【摘要】  　　目的：探讨小梁切除联合应用丝裂霉素C治疗青光眼再手术的远期疗效。方法：回顾性分析19例21眼常规小梁切除无功能滤过泡、眼压失控再次手术的病例资料，手术方式为再次小梁切除联合应用丝裂霉素C并术后随访1~3a。疗效判定标准 ：A 疗效好：眼压 ＜16 mmHg、视力≥0.3、视盘与视野损害无进展。B 疗效较好：不用或仅用局部抗青光眼药物眼压≤21 mmHg、视力0.1～0.25、视盘与视野损害无进展。C 疗效差：眼压失控、药物不能控制在正常范围或手术治疗。手术成功判定标准：A B项为手术成功标准。结果：随访1a以上19例21眼(100%)，随访3a以上16例（18眼）(76%)。术后平均眼压16.3±4.1 mmHg。较术前眼压35.8±5.32 mmHg明显降低.( P ≤0.001) 、11眼眼压控制在13±2.7 mmHg , 8眼局部应用抗青光眼一种药物眼压控制好, 较术前眼压难以控制有显著意义。检眼镜观察杯盘比值与视野检查,术前术后无显著差异。术后裸眼与矫正视力为0.02～0.5，视力满意（＞0.3）8眼（38%），17眼（0.1以上）保持有用视力（81%）。根据上述标准：疗效好8眼、疗效较好9眼、4眼疗效差。1a手术成功率86%。3a手术成功率76%。本组病例术后早期并发症：角膜上皮损害6眼，低眼压、浅前房发生9眼，其中滤过强与渗漏4眼，2眼脉络膜脱离,1眼发生睫状环阻塞性青光眼。3a随访晶状体浑浊加重5眼，2眼再一次出现眼压失控行抗青光眼联合手术。结论：小梁切除联合应用丝裂霉素C治疗青光眼手术成功率高，远期效果好，再次手术疗效满意。

【关键词】  小梁切除　丝裂霉素C　青光眼再手术　随访研究

　　Long-term effect of trabeculectomy combined with MMC on repeated surgery for glaucoma

    Ping Ming , Bin Zhou, Ze-Rong Li

    Department of Ophthalmology, the Ninth People's Hospital of Chongqing,Chongqing 400700, China

     Abstract AIM:To evaluate the long-term effect of trabeculectomy combined with MMC on repeated surgery for Glaucoma. METHODS:This retrospective study included 19 cases(21 eyes) with Glaucoma patients for trabeculectomy and followed up for 1- 3 years . Definition of effect for surgery were determined as A Nice :Intraocular Pressure( IOP) ≤16 mmHg , visual acuity≥0.3 , Optic Nerve and vision field without advanced damage ; B Good : no antiglaucoma medication or only local medication of topical antiglaucoma drops， IOP≤21mmHg , visual acuity≥0.1-0.25 and optic Nerve and vision field without advanced damage; C No effect:IOP could not been controlled and also with antiglaucoma topical drops . Definition of successful surgery : A and B is successful .RESULTS: The study included 19 cases (21 eyes) with 100% patients who followed up for over one year, 16 cases (18 eyes) with 76% patients who followed up for over 3 years. After surgery , the average IOP was significantly lowered to 16.3±4.1mmHg from 35.8±5.32mmHg( P≤0.001) ,there were 11 cases which the IOP was 13±2.7mmHg , 8 cases which the IOP were controlled with topical antiglaucoma drops. There was no significantly difference in the cup-disc ratio (C/D) and the vision field . the visual acuity after surgery was 0.02-0.5. there were 8 eyes with 38% patients who had visual acuity>0.3 ,17 eyes with 81% patients who had visual acuity>0.1.Based on the criteria for successful surgery : A 8eyes, B 9 eyes, C 4 eyes. The successful rate of surgery was 86% at one year, 76% at three years. Among 21 eyes for early complication: there were 6 eyes with the corneal epithelial defect, 9 eyes with lower IOP and shallow anterior chamber, two eyes with choroidal detachment,1 eye with ciliary block glaucoma .After followed-up for three years ,there were 5 eyes with advanced cataract， 2 eyes were underwent cataract surgery combined with antiglaucoma because of uncontrolled IOP .
CONCLUSION: Trabeculectomy combined MMC has a high successful rate in treatment of glaucoma with good long-term effect, Observation from repeated surgery also showed satisfactory results.

    · KEYWORDS: trabeculectomy ; mitomycin; follow-up time ; repeated surgery for glaucoma

　　0引言

    小梁切除联合丝裂霉素C应用是现代治疗青光眼的主要术式，并取得好的手术效果，但对抗青光眼术后眼压失控病例的再手术的观察报道不多。我院自2001年以来采用此术式治疗青光眼再手术病例19例21眼。现将其追踪随访资料进行回顾性分析并报告如下。

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