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目的 评价环胞霉素A(CsA)与5氟尿嘧啶(5-FU)用于青光眼滤过术的临床疗效及应用价值。方法 采取随机对照临床试验研究方法,将52例原发性开角型青光眼(POAG)患者分为两组,每组32只眼,两组患者术中应用2％CsA溶液于巩膜瓣下及结膜瓣下。另一组用25mg/ml 5-FU溶液浸润巩膜瓣上及结膜瓣下,有早期失败倾向者追加5-FU 5mg结膜下注射,术後第三天开始结膜下注射,隔天1次共3次。术後随访6～15月。结果 (1)CsA组完全成功率与条件成功率分别为76.7％(23/30),96.7％(29/30)与5-FU组的72.4％(21/29),82.8％(24/29)疗效相当。(X~2=0.357 2,P>0.05)。(2)两组术後滤过泡形态不同,CsA组以Ⅱ型为主,5-FU组则以Ⅰ型为主。(X~2=6.171,P>0.05)。(3)CsA组对眼部毒副作用少,但术後出现结膜创口渗漏多,这可以通过严密缝合结膜瓣来预防,而5-FU常引起薄壁滤过泡、低眼压、低眼压黄斑病变致患者术後视力下降。CsA组术後视力下降5例(16.7％),5-FU组为13例(44.83％),有显著性差异。(X~2=5.101 0,P<0.05)。结论 CsA应用于滤过手术,其减少滤过手术失败的作用与5-FU相当,且并发症比5-FU少。因而更加安全有效。
Objective To evaluate the clinical efficacy and clinical value of CsA and 5-fluorouracil (5-FU) for glaucoma filtration. Methods Fifty-two patients with primary open-angle glaucoma (POAG) were randomly divided into two groups (32 eyes). The two groups were treated with 2% CsA solution under scleral flap and conjunctiva Under the flap. The other group with 25mg / ml 5-FU solution infiltration on the scleral flap and conjunctival flap, the tendency of early failure were additional 5-FU 5mg subconjunctival injection, subconjunctival injection started on the third day after the operation, a total of 3 days the next day Times. Follow-up 6 to 15 months. Results The complete success rate and conditional success rate of CsA group were 76.7% (23/30), 96.7% (29/30), 72.4% (21/29) and 82.8% (24/29) respectively in 5-FU group ) The same effect. (X ~ 2 = 0.357 2, P> 0.05). (2) The morphology of postoperative bleb was different. CsA group was predominantly type Ⅱ, while 5-FU group was predominantly type Ⅰ. (X ~ 2 = 6.171, P> 0.05). (3) CsA group has few toxic side effects on the eye, but there is more leakage of conjunctival wound after operation, which can be prevented by tight suture of conjunctival flap. However, 5-FU often causes thin-wall blebs, hypotony, Patients with macular degeneration caused by decreased visual acuity. Visual acuity decreased in 5 (16.7%) patients in CsA group and 13 (44.83%) in 5-FU group, with significant difference. (X ~ 2 = 5.101 0, P <0.05). Conclusions CsA is used in filtration surgery, which has the same effect as 5-FU in reducing the failure of filtration surgery with less complications than 5-FU. Thus safer and more effective.