Primary glaucoma triple procedure with or without adjunctive mitomycin - Prognostic factors for filtration failure
Primary glaucoma triple procedure with or without adjunctive mitomycin - Prognostic factors for filtration failure
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DOI：
10.1016/s0161-6420(96)30406-5
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发表时间：
1996-11-01
期刊：
影响因子：
13.7
通讯作者：
Obertynski, T
中科院分区：
文献类型：
--
作者：
Shin, DH;Hughes, BA;Obertynski, T
目的：在原发性青光眼三联手术 (PGTP) 中选择性使用辅助丝裂霉素 C (MMC) 的前提是更好地了解预后因素。因此，作者对有或没有辅助MMC的PGTP结果进行了当前的研究，以确定PGTP滤过失败的预后因素。方法：研究患者由174名连续接受PGTP的原发性开角型青光眼（POAG）患者组成。在 PGTP 期间，他们被随机分配至不接受辅助 MMC（93 名患者的 93 只眼睛）或接受辅助结膜下 MMC（81 名患者的 81 只眼睛）。手术后，定期检查患者的视力、眼压（IOP）控制、药物治疗要求和并发症。根据两个不同的标准确定滤过失败：(1) 一组不太严格的标准（标准 I）和 (2) 一组更严格的标准（标准 II）。 结果：在 25.1 +/- 5.5 个月的平均随访期间（+/- 标准差）期间，使用和不使用辅助 MMC 的组之间在术后眼压、药物数量和视力结果方面没有统计学显着差异（P > 0.05）每个）。然而，对照组存在滤过失败的预后因素，而MMC组则没有。根据标准 I，黑人种、糖尿病、术前眼压大于或等于 20 mmHg、术前用药次数大于 2 种被认为是滤过失败的显着预后因素。 根据标准 II，黑人种、术前眼压大于或等于 20 mmHg、术前用药次数大于 1 种是滤过失败的显着预后因素。未经选择的原发性开角型青光眼患者。黑人种族、糖尿病（仅根据标准 I）、术前眼压大于或等于 20 mmHg、术前用药次数大于 2 种（根据标准 I）或大于 1 种（根据标准 II）被发现是无辅助 MMC 的 PGTP 滤过失败的重要独立预后因素，但有辅助 MMC 时则不然。在 PGTP 中辅助结膜下 MMC 的使用可能必须有选择性，主要针对那些患有原发性开角型青光眼且具有一种或多种滤过失败预后因素的患者。
Purpose: The prerequisite for selective use of adjunctive mitomycin C (MMC) in primary glaucoma triple procedure (PGTP) is a better understanding of the prognostic factors. Therefore, the authors carried out the current study on the outcome of PGTP with and without adjunctive MMC to determine the prognostic factors for filtration failure of PGTP.Methods: The study patients consisted of 174 consecutive primary open-angle glaucoma (POAG) patients undergoing PGTP. They were assigned randomly to either no adjunctive MMC (93 eyes of 93 patients) or adjunctive subconjunctival MMC (81 eyes of 81 patients) during the PGTP. After surgery, the patients were examined at regular intervals for visual acuity, intraocular pressure (IOP) control, medical therapy requirements, and complications. Filtration failure was determined according to two different criteria: (1) a less stringent set of criteria (criterion I) and (2) a more stringent set of criteria (criterion II).Results: There were no statistically significant differences between the groups with and without adjunctive MMC with respect to postoperative IOP, number of medications, and visual acuity outcome during mean follow-up (+/- standard deviation) of 25.1 +/- 5.5 months (P > 0.05 for each). However, there were prognostic factors for filtration failure in the control group but not in the MMC group. Black race, diabetes mellitus, preoperative IOP greater than or equal to 20 mmHg, and number of preoperative medications greater than two were found to be significant prognostic factors for filtration failure by criterion I. Black race, preoperative IOP greater than or equal to 20 mmHg and number of preoperative medications greater than 1 were significant prognostic factors for filtration failure by criterion II.Conclusion: There was no statistically significant difference in the overall outcome of PGTP between control and MMC groups of nonselected patients with primary open-angle glaucoma. Black race, diabetes mellitus (by criterion I only), preoperative IOP greater than or equal to 20 mmHg, and number of preoperative medications greater than 2 (by criterion I) or greater than 1 (by criterion II) were found to be significant independent prognostic factors for filtration failure of PGTP without adjunctive MMC but not with adjunctive MMC. The use of adjunctive subconjunctival MMC in PGTP may have to be selective, primarily in those patients with primary open-angle glaucoma with one or more of the prognostic factors for filtration failure.