结膜下注射丝裂霉素C在新生血管性青光眼Ahmed阀植入术后的应用价值分析

摘要

目的 探讨结膜下注射丝裂霉素C在新生血管性青光眼Ahmed阀植入术后的应用价值.方法 选择2012年8月至2015年6月在广东省深圳市龙岗区第五人民医院住院治疗的新生血管性青光眼患者130例,按照随机数字表法分为观察组与对照组,各65例.观察组结膜下注射丝裂霉素C 10 ml结合Ahmed阀植入术治疗,对照组只给予Ahmed阀植入术治疗,观察2组总有效率、眼压、并发症、滤过泡形成情况差异.结果 观察组总有效率高于对照组,差异有统计学意义[96.9％ (63/65)比84.6％ (55/65),P＜0.05].观察组术后1、3个月眼压明显低于同时点对照组,差异均有统计学意义[(12.3±4.1)mmHg(1 mmHg=0.133 kPa)比(16.3 ±2.9) mmHg、(12.0 ±4.0) mmHg比(15.9 ±3.1)mmHg,均P＜0.05].观察组术后3个月浅前房、前房出血、脉络膜脱离、眼内炎等并发症发生率明显低于对照组,差异均有统计学意义[3.1％ (2/65)比4.6％ (3/65)、3.1％(2/65)比6.2％ (4/65)、0.0％ (0/65)比6.2％(4/65)、0.0％(0/65)比4.6％(3/65),均P＜0.05].术后3个月观察组功能性滤过泡形成率为100.0％ (65/65),对照组为87.7％ (57/65),观察组明显高于对照组,差异有统计学意义(P＜0.05).结论 结膜下注射丝裂霉素C能提高新生血管性青光眼Ahmed阀植入术后手术疗效,减少并发症的发生,维持滤过泡形态,保持房水引流的持续性,进而实现降低眼压的目的.%Objective To investigate the therapeutic value of subconjunctival injection of mitomycin C after Ahmed valve implantation surgery in treating neovascular glaucoma(NVG).Methods Totally 130 patients with NVG from August 2012 to June 2015 in Longgang District the Fifth People's Hospital of Shenzhen were randomly divided into observation group and control group,with 65 cases in each group.All patients had Ahmed valve implantation.The observation group was given subconjunctival injection of mitomycin C after surgery.Total effective rates,intraocular pressures,complications,formations of filtering blebs were analyzed.Results The total effective rate in observation group was significantly higher than that in control group [96.9％ (63/65) vs 84.6％(55/65),P ＜ 0.05].In observation group,intraocular pressures 1 month and 3 months after surgery were significantly lower than those in control group [(12.3 ± 4.1) mmHg vs (16.3 ± 2.9) mmHg,(12.0 ± 4.0) mmHg vs (15.9 ± 3.1) mmHg,P ＜0.05].Three months after surgery,complications of shallow anterior chamber,hyphema,choroidal detachment and entophthalmia in observation group were significantly lower than those in control group [3.1％ (2/65) vs 4.6％ (3/65),3.1％ (2/65) vs 6.2％ (4/65),0.0％ (0/65) vs 6.2％ (4/65),0.0％(0/65) vs 4.6％ (3/65),P ＜ 0.05].Three months after surgery,the forming efficiency of functional filtering blebs in observation group was significantly than that in control group [100.0％ (65/65) vs 87.7％ (57/65),P ＜0.05].Conclusion Subconjunctival injection of mitomycin C can improve the efficacy of Ahmed valve implantation in NVG,reduce occurrences of complications,maintain forms of filtering blebs and the drainage of aqueous humor and lower intraocular pressure.