The Short-term Effect of Subtenon Sponge Application Versus Subtenon Irrigation of Mitomycin-C on the Outcomes of Trabeculectomy With Ex-PRESS Glaucoma Filtration Device: A Randomized Trial
The Short-term Effect of Subtenon Sponge Application Versus Subtenon Irrigation of Mitomycin-C on the Outcomes of Trabeculectomy With Ex-PRESS Glaucoma Filtration Device: A Randomized Trial
复制标题
球囊囊下海绵应用与丝裂霉素 C 囊下冲洗对 Ex-PRESS 青光眼滤过装置小梁切除术结果的短期影响：一项随机试验
作者：
Michael S. Quist;Ninita Brown;Amanda K. Bicket;L. Herndon
目的：传统上，在小梁切除术中，使用手术海绵将丝裂霉素C（MMC）应用于组织。然而，存在替代的应用模式。本研究评估了通过海绵与冲洗接受筋膜下MMC应用的患者的成功率、并发症发生率、最终眼内压（IOP）和滤过泡特征。患者和方法：共纳入100例青光眼患者，将其随机分为2个治疗组。患者接受了小梁切除术、Ex-PRESS分流和MMC放置，并随访6个月。评估的并发症发生率包括滤过泡衰竭、滤过泡渗漏、滤过泡包裹和张力减退等。评价的其他因素包括滤过泡形态、青光眼滴剂使用、氟尿嘧啶（5-FU）应用、滤过泡翻修和随后的青光眼手术。结果如下：冲洗方法提供了更大的IOP降低效果（P=0.03）;相应地，冲洗组的低眼压发生率更高（P=0.03），但无显著后果。单纯行小梁切除术/Ex-PRESS的患者IOP降低程度大于同期行白内障手术的患者（P<0.001）。海绵组的5-FU使用率（P=0.007）和再次手术率（P=0.02）均高于冲洗组。成功定义为达到4 mm Hg/IOP ~ 15 mm Hg，无任何解剖学滤过泡失败或随后的青光眼手术。总体成功率为87%。结论：与使用海绵相比，通过冲洗应用筋膜下MMC似乎提供了改善的短期结局。由于具有类似的安全性，冲洗方法可以提供更好的IOP控制，并减少了小梁切除术后短期内进一步临床/手术干预的需要。长期研究将有助于分析这些差异是否会随着时间的推移而持续。
Purpose: Traditionally, during trabeculectomy, Mitomycin-C (MMC) is applied to the tissues using surgical sponges. However, alternate modes of application exist. This study assessed the success rates, complication rates, final intraocular pressure (IOP), and bleb characteristics between patients receiving subtenon MMC application by sponge versus irrigation. Patients and Methods: A total of 100 patients with glaucoma were enrolled and each was randomized to 1 of the 2 treatment groups. Patients underwent trabeculectomy with Ex-PRESS shunt and MMC placement and were followed for 6 months. Complication rates assessed included bleb failure, bleb leaks, bleb encapsulation, and hypotony, amongst others. Additional factors evaluated included bleb morphology, glaucoma drop usage, Fluorouracil (5-FU) application, bleb revision, and subsequent glaucoma surgery. Results: The irrigation method provided greater IOP lowering effects (P=0.03); correspondingly the irrigation group had higher rates of hypotony (P=0.03) but with no significant consequences. Patients who had trabeculectomy/Ex-PRESS alone had greater IOP reduction than those who had concurrent cataract surgery (P<0.001). The sponge group had higher rates of 5-FU use (P=0.007) and higher reoperation rates (P=0.02) when compared with the irrigation group. Success was defined as achieving 4 mm Hg⩽IOP⩽15 mm Hg without any anatomical bleb failure or subsequent glaucoma surgery. The overall success rate was 87%. Conclusions: Application of subtenon MMC by irrigation seems to provide improved short-term outcomes compared with application with sponges. With a similar safety profile, the irrigation method provides better IOP control, and decreases the need for further clinical/surgical intervention in the short-term after trabeculectomy. Longer-term studies will be useful in analyzing if these differences persist with time.
影响因子：
--
作者：
LESKE, MC;CONNELL, AMS;HYMAN, L
通讯作者：
HYMAN, L