中华眼科杂志 2000年第2期第36卷 论 著
作者：张秀兰 彭大伟 周文炳 叶天才 葛坚
单位：张秀兰（510060 广州，中山医科大学中山眼科中心）；彭大伟（510060 广州，中山医科大学中山眼科中心）；周文炳（510060 广州，中山医科大学中山眼科中心）；叶天才（510060 广州，中山医科大学中山眼科中心）；葛坚（510060 广州，中山医科大学中山眼科中心）
关键词：青光眼；滤过术；干扰素α-2b；丝裂霉素C
【摘要】 目的 评价干扰素α-2b （interferon α-2b,IFN α-2b）与丝裂霉素C (mitomycin C,MMC)用于青光眼滤过术的临床疗效及应用价值。方法 采取随机对照临床试验研究方法，将41例（68只眼）晚期原发性开角型青光眼(primary open angle glaucoma, POAG) 患者分为两组。每组各有34只眼，其中27例为同一患者左右眼对照；患者年龄15～40岁，均为初次手术。IFN α-2b组于小梁切除术毕即刻、术后第3、7、10、14d，在滤过区旁球结膜下注射5×105 IU； MMC组在术中1次性应用MMC, 浓度为0.25 mg/ml, 共5 min。 随访时间6～15个月。结果 (1)术后第12个月末, IFN α-2b组和MMC组功能性滤过泡的累积百分率分别为(70.95±9.72)%和(77.01+10.51)%, 两组差异无显著性(u=0.2165, P＞0.05)。IFN α-2b组形成的滤过泡以II型为主, MMC组则以I型为主(χ2=6.261, P＜0.05); 前者眼压在10～15 mm Hg（1 mm Hg=0.133kPa）的控制率，以第3、6、9、12个月时均高于后者。(2)IFN α-2b组和MMC组的累计完全成功率和条件成功率分别为（70.95%±9.72）%、（94.59±5.26）%和（65.15±10.51）%、（84.61±7.26 ）%, 但差异亦无显著性(u= 0.817 4, 0.101 1, P＞0.05)。(3)IFN α-2b对眼部的副作用小,引起的并发症主要有短暂性角膜上皮染色; MMC引起的常见并发症有薄壁滤过泡、持续性低眼压及低眼压性黄斑病变。MMC组引起视力下降者占44.1%,IFN α-2b组占17.6%，差异有显著性(χ2=5.217 4, P＜0.05)。结论 IFN α-2b应用于青光眼滤过术, 其减少滤过手术失败的作用与MMC相当，且并发症较MMC少。根据各自的优缺点,建议两者联合应用或选择应用。
A clinical comparative study of interferon α-2b with mitomycin C applied in glaucoma filtering operation
ZHANG xiulan(Email: [email protected]), PENG Dawei, ZHOU Wenbin, et al.
（Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou 510060，China）
【Abstract】 Objective To compare the results of interferon α-2b (IFN α-2b) with mitomycin C (MMC) treatment in trabeculectomy.Method 41 cases 68 eyes with late stage of primary open angle glaucoma (POAG) were randomly studied by treatment with IFN α-2b or MMC following trabeculectomy, each group consisting of 34 eyes. Of the cases, 27 were bilateral, one eye was designed to use IFN α-2b, and the other eye, apply MMC. All patients were ranged from 15 to 40 years old, and they all received the surgery the first time. The surgical procedure was similar in all eyes. The IFN α-2b treated eyes were subconjunctivally injected 5×105IU at filtering bleb when the operation was finished immediately and on the postoperative day 3, 7, 10 and 14, respectively. The MMC-receiving eyes were intraoperatively administered with 0.25mg/ml via a sponge under the conjunctival flap for 5 minutes. The follow-up was ranged from 6 to 15 months.Results (1) The 12th month life-table success rate of functional bleb formation was (70.95±9.72)% in IFN α-2b-treated group and (77.01±10.51)% in MMC-received group, the difference being not statistically significant (u=0.216 5, P＞0.05). The eyes with IFN α-2b tended to form type II blebs were according to Kronfeld classification, whereas type I blebs were commonly seen in MMC-treated eyes (χ2=6.261, P＜0.05). The percentages of intraocular pressure between 10-15 mmHg on postoperative month 3, 6, 9 and 12, respectively in IFN α-2b group were higher than that in MMC group. (2) The 12th month life-table complete and qualified success rates were (70.95±9.72)% and (94.59±5.26)% in IFN α-2b group, (65.15±10.51)% and (84.61±7.26)% in MMC group, respectively (u=0.817 4, 0.101 1，P＞0.05). (3) Complications induced by IFN α-2b were rare, mainly involving transient corneal epithelial defect, whereas by MMC included thin-wall blebs, persistent hypotony and hypotonous maculopathy. The decrease of visual acuity was seen in 44.1% of the cases in MMC group, whereas only 17.6% occurred in IFN α-2b group (χ2=5.217 4, P＜0.05). Conclusion IFN α-2b has similar effect as MMC to reduce the risk of failure of glaucoma filtration surgery, but it has more advantages over because of its fewer complications.
【Key words】 Glaucoma； Filtering surgery； Interferon α-2b；Mitomycin C
在青光眼滤过术中应用抗代谢药物，可提高手术成功率。但由于这类药物有一定的危险性，应用指征有局限性，因此仍需不断探索更理想的青光眼治疗辅助药物。我院青光眼专业组在对5-氟脲嘧啶、高三尖杉酯碱、丝裂霉素C（mitomycin C,MMC）系列研究基础上［1］，将干扰素α-2b(interferon α-2b, IFN α-2b)应用于青光眼滤过术中，并与MMC进行疗效、毒副作用及并发症的对比，以评价IFN α-2b的临床应用价值。
资料与方法
一、选择病例标准
年龄15～40岁；需手术治疗的晚期原发性开角型青光眼（primary open angle glaucoma, POAG）患者；初次手术；无其他眼部或全身异常。 POAG的诊断标准参照1987年全国青光眼学组推荐的标准。
二、临床资料
我们采取随机对照临床试验研究方法，将1997年1月起收入我院的青光眼患者共41例（68只眼）分为两组，每组各34只眼，其中27例为同一患者左右眼对照，另14例为单眼。两组患者的年龄、性别、眼别、术前视力和眼压、C/D值、术前所用降眼压药物种类及随访时间等临床参数均衡。所有患者随访时间6～15个月。
三、 手术方法
所有患者均行规范统一的小梁切除术。双侧眼由同一术者操作，显微镜下进行，手术方式统一。以角膜缘为基底，结膜瓣高度至少为6或7 mm，范围120°，不剪除Tenon囊组织，方形巩膜瓣为3.5 mm×3.5 mm，1/2厚度，角巩膜缘切除口为1.5 mm×2.0 mm。
四、用药方法
1．MMC组：术中1次性给予。用3 mm×4 mm棉片浸泡含0.25 mg/ml的MMC后，置于滤过区结膜下、巩膜瓣上5 min，去除棉片，立即用30～50ml BSS液冲洗。
2．IFN α-2b组：术毕当时、术后第3、7、10及14天，于滤过区旁球结膜下注射1次IFN α-2b 5×105 IU。所用剂量及方法均在动物实验基础上制定。
五、统计学方法
术后比较两组疗效、并发症及视功能变化情况。所有数据均经统计学处理，分别采用χ2检验、t检验及u检验方法。
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