结膜下注射5-氟尿嘧啶在中青年复合式小梁切除手术中的应用  

Application of subconjunctival injection of 5-fluorouracil in combined trabeculectomy for young and middle-aged patients

作　　者：陈彬[1] 王韬[1] CHEN Bin;WANG Tao(Changshu NO.1 People's Hospital,Changshu 215500,Jiangsu,China)

机构地区：[1]常熟市第一人民医院眼科,江苏常熟215500

出　　处：《实用防盲技术》2024年第1期14-18,共5页Journal of Practical Preventing Blind

摘　　要：目的探讨在青光眼小梁切除术中结膜下注射5-氟尿嘧啶,对于易瘢痕化的中青年青光眼患者的远期治疗效果和眼表保护作用。方法研究2021年1月至2021年12月在常熟市第一人民医院行青光眼手术的患者39例(58只眼),分为结膜下注射组(18只眼),棉片组(20只眼)和对照组(20只眼)。其中对照组术中行小梁切除术+巩膜可调整缝线;结膜下组术中行小梁切除术+巩膜可调整缝线,同时术毕前结膜下注射5mg 5-氟尿嘧啶;棉片组行小梁切除术+巩膜可调整缝线,结膜瓣下方放置浸湿5-氟尿嘧啶棉片。术后进行共计6个月的随访,比较术后眼压、滤过情况、术后有效率情况和眼表疾病指数量表(ocular surface disease index,OSDI)评分情况。结果结膜下注射组和棉片组术后1个月、6个月眼压均较对照组低,且术后半年有效率高于对照组,安全性良好。同时,结膜下注射组术后OSDI评分显著低于棉片组和对照组。结论青光眼小梁切除术毕前结膜下注射5氟尿嘧啶,可以改善瘢痕化的中青年青光眼患者的手术效果、成功率和眼表症状且具有相当的安全性。Objective To investigate the long-term therapeutic effect and ocular surface protection of subconjunctival injection of 5-fluorouracil in glaucoma trabeculectomy in young and middle-aged glaucoma patients prone to scarring.Methods Thirty-nine patients(58 eyes)who underwent glaucoma surgery at the First People's Hospital of Changshu from January 2021 to December 2021were studied and divided into a subconjunctival injection group(18 eyes),a cotton pad group(20 eyes)and a control group(20eyes).In the control group,trabeculectomy+scleral adjustable sutures were performed intraoperatively;in the subconjunctival group,trabeculectomy+scleral adjustable sutures were performed intraoperatively and 5 mg of 5-fluorouracil was injected subconjunctivally before the end of the operation;and in the cotton pad group,trabeculectomy+scleral adjustable sutures were performed,and a dampened 5-fluorouracil pad was placed under the conjunctival flap.A total of 6 months of follow-up was conducted to compare the postoperative IOP,filtration status,postoperative efficiency and ocular surface disease index(OSDI)score.Results The subconjunctival injection group and the cotton pad group had lower IOP than the control group at 1 month and 6 month,and the 6 month postoperative efficiency was higher than that of the control group.Meanwhile,OSDI scores were significantly lower in the subconjunctival injection group than in the cotton pad group and the control group.Conclusion Subconjunctival injection of 5-fluorouracil before the completion of trabeculectomy in glaucoma can improve the surgical outcome,success rate and ocular surface symptoms in young and middle-aged glaucoma patients with scarring and has considerable safety.

关 键 词：结膜下注射 青光眼手术 5-氟尿嘧啶 眼表症状 

分 类 号：R779.6[医药卫生—眼科]