Effect of different application depths of mitomycin-C in deep sclerectomy with collagen implant: a randomized controlled trial
Effect of different application depths of mitomycin-C in deep sclerectomy with collagen implant: a randomized controlled trial
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DOI：
10.1111/j.1442-9071.2009.02030.x
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发表时间：
2009-04-01
影响因子：
4
通讯作者：
Ravinet, Emilie
中科院分区：
文献类型：
--
作者：
Mansouri, Kaweh;Ravinet, Emilie
为评价丝裂霉素C（MMC）在深层巩膜切除术中的作用，将胶原植入物应用于浅层巩膜瓣下或深层巩膜瓣下，25例原发性或继发性开角型青光眼患者接受了深层巩膜切除术，并随机分配到两个治疗组。浅层MMC组（S-MMC）在浅层巩膜瓣下用海绵浸泡MMC 60 s;深层MMC组（D-MMC）在深层巩膜瓣下用MMC 60 s后进入Schlemm管。在两组中，剩余MMC用40 mL平衡盐溶液冲洗。患者随访2年。在最后一次随访时用超声生物显微镜研究滤过泡的体积，术前平均眼压（IOP）为D-MMC眼20.5 ± 8.9 mmHg，S-MMC眼21.6 ± 6.6 mmHg（P = 0.67）。第1天的平均术后IOP为5.3 +/- 3.3 mmHg（D-MMC）和6.9 +/- 4.8 mmHg（S-MMC）（P = 0.22），末次随访时为11.4 +/- 6.3 mmHg（D-MMC）和11.3 +/- 4.6 mmHg（S-MMC）（P = 0.54）。每例患者的平均用药次数从2.5 +/- 0.5降至0.4 +/- 0.5（D-MMC）（P < 0.001），从2.5 +/- 0.9降至0.3 +/- 0.4（S-MMC）（P < 0.001）。24个月时超声生物显微镜显示平均巩膜内容积为1.97 ± 0.35 mm 3（D-MMC）和5.68 ± 0.42 mm 3（S-MMC）（P < 0.05）。然而，深层巩膜应用MMC似乎产生明显更小的巩膜内滤过泡。
To evaluate effects of mitomycin-C (MMC) in deep sclerectomy with collagen implant applied under the superficial scleral flap or under the deep scleral flap.Twenty-five patients with primary or secondary open-angle glaucoma and at high risk for postoperative cicatrization underwent deep sclerectomy and were randomly distributed to the two treatment arms. In the superficial MMC group (S-MMC), MMC was applied under the superficial scleral flap using a soaked sponge for 60 s; in the deep MMC group (D-MMC), MMC was applied under the deep scleral flap for 60 s before entering the Schlemm's canal. In both groups, remaining MMC was irrigated with 40 mL balanced salt solution. Patients were followed up for up to 2 years. The volume of filtering blebs was studied with ultrasound biomicroscopy at the last follow-up visit.Mean preoperative intraocular pressure (IOP) was 20.5 +/- 8.9 mmHg for D-MMC and 21.6 +/- 6.6 mmHg for S-MMC eyes (P = 0.67). The mean postoperative IOP was 5.3 +/- 3.3 mmHg (D-MMC) and 6.9 +/- 4.8 mmHg (S-MMC) at day 1 (P = 0.22) and 11.4 +/- 6.3 mmHg (D-MMC) versus 11.3 +/- 4.6 mmHg (S-MMC) at last follow up (P = 0.54). The mean number of medications per patient was reduced from 2.5 +/- 0.5 to 0.4 +/- 0.5 (D-MMC) (P < 0.001) and from 2.5 +/- 0.9 to 0.3 +/- 0.4 (S-MMC) (P < 0.001). Ultrasound biomicroscopy at 24 months showed mean intrascleral space volume of 1.97 +/- 0.35 mm3 (D-MMC) and 5.68 +/- 0.42 mm3 (S-MMC) (P < 0.05).No significant difference in efficacy and safety was found between the two groups at a mean of 19.2 months of follow up. Deep scleral application of MMC, however, seems to produce significantly smaller intrascleral blebs.