目的 比较原发性闭角性青光眼在初次小梁切除术中分别应用丝裂霉素C(MMC)、5-氟尿嘧啶(5-FU)或生物羊膜的疗效及并发症.方法 急慢性闭角型青光眼41例(49只眼),随机分为3组,做以角膜缘为基底的结膜瓣.应用抗代谢药物者,在完成板层巩膜瓣后接受结膜瓣下放置浸渍浓度为0.2 mg/ml的MMC棉片3 min,或25 mg/ml的5-Fu棉片5 min,取出后用200 ml生理盐水冲洗结膜下及巩膜瓣下.应用生物羊膜者,在巩膜瓣下及结膜瓣下分别置单层羊膜.其他步骤同常规小梁切除术.结果 随访半年以上,3组病例在眼压控制及手术成功率上均未见显著差异.MMC组滤过泡以微囊型为主(68.8%);5-Fu及羊膜组以弥漫扁平型占优(分别为53.3%和61%),但羊膜组较易发生包裹型滤泡倾向.MMC组的并发症发生率较其他两组高,主要为浅前房、结膜瓣渗漏、低眼压和黄斑水肿.结论 三种方法均可应用于首次小梁切除患者,但需注意应用MMC者并发症较多;使用羊膜者需注意滤过泡的无功能化.%Objective To compare the efficacy and complications of intraoperative mitomycin C (MMC) , 5-flu orouracil(5-Fu) and biotic amniotic membrane in primary trabeculectomy for primary angle-closure glaucoma ( PACG). Methods 49 eyes of 41 subjects were randomized to 3 groups, receiving either of MMC or 5-Fu or biotic amniotic membrane. Trabeculectomy was done as routine : limbal-based conjunctival flap was made firstly. For those receiving anti-metabolite , sponges with MMC 0. 2 mg/ml were applied under the conjunctival flap for 3 minutes, or with 5-Fu 25 mg/ml for 5 minutes, respectively, then rinsed with 200ml of saline solution. For the third group , biotic amniotic membranes were ap - plied both under the scleral flap and tenon ' s capsule with appropriate sutures. During 6 months of follow-up, the intraocular pressure (IOP) , success rate, filtering bleb and complications were observed and recorded . Results There were no significant differences in respect of IOP control and success rate among 3 groups. For bleb types, most of patients in MMC group were cystic (68. 8% ) ; whereas diffuse bleb took up 53. 3% and 61% in 5-Fu group and amniotic membrane group respectively, but the latter showed a higher tendency to transform into encapsulated bleb . The incidences of complications were higher in MMC group , including shallow anterior chamber , bleb leakage, persistent hypotony and hypotonous macu - lopathy. Conclusion Although any of 3 adjuncts can be used in primary trabeculectomy for PACG , the complications were relatively higher in the group of using MMC ; whereas there was a higher liability of encapsulated bleb in the group of using biotic amniotic membrane.
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