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目的 评估高三尖杉酯碱 (homoharringtonine ,HH)作为青光眼滤过手术辅助药的中远期疗效和并发症。方法 采用前瞻性随机对照方法将 63例 ( 73只眼 )难治性青光眼随机分为HH组 3 2例 ( 3 7只眼 )和对照组 3 1例 ( 3 6只眼 )。所有病例均接受同一标准的小梁切除手术。术毕及术后HH组分次球结膜下注射高三尖杉酯碱 ,每次 0 1ml ( 0 1mg) ,对照组未用药。术后随访观察 5～ 8年 (平均 6 4年 )。采用寿命表分析法统计。结果 至最后一次复查时 ,HH组功能性滤过泡的累计百分率为 73 0 % ,对照组为 44 2 % (P <0 0 1 ) ;HH组手术成功的累计百分率为 75 7% ,对照组为 41 7% (P <0 0 1 )。用药组角膜上皮缺损发生率为 1 8 9% ,对照组为2 7% (P <0 0 5)。HH组薄壁滤过泡的发生率为 41 0 % ,对照组为 2 3 0 % (P <0 0 5)。结论 高三尖杉酯碱是一种有效、相对安全的难治性青光眼滤过手术的辅助药。
Objective To assess the long-term efficacy and complications of homoharringtonine (HH) as an adjunct to glaucoma filtration surgery. Methods 63 cases (73 eyes) of refractory glaucoma were randomly divided into three groups (36 eyes) and 32 cases (37 eyes) of HH group by prospective randomized controlled trial. All cases underwent the same standard of trabeculectomy. HH sub-subconjunctival injection of homoharringtonine after surgery and postoperative Hiluxun, each 0 1ml (0 1mg), the control group without medication. Follow-up observation of 5 to 8 years (average 64 years). Using life table analysis statistics. Results At the last review, the cumulative percentage of functional filtration bleb in HH group was 73 0%, 44 2% in control group (P 0 01). The cumulative success rate in HH group was 75 7%. In control group 41 7% (P <0.01). The incidence of corneal epithelial defects was 18.9% in the medication group and 27% in the control group (P <0.05). The incidence of thin-wall bleb in HH group was 41 0% and that in control group was 230% (P <0.05). Conclusions Homoharringtonine is an effective and safe adjuvant for refractory glaucoma filtration surgery.