小梁切除术中应用丝裂霉素C 对角膜内皮细胞的影响

目的:观察小梁切除术中应用丝裂霉素C(MMC)对角膜内皮细胞的影响。方法:收集2010年9月2011年5月在我院行小梁切除术的青光眼患者60例(78眼),随机分为术中应用丝裂霉素C的36例(46眼)患者为A组,术中不用丝裂霉素C的24例(32眼)为B组,分别观察术前、术后1个月和术后3个月两组眼压(IOP)、角膜内皮细胞的密度(CD)、平均细胞面积(AVG)及细胞面积变异系数(CV),分析其数量的改变及两组间的差异。结果:A组术前眼压为(35.4±13.7)mmHg,B组术前眼压为(32.5±13.5)mmHg差异无统计学意义(P>0.05),A组术后1个月及术后3个月眼压分别为(15.7±3.7)mmHg、(17.0±3.2)mmHg,均低于B组的(19.4±3.7)mmHg、(20.2±2.1)mmHg,差异有统计学意义(P<0.05)。A组术前、术后1个月及术后3个月角膜内皮细胞密度分别为(2475±484)个/mm2、(2199±373)个/mm2、(2164±332)个/mm2;平均细胞面积分别为(431.4±67.6)μm2、(480.6±66.8)μm2、(463.8±46.2)μm2;细胞面积变异系数分别为(31.1±7.4)%、(34.4±6.3)%、(31.2±7.5)%;术后1个月及术后3个月各参数与术前比较,差异均有统计学意义(P<0.05)。B组术前、术后1个月及术后3个月角膜内皮细胞密度分别为(2342±94)个/mm2、(2185±215)个/mm2、(2074±218)个/mm2;平均细胞面积分别为(453.9±94.8)μm2、(516.3±100.8)μm2、(499.81±106.4)μm2;细胞面积变异系数分别为(30.2±3.0)%、(32.7±2.9)%、(31.4±4.3)%;除术后3个月角膜内皮细胞与术前比较有意义(P<0.05)外,余参数术后1个月及术后3个月与术前比较差异均无统计学意义(P>0.05)。术后1个月A组的角膜内皮细胞丢失率为10.4%高于B组的6.1%,差异有统计学意义(P<0.05);术后3个月A组的角膜内皮细胞丢失率为11.1%高于B组的10.0%,差异无统计学意义(P>0.05)。结论:小梁切除术中用丝裂霉素C的降压效果比不用丝裂霉素C的效果好,但短期内前者角膜内皮细胞的丢失率高于后者。

The Effect of Mitomycin C on Corneal Endothelial Cells in Trabeculectomy

Objective: To investigate the effect of mitomycin C on corneal endothelial cells in trabeculectomy.Methods: 60 patients(78 eyes) were diagnosed with glaucoma and operated trabeculectomy in our hospital from September 2010 to May 2011,they were collected and randomly divided into group A and group B.All cases had undergone test for intraocular pressure(IOP),corneal endothelial cell density(CD),average cell area(AVG) and cell area of variation(CV) before 1 month and 3 months after the operation,to analyze the changes of the number and the differences between the two groups.Results: The intraocular pressure(IOP)before the operation were(35.4±13.7)mmHg in group A,and were(32.5±13.5)mmHg in group B.There was no significant difference between the two groups(P>0.05).The intraocular pressure(IOP)in the group A was(15.7±3.7)mmHg and(17.0±3.2)mmHg at 1 month and 3 months after the operation.The IOP was lower than the(19.4±3.7)mmHg and(20.2 ±2.1)mmHg in the group B.There was significant difference between two groups(P<0.05).The corneal endothelial cell density,average cell area,cell area of variation before and 1 month and 3 months after the operation were(2475±484)/mm2,(2199±373)/mm2,(2164±332)/mm2;(431.4±67.6) μm2,(480.6 ±66.8) μm2,(463.8±46.2) μm2,(31.1±7.4)%,(34.4±6.3) %,(31.2±7.5) %,respectively,in group A;The results for the group B respectively were(2342±94)/mm2,(2185±215)/mm2,(2074± 218)/mm2;(453.9±94.8)m2,(516.3± 100.8)m2,(499.81±106.4) m2;(30.2± 3.0) %,(32.7±2.9) %,(31.4±4.3) %.The first month and postoperative 3 months parameters and the comparison,are statistical.There was significant difference before the operation and 1 month or 3 months after the operation when endothelial cell density,average cell area,cell area of variation in group A were compared(P < 0.05).But there was no significant difference in group B(P>0.05) except of the corneal endothelium after 3 months.The loss rate of corneal endothelium cells in the group A was 10.4% at 1 month after the operation,which was higher than the 6.1% in group B(P<0.05).The loss rate of corneal endothelium cells in the group A was 11.1%at 3 months after the operation,which was higher than 10.0% that in group B(P>0.05).Conclusion: The step-down effect of using mitomycin C is better than without mitomycin C in trabeculectomy,but the loss rate of corneal endothelial of the former is higher than the latter in short-term.