5—氟尿嘧啶和丝裂霉素C在抗青光眼滤过术中的副作用

抗青光眼滤过术失败的主要原因是滤过泡的瘢痕化，５－氟尿嘧啶和丝裂霉素Ｃ可提高手术的成功率，但使用不当，也会产生一些严重的并发症，如低眼压综合征。此文总结了近年来的研究资料，介绍了常见的并发症及其预防和治疗措施。     

5—氟尿嘧啶在原发性青光眼滤过术中及术后的应用

5—氟尿嘧啶（5－FU）作为一种有效的抗代谢类药物，在抗青光眼术后应用，可抑制滤过道处的瘢痕形成，提高青光眼滤过性手术的成功率。但因其剂量大，给药次数多，疗程长，眼部并发症相对高，在一定程度上限制了临床上的广泛应用[1]。因此，有必要探讨其最适剂量及最佳给药途径。我们自1991年6月至1992年12月，对16例16眼原发性青光眼行小梁切除手术局部应用5－FU，并且手术后低剂量球结膜下注射5—FU，取得了满意的疗效，现报告于下。临床资料1．一般情况：本组病例中，男6人，女10人。年龄最小29岁，最大78岁，平均56岁。其中急性闭角…     

应用丝裂霉素C提高青光眼滤过术疗效的观察

对２３例（２３眼）难治性青光眼行滤过过性手术，术中一次性应用丝裂霉素Ｃ，进行疗效观察并随访８－２１个月，平均１４个月，眼压有效控制率８２．６％。效果良好，药物毒副反应轻微。对青光眼滤过术的失败原因及丝裂霉素Ｃ的药性、药效和药物毒副作用进行了讨论。     

5—氟尿嘧啶和丝裂霉素C在青光眼滤过性手术中的应用进展

滤过滤瘢痕形成是青光眼手术失败的主要原因。５－氟尿嘧啶和丝裂霉素Ｃ作为青光眼滤过术辅助治疗药物，经体外实验表明可明显抑制成纤维细胞增殖，有助于功能性滤过泡形成，从而提高青光眼滤过术的成功率。随着研究的深入，抗代谢类药物在滤过术的应用范围不断扩大。但这类药物副作用限制了它们在临床上的广泛应用，近年来研究的兴趣转向了寻求最小有效药剂量，最佳给药方法，从而达到最大手术成功率，取得了很大进展。     

抗青光眼滤过术中应用5-氟尿嘧啶和丝裂霉素C对泪膜的影响

目的　观察抗青光眼滤过术中应用5-氟尿嘧啶（5-fluourouracil,5-Fu）和丝裂霉素C（mitomycinC,MMC）对泪膜的影响。方法　回顾性分析难治性青光眼71例,其中使用5-Fu组24例（24只眼）,MMC组17例（17只眼）,对照组（未用药）30例（30只眼）,观察指标包括眼部异物感、干涩、畏光、痒感、结膜充血、分泌物、角膜荧光素染色及结膜、角膜虎红染色、泪膜破裂时间、Schirmer试验及眼压测量值。结果　5-Fu组患者的眼部症状和体征明显,泪膜功能受损,与对照组比较差异有显著性（P<0.05）,MMC组患者眼部干涩症状明显（P<0.05）,而其他观察指标与对照组相比差异无显著性。结论　抗青光眼滤过术后应用5-Fu可明显损害泪膜的功能。     

5-氟尿嘧啶及丝裂霉素C在翼状胬肉术中的应用

我科从 1996年 1月至 1999年 12月对 6 0例 77眼原发性和复发性翼状胬肉行手术切除 ,并分别于术中使用 5 氟尿嘧啶 ( 5 Ｆｕ)和丝裂霉素Ｃ(ＭＭＣ)辅助治疗 ,以预防胬肉复发 ,现报告如下 :临床资料 :本组病例为 1996年 1月～ 1999年 12月在我院就诊的翼状胬肉共 6 0例 77眼 ,男 38例 49眼 ,女 2 2例 2 8眼 ,年龄 30～ 73岁 ,平均 5 3 5岁 ,随机分成 5 Ｆｕ组、ＭＭＣ组和对照组 :( 1) 5 Ｆｕ组 2 0例 2 7眼 ,男 14例 19眼 ,女 6例 8眼 ,原发性 2 4眼 ,复发性 3眼。 ( 2 )ＭＭＣ组 2 0例 2 6眼 ,男 12例 16眼 ,女 8例10眼 ,原发性 2 5眼 …     

丝裂霉素C与5-氟尿嘧啶在青光眼滤过性手术中的应用比较

青光眼滤过手术后2年内的手术失败率仍居高不下,主要原因为滤过道瘢痕化。丝裂霉素C(MMC)与5-氟尿嘧啶(5-FU)作为抗代射药物能减少滤过道瘢痕形成,提高了手术成功率。现对MMC与5-FU在青光眼滤过性于术中的应用效果报告如下。     

丝裂霉素C在难治性青光眼滤过术中的应用

目的 为明确丝裂霉素Ｃ（ｍｉｔｏｍｙｃｉｎ，ＭＭＣ）在青光眼滤过术后，抗滤过泡瘢痕形成的作用。方法 将３０例（４０只眼）难治性青光眼随机分为ＭＭＣ治疗组２１只眼和对照组１９只眼。ＭＭＣ组在小梁切除术中１次使用０．４ｍｇ／ｍｌ的ＭＭＣ，对照组不使用ＭＭＣ。术后追踪６￣２５个月，平均１０个月。结果 ＭＭＣ组手术成功率为９０．４％，对照组为２６．３％，Ｐ≤０．０００１。功能性滤过泡眼数，ＭＭＣ组为１７／     

丝裂霉素C与5—Fu用于抗青光眼滤过性手术的对比研究

采用随机、双讯，前瞻对照的方法比较了丝裂霉素Ｃ（ＭＭＣ）和５－氟尿嘧啶对难治性青光眼小梁切除手术的安全性和有效性。３９例病人随机分成二组，一组使用ＭＭＣ，另一组使用５－Ｆｕ。结果提示：（１）ＭＭＣ组手术成功率高于５－Ｆｕ组；（２）ＭＭＣ组角膜上皮缺损发生率，结膜创口渗漏率明显低于５－Ｆｕ组。     

丝裂霉素C在青光眼滤过术中的应用

青光眼滤过术后，结膜滤过泡的瘢痕化是手术失败的重要因素。近年来，国内外致力于多种抗瘢痕药物的研究，手术中应用丝裂霉素C（Mitomycin——C，MMC）作为青光眼滤过手术的辅助药物，提高了手术成功率。作者于1994年对10眼应用了MMC，经临床观察，效果良好，现报告如下：对象：1994年随机选择住院病人需行滤过性手术者18例，20眼；其中男3例，女匕例，年龄55－65岁，全部为闭角型青光眼，随机分为MMC治疗组10眼，对照组10眼，术前按常规检查。方法：全部病例选用小梁切除术。手术按常规进行。MMC治疗组在完成巩膜瓣后将饱含0．Zmgl…     

Postoperative 5-fluorouracil versus intraoperative mitomycin C in high-risk glaucoma filtering surgery: extended follow up

Purpose: To compare the long‐term efficacy and safety of postoperative subconjunctival 5‐fluorouracil (5‐FU) injections with that of intraoperative mitomycin C (MMC) in eyes at high risk for failure of trabeculectomy. Methods: In a retrospective, non‐randomized comparative trial, 36 eyes of 36 consecutive patients at high risk for failure of trabeculectomy underwent glaucoma filtering surgery with either postoperative subconjunctival 5‐FU injections (19 eyes) or intraoperative application of MMC (17 eyes). Intraocular pressure, number of postoperative antiglaucoma medications, postoperative visual acuity, interventions, and complications were evaluated. Results: Overall success (intraocular pressure ≤21 mmHg) at 1 year was 73.6% in the 5‐FU group and 82.3% in the MMC group. The cumulative 4‐year success was 52.6% in the 5‐FU group and 60.5% in the MMC group (P = 0.6). At 4‐year follow up, mean ± SD intraocular pressures were 17.58 ± 4.01 mmHg in the 5‐FU group and 13.33 ± 3.36 mmHg in the MMC group (P = 0.01). There was no significant difference in the number of post­operative medications (P = 0.84), appearance of blebs (P = 0.20), final visual acuity (P = 1.00), and complications (P > 0.05) between the groups. Conclusions: These results suggest that both postoperative 5‐FU injections and intraoperative MMC application have long‐term success in high‐risk patients. However, MMC results in a greater decrease in intraocular pressure than 5‐FU.     

5-fluorouracil and glaucoma filtering surgery. II. A pilot study

5-Fluorouracil (5-FU) was injected subconjunctivally after glaucoma filtering surgery in a pilot study of eyes with poor surgical prognoses. Twenty-seven (79%) of the 34 aphakic eyes with glaucoma achieved an intraocular pressure (IOP) of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 91 -468 days). Nine (69%) of 13 eyes with neovascular glaucoma achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 120-379 days). Eight (89%) of nine phakic eyes with glaucoma following unsuccessful filtering procedures achieved an IOP of less than or equal to 21 mmHg (range of follow-up on nonreoperated eyes, 134-394 days). Visual acuities remained within one line of their preoperative levels or improved in 32 (94%) of the 34 aphakic eyes with glaucoma, eight (62%) of the 13 eyes with neovascular glaucoma, and six (67%) of the nine phakic eyes with glaucoma following unsuccessful filtering procedures. Postoperative corneal epithelial defects occurred in 45% of the cases. Conjunctival wound and conjunctival needle tract leaks were observed in 41% of the cases, but only one eye required wound revision. No other serious side effects that we attributed to 5-FU were observed. It seems that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control following filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this.     

MMC与5-FU联合可调整缝线的小梁切除术治疗青光眼的疗效比较

目的：对比分析青光眼患者联合可调整缝线的小梁切除术中使用丝裂霉素C(mitomycin C,MMC)与5-氟尿嘧啶(5-fluorouracil,5-FU)的临床预后及并发症。

方法：回顾性病例系列研究。选取本院2016-06/2017-10的71例71眼青光眼(包括原发性开角型青光眼和原发性慢性闭角型青光眼)患者,分为两组,其中MMC组36例,5-FU组35例,均给予联合可调整缝线的小梁切除术,分别使用MMC、5-FU抗瘢痕治疗,术后随访6mo,比较两组患者的临床眼压控制疗效、滤过泡形态及并发症发生率。

结果：MMC组患者术后眼压控制低于5-FU组,差异有统计学意义(P<0.05),MMC组总手术成功率与5-FU组比较,差异无统计学意义(P>0.05),MMC组功能性滤过泡形成率高于5-FU组,MMC组非功能性滤过泡形成率低于5-FU组,差异有统计学意义(P<0.05),MMC组与5-FU组并发症发生率差异无统计学意义(P>0.05)。

结论：MMC及5-FU作为抗瘢痕药均能提高青光眼小梁切除手术的成功率,MMC能将眼压降到更低,形成功能性滤过泡方面MMC优于5-FU,根据患者制定个性化的手术方案MMC与5-FU的并发症发生率无明显差异,使用5-FU时需术后多次分离滤过泡及结膜下再次注射5-FU。     

Reducing corneal toxicity of 5-fluorouracil in the early postoperative period following glaucoma filtering surgery

To gain a better understanding of the relationship between postoperative 5-fluorouracil administration and corneal complications associated with its use, we analysed 43 consecutive filtering procedures in which it had been employed. Nine of the 43 eyes had corneal complications during that period. At the end of the three-month period, these corneal complications had all resolved. There was no correlation between postoperative intraocular pressure lowering and incidence of corneal complications. A low dose of 5-flourouracil, and early recognition and treatment of corneal toxicity associated with its use may reduce corneal complications while maintaining filtration in eyes with poor surgical prognosis.     

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。     

5-fluorouracil and glaucoma filtering surgery: I. An animal model

Failure of a glaucoma filtering procedure commonly results from scarring at the surgical site. Fibroblasts play an important role in the scarring process. 5-fluorouracil is an antimetabolite capable of inhibiting fibroblast proliferation. We tested the ability of 5-fluorouracil to inhibit cicatrization at the filtering site in an experimental model. Posterior lip sclerectomies were performed in each eye of ten normal owl monkeys. Postoperatively, one eye of each animal received subconjunctival injections of fluorouracil and the fellow eye received saline injections in a randomized, masked fashion. Two animals died of undetermined causes. None of the control eyes developed blebs, but six of the eight treated eyes in surviving animals developed blebs. The difference between intraocular pressures in fluorouracil-treated and control eyes was statistically significant (P less than 0.05). Signs of ocular toxicity included persistent corneal epithelial defects and delayed healing of the conjunctival incision. These results are considerably more favorable than those previously reported with experimental filtering procedures in non-human primates. Pharmacologic modulation of wound healing may decrease the risk of failure of filtering operations.     

环孢霉素A在抗青光眼滤过性手术中抗增殖作用的实验研究

目的：研究环孢霉素A（cyclosporin A,CsA)在抗青光眼过性手术中的抗增殖作用。方法：将30只健康新西兰大白兔随机分成3组，即实验组（CsA)、对照组1为5－氟尿嘧啶（5－fluorouracil,5-Fu)组、对照组2为丝裂霉素C(mitomycin C,MMC）组均行小梁切除术，术中分别在Tenon囊和巩膜之间放置2％CsA、0．5％5－Fu、0．002％MMC的海绵块5分钟后，用0．9％生理盐水冲洗干净.分别在术后第7天、30天、60天检查眼压、滤过泡、角膜、眼底，并进行病理、透射电镜检查。结果：CsA组眼压多控制理想，较对照组1、2有明显差异（分别为P＜0．001和P＜0．0001），多数形成功能性滤过泡，无任何并发症，病理未见结缔组织胶原化。电镜下，胞浆内可见空泡，线粒体较少，纤维细胞异染色质功能不活跃。结论：CsA在抗青光眼过术中抗增殖作用较5－Fu、MMC 效果好，副作用小，值得推广应用。     

Efficacy and tolerability of nonpenetrating glaucoma surgery augmented with mitomycin C in treatment of open-angle glaucoma: a meta-analysis

Objective: To evaluate the efficacy and tolerability of nonpenetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) compared with trabeculectomy (TE) plus MMC in the treatment of patients with open-angle glaucoma.Design: Systematic review and meta-analysis.Participants: Eight clinical trials, including 4 cohort and 4 randomized, enrolled 459 eyes.Methods: Pertinent studies were selected through extensive searches of the Cochrane Library, MEDLINE, EMBASE, and meeting abstracts. Efficacy measures were weighted mean differences (WMDs) for the percentage intraocular pressure (IOP) reduction and relative risks (RRs) for success rates. Tolerability measures were RRs for adverse events. Pooled estimates were carried out in RevMan software v. 4.2.Results: NPGS augmented with MMC was associated with a numerically smaller but nonsignificant percentage reduction in IOP compared with TE plus MMC, with a WMD of −1.27% (95% Cl −5.61 to 3.07) at 1 year, −4.55% (−10.35 to 1.24) at 2 years, −0.82% (−8.80 to 7.17) at 3 years, and −6.16% (−25.97 to 13.65) at 4 years. Significantly greater proportions of TE plus MMC patients than NPGS augmented with MMC patients achieved the target IOP without antiglaucoma medication at the end point, with a pooled RR of 0.74 (0.63-0.86). NPGS augmented with MMC was associated with a significantly lower frequency of shallow anterior chamber and cataract than TE plus MMC, with pooled RRs of 0.31 (0.16-0.60) and 0.23 (0.11-0.47), respectively.Conclusions: NPGS augmented with MMC was associated with IOP-lowering efficacy comparable to that of TE plus MMC. However, significantly fewer patients achieved the target IOP with NPGS augmented with MMC than with TE plus MMC. NPGS augmented with MMC was better tolerated than TE plus MMC.     

青光眼滤过术后联合结膜下注射5-Fu剂量、时机及频率的研究

目的:探讨青光眼滤过术后联合不同的结膜下注射5-Fu方案对手术成功率的影响。方法:2001-01/2007-08间收治的青光眼滤过联合术后结膜下注射5-Fu患者176例,记录各例具体的5-Fu使用方案,并对手术成功率及并发症进行比较。结果:较高剂量的5-Fu并不能产生更高的手术成功率(P=0.320);术后第1d即使用5-Fu的患者手术成功率最高(P=0.015);5-Fu于术后1mo内平均注射次数为5.4次可收到较好的效果。结论:5-Fu作为青光眼滤过术辅助用药,正确、合理的使用能显著提高手术成功率。     

青光眼滤过术中联合应用丝裂霉素C的临床观察

目的:探讨丝裂霉素C在青光眼滤过手术中应用的疗效。方法:对32例35眼青光眼滤过手术中应用丝裂霉素C(mitomycin,MMC)观察疗效。结果:术后视力增进21眼,无变化14眼,术后平均随访2a,Ⅰ型滤过泡18眼,Ⅱ型15眼,Ⅲ型1眼,无滤过泡眼压正常1眼。结论:眼滤过手术联合MMC是治疗青光眼的有效办法。