青光眼小梁切除术应用丝裂霉素及5-氟尿嘧啶的临床疗效观察

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。

Clinical Observation for Trabeculectomy with Mitomycin and 5-fluorouracil

Objective：Application of mitornycin C trabeculectomy,postoperative with 5-fluorouracil（5-Fu）treatment of glaucoma.Methods：42 patients（49 eyes）with glaucoma were randomly divided into two groups：A group of 23 eyes for the treatment group,to trabeculectomy with mitomycin,patients with 5-fluorouracil（5-Fu）subconjunctival injection.The other group was the control group with 26 eyes,to trabeculectomy only with mitomycin,afte not with 5-fluorouracil（5-Fu）treatment.Were followed up for six months to two years,eye patients before and after treatment visual acuity,intraocular pressure,bleb as well as shallow anterior chamber and low intraocular pressure and othe indicators of corneal damage,success rate and complications of surgery were compared.Results：Treatment group,visual acuity improved in 5 eyes（21.7%）,not improved in 16 eyes（69.6%）,decreased in 2 eyes（8.7%）;The mean preoperative IOP（42.57±4.51）mmHg,the mean postoperative IOP（11.46±3.45）mmHg,Hypotony and shallow anterior chamber occurred in 5 eyes（21.7%）,Corneal lesions in 4 eyes（17.4%）,Hyphemain 1 eye（4.3%）,subconjunctival hemorrhage,4 eyes（17.4%）;Effective filtering bleb in 20 eyes（87.0%）,invalid bleb 3 eyes（13.0%）.The control group visual acuity improved in 4 eyes（15.4%）,not improved in 19 eyes（73.1%）,decreased in 3 eyes（11.5%）;The mean preoperative IOP（43.23±5.12）mmHg,the mean postoperative IOP（13.35±4.63）mmHg,Hypotony and shallow anterior chamber occurred in 4 eyes（15.4%）,Corneal lesions in 1 eyes（3.8%）,Hyphemain 0 eye,subconjunctival hemorrhage,1 eyes（3.8%）;Effective filtering bleb in 17 eyes（65.4%）,invalid bleb 9 eyes（34.6%）.Conclusion：Mitomycin and 5-Fu as adjuvant glaucoma filtering surgery can be reduced,the prevention of postoperative bleb recurrence of glaucoma caused by adhesions package,both can play a synergistic role in combination to improve the success rate of surgery.But after 5-Fu combined to increase the incidence of shallow anterior chamber with low intraocular pressure,in the same time the damage to the cornea while the corresponding increase pressure;If the merger taking systemic vasodilators can cause subconjunctival or anterior chamber bleeding complications;So it should be correct and reasonable use of mitomycin and 5-Fu,note that the timing of medication,dose and concentration.