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（10P）、角膜内皮细胞的密度（co）、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、（2074218）个／mm2；平均细胞面积分别为（453．9土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土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 （lOP）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.