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首页> 外文期刊>Middle East African Journal of Ophthalmology >A Comparative Study of Mitomycin C and 5-Fluorouracil Trabeculectomy in West Africa
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A Comparative Study of Mitomycin C and 5-Fluorouracil Trabeculectomy in West Africa

机译：西非丝裂霉素C和5-氟尿嘧啶小梁切除术的比较研究

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Purpose:To report the comparative efficacy and safety of intraoperative 5-fluorouracil (5-FU) or mitomycin C (MMC) in primary trabeculectomy in Nigeria.Materials and Methods:Retrospective chart review of patients undergoing primary antimetabolite trabeculectomy in Lagos, Nigeria between 1996 and 2003. We included 129 patients (132 eyes) of the 210 patients with greater than one year postoperative follow-up. Success rates between groups were compared by Kaplan–Meier survival analysis. IOP changes between groups were compared with ANOVA test. Non-parametric comparisons were performed with the Chi-square test with Yates correction or Fisher exact test. A P value less than 0.05 was considered statistically significant.Results:Seventy-three eyes underwent 5–FU (5-FU group) and 59 eyes underwent MMC augmentation (MMC group) during primary trabeculectomy. The 5-FU group had longer mean follow-up of 53 ± 26 months than the MMC group (38 ± 18 months, P<0.001). The preoperative intraocular pressure was 25.4 ± 6.2 in the MMC group and 25.8 ± 6.0 mm Hg in the 5FU group (P=0.8). Postoperative IOPs were significantly lower (P<0.05) in the MMC group at all follow up visits except between 30-35 months (P=0.07). The probability of maintaining an IOP less than 19 mmHg and 15 mmHg without additional medication or needle revisions at 2 and 3 years postoperatively was 71 (95% CIs, 54-82%) and 64% (95% CIs, 53-76%) respectively for the 5FU group and 81 (95% CIs,71-92%) and 79% (95% CIs,69-90%) respectively for the MMC group. The MMC group had significantly better survival times, both for IOP less than 19 mm Hg (P=0.03) and IOP less than 15 mm Hg (P= 0.006). At last follow up, 40 eyes (30.3%) had lost more than 2 lines of Snellen visual acuity, 24 from 5-FU and 16 from the MMC group (P=0.8). The MMC group was statistically less likely than the 5-FU group to require medications (18.5% vs. 41.1%, P =0.007) or needle revisions (5.1% vs. 17.8%, P=0.03) to control IOP. Blebitis and endophthalmitis developed in one eye each in both groups. Persistent hypotony was observed in 4 eyes (6.8%) in the MMC group only.Conclusions:In this study of Nigerian patients, intraoperative application of MMC was more efficacious than 5-FU in lowering IOP following primary trabeculectomy. However, delayed ocular hypotony was only seen with MMC use.
机译：目的：报道术中5-氟尿嘧啶（5-FU）或丝裂霉素C（MMC）在尼日利亚原发性小梁切除术中的比较疗效和安全性。材料与方法：回顾性图表回顾回顾了1996年在尼日利亚拉各斯接受原发性抗代谢小梁切除术的患者和2003年。我们纳入了210例术后随访一年以上的患者中的129例（132眼）。组间成功率通过Kaplan-Meier生存分析进行比较。两组之间的眼压变化与方差分析进行比较。用卡方检验和Yates校正或Fisher精确检验进行非参数比较。 P值小于0.05认为具有统计学意义。结果：初次小梁切除术中，对73眼进行了5–FU（5-FU组）和59眼进行了MMC增大（MMC组）。 5-FU组的平均随访时间比MMC组的平均随访时间长53±26个月（38±18个月，P <0.001）。 MMC组的术前眼压为25.4±6.2 Hg，5FU组的术前眼压为25.8±6.0 mm Hg（P = 0.8）。在所有随访中，MMC组术后IOP均显着降低（P <0.05），除了30-35个月之间（P = 0.07）。术后2年和3年不进行额外药物治疗或针头翻修而维持IOP低于19 mmHg和15 mmHg的可能性为71（95％CIs，54-82％）和64％（95％CIs，53-76％）对于5FU组，MMC组分别为81（95％CI，71-92％）和79％（95％CI，69-90％）。 MMC组的IOP小于19 mm Hg（P = 0.03）和IOP小于15 mm Hg（P = 0.006）的生存时间均明显更长。在最后一次随访中，有40眼（30.3％）的Snellen视力丧失了2行以上，其中5-FU丧失了24眼，MMC组丧失了16眼（P = 0.8）。与5-FU组相比，MMC组控制IOP的药物（18.5％比41.1％，P = 0.007）或针头翻修（5.1％vs. 17.8％，P = 0.03）的可能性要小。在两组中，每只眼睛都患有小脑炎和眼内炎。结论：仅在MMC组中有4只眼（6.8％）出现了持续性低渗。结论：本项尼日利亚患者的研究表明，术中应用MMC比5-FU在小梁切除术后降低眼压方面更为有效。但是，仅在使用MMC的情况下才出现眼肌张力低下。

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