Bleb-related endophthalmitis after trabeculectomy with mitomycin C
Bleb-related endophthalmitis after trabeculectomy with mitomycin C
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DOI：
10.1016/s0161-6420(96)30639-8
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发表时间：
1996-04-01
期刊：
影响因子：
13.7
通讯作者：
Skuta, GL
中科院分区：
文献类型：
--
作者：
Higginbotham, EJ;Stevens, RK;Skuta, GL
目的：确定辅助使用丝裂霉素C （MMC）引起的滤过性水泡是否会增加眼内炎的风险。方法：回顾性分析1990年5月至1993年6月在w.k.k Kellogg眼科中心辅助使用MMC的232例连续小梁切除术的记录。从记录中获得的数据包括患者的年龄、性别、种族、青光眼类型、滤过手术部位、MMC暴露浓度和持续时间、早期或晚期水泡渗漏的存在以及眼内炎的发生。结果：3例患者术后1个月内失访。共有192名患者（110名女性和82名男性）的229只眼睛被纳入研究。无感染患者的平均随访时间为18.5±10.8个月（范围1 ~ 44个月）。水泡相关性眼内炎的总发生率为2.6%。采用下入路的患者中有8%（50例中有4例）发生眼内炎，而采用上入路的患者中有1.1%（179例中有2例）发生眼内炎（P = 0.02， Fisher精确检验）。下滤过部位与上滤过部位合并辅助MMC的小梁切除术后眼内炎发生的比值比估计为7.7。结论：辅助使用MMC的小梁切除术的短期随访显示，眼内炎的总体发生率与使用5-氟尿嘧啶或不使用抗纤维化药物的滤过手术相当。然而，与使用滤光片的下小梁切除术相比，使用辅助MMC的下小梁切除术发生水泡相关性眼内炎的风险明显增加。
Purpose: To determine whether filtering blebs resulting from adjunctive use of mitomycin C (MMC) leads to an increased risk of endophthalmitis.Methods: The authors retrospectively reviewed the records of 232 consecutive trabeculectomies performed at the W. K. Kellogg Eye Center with adjunctive use of MMC from May 1990 through June 1993. Data obtained from the records included patient age, sex, race, type of glaucoma, site of filtration surgery, concentration and duration of exposure to MMC, presence of early or late bleb leakage, and the occurrence of endophthalmitis.Results: Three patients were lost to follow-up less than 1 month after surgery. A total of 229 eyes of 192 patients (110 women and 82 men) were included in the study. Mean follow-up of patients remaining free of infection was 18.5 +/- 10.8 months (range, 1-44 months). The overall incidence of bleb-related endophthalmitis was 2.6%. Endophthalmitis developed in 8% of patients (4 of 50) in whom an inferior approach was used and in 1.1% (2 of 179) in whom a superior approach was used (P = 0.02, Fisher's exact test). The estimated odds ratio for the development of endophthalmitis after trabeculectomy with adjunctive MMC for inferior versus superior filtration sites was 7.7.Conclusion: Short-term follow-up of trabeculectomies performed with adjunctive use of MMC demonstrates an overall incidence of endophthalmitis comparable to filtration procedures performed with 5-fluorouracil or without antifibrotic agents. However, inferior trabeculectomy performed with adjunctive MMC carries a significantly increased risk of bleb-related endophthalmitis compared with filters performed superiorly.