ;2只眼术中未发现小穿孔 ,而前房角镜下观察有小裂隙。结论　非穿透小梁手术中应用丝裂霉素C ,能有效降低开角型青光眼的眼压。术后患者视力恢复快 ,并发症少而轻。     

A randomised, prospective study comparing trabeculectomy with viscocanalostomy with adjunctive antimetabolite usage for the management of open angle glaucoma uncontrolled by medical therapy

AIMS: To compare trabeculectomy with viscocanalostomy augmented with adjunctive antimetabolite use for the control of intraocular pressure (IOP) in open angle glaucoma (OAG). METHODS: 45 patients (50 eyes) with uncontrolled OAG were randomised to either trabeculectomy (25 eyes) or a viscocanalostomy technique (25 eyes). Preoperatively, all eyes were graded in terms of risk factors for drainage failure and were given intraoperative antimetabolites (5-fluorouracil 25 mg/ml (5-FU), mitomycin C (MMC) 0.2 mg/ml and 0.4 mg/ml) according to a standard protocol. RESULTS: There were no significant differences between the groups in age, sex, type of OAG, preoperative medications, risk factors for drainage failure, and preoperative IOP. Mean follow up was 20 months (range 3-24 months). It was 12 months or longer in all eyes, except two lost to follow up at 3 months. At 12 months, complete success (IOP<21 mm Hg without antiglaucoma medications) was seen in 91% of eyes undergoing trabeculectomy, but in only 60% of eyes undergoing viscocanalostomy (p<0.02). Similarly, at the last follow up visit (mean 20 months) complete success was seen in 68% of eyes undergoing trabeculectomy and 34% with viscocanalostomy (p<0.05). In terms of qualified success (IOP<21 mm Hg with or without glaucoma medications) and mean IOP measurements postoperatively there were no difference between the groups, although the mean number of antiglaucomatous medications required postoperatively was less with trabeculectomy (0.39) than viscocanalostomy (1.04) (p<0.05). Needling procedures were more commonly required after trabeculectomy (p<0.02). YAG goniotomy was required in three eyes (13%) after viscocanalostomy. Early transient complications such as anterior chamber shallowing and encysted blebs were more common in the trabeculectomy group (p<0.05). Late postoperative cataract formation was similar between the two groups. CONCLUSION: In terms of complete success and number of antiglaucomatous medications required postoperatively, IOP control appears to be better with trabeculectomy. Viscocanalostomy is associated with fewer early transient postoperative complications.     

小梁切除术中分别应用丝裂霉素C、5-氟尿嘧啶及生物羊膜的比较研究

目的比较原发性闭角性青光眼在初次小梁切除术中分别应用丝裂霉素C（MMC）、5-氟尿嘧啶（5-FU）或生物羊膜的疗效及并发症。方法急慢性闭角型青光眼41例（49只眼）,随机分为3组,做以角膜缘为基底的结膜瓣。应用抗代谢药物者,在完成板层巩膜瓣后接受结膜瓣下放置浸渍浓度为0.2 mg/ml的MMC棉片3min,或25 mg/ml的5-Fu棉片5 min,取出后用200 ml生理盐水冲洗结膜下及巩膜瓣下。应用生物羊膜者,在巩膜瓣下及结膜瓣下分别置单层羊膜。其他步骤同常规小梁切除术。结果随访半年以上,3组病例在眼压控制及手术成功率上均未见显著差异。MMC组滤过泡以微囊型为主（68.8%）;5-Fu及羊膜组以弥漫扁平型占优（分别为53.3%和61%）,但羊膜组较易发生包裹型滤泡倾向。MMC组的并发症发生率较其他两组高,主要为浅前房、结膜瓣渗漏、低眼压和黄斑水肿。结论三种方法均可应用于首次小梁切除患者,但需注意应用MMC者并发症较多;使用羊膜者需注意滤过泡的无功能化。