Ex-PRESS青光眼引流器植入术的疗效及并发症分析  

The clinical outcome and complications of Ex-PRESS glaucoma shunt implantation

作　　者：卢岚[1] 黄瓅[1] 沈惠玲[1] 翁景宁[1] 傅德生[1] 陈平[1] Lu Lan;Huang Li;Shen Hulling;Weng Jingning;Fu Desheng;Chen Ping(Department of Ophthalmology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院眼科,福州350001

出　　处：《中国医师杂志》2018年第10期1482-1486,共5页Journal of Chinese Physician

基　　金：福建省卫生计生科研人才培养项目(2017-CX-18)~~

摘　　要：目的报道一组青光眼患者行Ex-PRESS青光眼引流器植入术中术后出现的并发症,探讨Ex-PRESS青光眼引流器植入在临床实际开展中可能出现的并发症及其发生的相关因素和应对措施。方法回顾分析11例多种类型的青光眼患者施行Ex-PRESS青光眼引流器植入术的手术记录及录像,记录术中情况(包括手术切口,术中并发症)以及术后情况(包括视力、眼压、滤过泡形态、前房深度、眼底情况检查),分析并发症发生的原因、并发症与青光眼类型关系、并发症与既往手术的相关性。结果共11例11眼行Ex-PRESS青光眼引流器植入手术。其中2例行青光眼白内障联合手术,1例先天性青光眼先后植入P-50型及P-200型Ex-PRESS青光眼引流器。手术中2例植入引流器时出现意外,其中1例引流器脱入前房,1例引流器误入前房。手术后4例出现低眼压及浅前房,其中2例伴前房出血,2例伴脉络膜脱离; 1例行白内障青光眼联合手术术后出现人工晶体瞳孔夹持;随访中4例滤过泡扁平、眼压失控,其中2例伴引流器内口堵塞、头端周围增殖前粘连,见于既往有眼部手术史的原发性闭角型青光眼患者。滤过道外口瘢痕为术后常见的并发症(4/11)。引流器有关的并发症与青光眼类型有关。术后并发症的发生与手术史有关。结论 Ex-PRESS青光眼引流器植入治疗青光眼,常见的手术并发症种类与滤过手术类似。此外尚有与引流器本身有关的并发症。既往手术史、引流器植入的熟练程度以及原发疾病种类与并发症的发生有关。Objective To report operative course and relative complications in a group of patients who underwent Excessive Pressure Regulation System （Ex-PRESS） glaucoma shunt implantation in the real world, and discuss the ralated factors and possible interventions in clinical practice. Methods Preferred Ex-PRESS glaucoma shunt implantation were performed on l leyes with deverse types of glaucoma. Opera- tive course and relative complications were analyzed from recorded tapes and documents. The correlations between complications, types of glaucoma, and previous procedures were analyzed, the complications were appropriately managed. Results 11 patients with divet-e types of glaucoma who underwent Ex-PRESS glaucoma shunt implantation were recruited for the study. Among them, 2 patients had combined phacoe- mulcification surgery, 1 patient had repeat shunt implantation. During the procedure, 1 patient had disloca- ted shunt into anterior chamber; 1 patient had shunt entirely inserted into anterior chamber with plunger. 4 patients had hypotony and fiat anterior chamber, 2 of them had hyphema, 2 experienced subchoroid detach- ment. 1 patient had intraocular lens pupil clamping after combined cataract and glaucoma surgery; 4 cases had flat filtering blebs and uncontrolled intraocular pressure during the follow-up period, 2 of them had blocked drainage and proliferative anterior synechia around the head, which was found in the patients with primary angle-closure glaucoma who had previous operation history. The common long-term complication was external ostium occlusion （4/11 ）. The complications of drainage are related to the type of glaucoma and the history of operation. Conclusions Other than the complications which present commonly in trabeculectomy procedure, there were some complications related to the Ex-PRESS glaucoma shunt. History of ocular surgery, surgical techniques and the type of disease were associated with the incidence of comnlications.

关 键 词：青光眼/外科学 青光眼引流植入物 手术后并发症 

分 类 号：R779.6[医药卫生—眼科]