青光眼引流阀植入术式的改良和临床应用  

Improvement of glaucoma drainage valve implantation and its application in refractory glaucoma

作　　者：杨乾军 侯乒 姚乾灏 王新丹 倪海栋 杨倍倍 Qian-Jun Yang;Ping Hou;Qian-Hao Yao;Xin-Dan Wang;Hai-Dong Ni;Bei-Bei Yang(Special Department of Fundus Diseases,Jinhua Eye Hospital,Jinhua321000,Zhejiang Province,China)

机构地区：[1]金华眼科医院眼底病专科,中国浙江省金华市321000

出　　处：《国际眼科杂志》2018年第11期2078-2081,共4页International Eye Science

摘　　要：目的:评价改良的青光眼引流阀植入术治疗水眼(玻璃体切除术后)难治性青光眼患者的效果及其安全性。方法:手术术式改良:在角膜缘后5～7mm处以月形刀做宽约2mm、长约3mm的巩膜套袖,在距角膜缘3. 5mm处以月形刀做长约1. 5mm以角膜缘为基底的巩膜隧道,经该巩膜隧道以一次性矛形刀穿刺入后房,引流管修剪至合适长度后经巩膜套袖巩膜隧道穿入虹膜和人工晶状体之间的后房内,缩小瞳孔后可在瞳孔缘看见引流管口,引流管口斜面朝向瞳孔缘。将2016-03/2017-08入住我院行玻璃体切除和人工晶状体植入术后继发青光眼的患者26例26眼纳入本研究。所有患者均采用改良术式行青光眼引流阀植入术。术后随访时间:1、3d,1wk,1、6mo,此后每6mo随访1次。对手术前后眼压和术中术后并发症及其相关的处理方式进行分析。结果:术前、术后第1d、末次随访平均眼压分别为42. 5±8. 1、12. 1±11. 2、14. 3±5. 9mmHg。术前与术后第1d眼压和末次随访眼压比较,差异均有统计学意义(P<0. 001)。术后第1d与末次随访眼压比较,差异无统计学意义(P=0. 89)。术后第1d眼压<6mmHg者有8眼,术后第1d眼压>6mmHg、术后第3d降到6mmHg以下者6眼,术后早期低眼压率54%。予玻璃体腔注气(空气)、注药(曲安奈德)或前房注入黏弹剂等处理后眼压逐渐恢复正常。随访期间无角膜内皮失代偿、引流管暴露、爆发性脉络膜出血、眼内炎等严重并发症。结论:改良的青光眼引流阀植入术是治疗玻璃体切除术后难治性青光眼的一种安全、有效、并发症少的手术方式。前房注黏弹剂、玻璃体腔注气是治疗青光眼阀植入术后早期低眼压的简单、有效、可重复、操作简便的方法。AIM： To assess the efficacy and safety of improvedglaucoma drainage valve implantation in the treatment ofrefractory glaucoma after vitrectomy.METHODS： The improved procedure： the surgeon useda crescent knife to make a scleral sleeve with a width ofabout 2mm and a length of about 3mm behind the limbus5mm to 7mm; maked a length of about 1. 5mm scleraltunnel at a distance of 3. 5mm from the limbus; piercingthe posterior chamber by a one-time spear knife throughthe scleral tunnel; the drainage tube was trimmed to theproper length, then placed between the iris andintraocular lens in the posterior chamber through thescleral sleeve and scleral tunnel. Reduce the pupil, wecould see the drainage tube port in the pupil margin,drainage tube mouth beveled toward the pupil edge. Allpatients underwent modified surgical glaucoma drainagevalve implantation. Patients incorporated into the studywho had secondary glaucoma after vitrectomy andintraocular lens implantation admitted to our hospitalfrom March 2016 to August 2017. Follow-up time： 1, 3d,1wk, 1 and 6mo, followed up every 6mo. The intraocularpressure, intraoperative and postoperative complicationsand related treatment methods were analyzed before andafter surgery. Intraocular pressure （IOP） at different timepoints before and after surgery was compared usingrepeated measures of variance analysis. RESULTS： A total of 26 patients were enrolled in thestudy. The average IOP was 42. 5 ± 8. 1 mmHgpreoperatively, 12. 1 ± 11. 2mmHg on the first day aftersurgery, 14. 3±5. 9mmHg in the last follow-up. There wasa statistically significant difference between preoperativeIOP and that on the first postoperative day （ P 〈 0. 001 ）.There was no significant difference in intraocular pressurebetween the first day after surgery and the last follow-up（P= 0. 89）. There were 8 eyes with IOP less than 6mmHgon the first postoperative day. There were 6 eyes with IOPhigher than 6mmHg on the first postoperative day, thendropped below 6mmHg on the third postoperative day.Th

关 键 词：青光眼引流阀 AHMED 人工晶状体植入术 玻璃体切除术 青光眼 继发性 

分 类 号：R779.6[医药卫生—眼科]