EX-PRESS引流钉植入术治疗开角型青光眼的疗效观察  

EX-PRESS glaucoma shunt for the treatment of open-angle glaucom

作　　者：李维娜[1] 李学喜[1] 林小兰[1] 赖钟祺 

机构地区：[1]解放军第180医院眼科,福建泉州362000

出　　处：《临床眼科杂志》2016年第3期229-232,共4页Journal of Clinical Ophthalmology

基　　金：南京军区医学科技创新课题(MS099)

摘　　要：目的评价EX-PRESS引流钉植入术治疗开角型青光眼的疗效。方法采用回顾性病例分析。收集2013年9月至2015年3月在本院眼科确诊为开角型青光眼的患者22例（30只眼）,其中原发性开角型青光眼（POAG）12例（17只眼）,继发性开角型青光眼（SOAG）10例（13只眼）,随访6-21个月。记录患者入院前,术后1周、1个月、3个月和末次随访时的裸眼视力、眼压、末次随访时使用降眼压药物的数量以及术中术后并发症等情况。结果手术前后不同时间点的视力比较,差异无统计学意义（P〉0.05）。入院前眼压（38.69±12.23）mm Hg,术后1周（11.03±5.46）mm Hg,术后1个月（14.62±8.04）mm Hg,术后3个月（15.59±7.87）mm Hg,末次随访时（18.89±9.06）mm Hg。手术前后不同时间点的眼压变化差异具有统计学意义（P〈0.001）,术后各时间点的眼压均明显低于术前。末次随访时,24只眼眼压≤21 mm Hg（80%）,其中22只眼无需使用降眼压药物,2只眼分别使用1种和2种降眼压药物。6只眼眼压〉21 mm Hg（20%）,4只眼未用药,2只眼用2种降眼压药物。EX-PRESS引流钉植入位置偏后5只眼,其中3只眼引流钉接触虹膜。位置偏前1只眼,未接触角膜。术后早期2级浅前房7只眼,其中1只眼合并前房少量出血,经过治疗出血吸收,前房恢复。1只眼术后脉络膜脱离,激素治疗后复位。结论EX-PRESS引流钉治疗开角型青光眼,降眼压效果良好,对视力影响小,引流钉植入术有其独有的并发症,需引起重视。Objective To evaluate the therapeutic effects of EX-PRESS glaucoma shunt in open-angle glaucoma.Methods A retrospective case analysis. Twenty-two subjects（ 30 eyes） were enrolled,among which 12 cases（ 17 eyes）were confirmed to be primary open-angle glaucoma（ POAG） and the rest 10 cases（ 13 eyes） were secondary open-angle glaucoma（ SOAG）. Follow-up time ranged from 6 to 21 months. Visual acuity,intraocular pressure before admission,at 1week,1 month and 3 months after surgery,and at final follow-up were recorded. The amount of pressure-lowering agents used at final follow-up and surgical related complications were also analyzed. Results There was no significant difference in visual acuity among different time-points. IOPs were 38. 69 ± 12. 23 mm Hg,11. 03 ± 5. 46 mm Hg,14. 62 ± 8. 04 mmHg,15. 59 ± 7. 87 mm Hg,18. 89 ± 9. 06 mm Hg before admission and at 1 week,1 month and 3 months after surgery,and at final follow-up respectively. The IOPs after surgery were significantly lower than that prior to admission（ P〈0. 001）.The IOL was ≤21mm Hg in 24 eyes（ 80%） at last follow-up. In these cases,22 patients were not using any eye drops,and one patient used only one pressure-lowering eye drop and another patient used two eye drops. The IOL were 〉21 mm Hg（ 20%） in 6 patients. In these cases,4 patients were not using any drops while two patients were on 2 different drops. The position of EXPRESS was too posterior in 5 cases and touched iris in 3 patients. In 1 patient it located too anteriorly but did not touch the cornea. Seven patients suffered from grade II shallow anterior chamber,but only minimal hyphema was found in 1 patient and it resolved rapidly after treatment. One patient experienced choroid detachment and was cured with steroid administration. Conclusions EX-PRESS is effective to lower IOP in open-angle glaucoma and has little impact on visual acuity. However,it should raise physician＇s concern that EX-PRESS could lead to some unique complications.

关 键 词：EX-PRESS引流钉 小梁切除术 开角型青光眼 疗效 并发症 

分 类 号：R779.6[医药卫生—眼科]