Ex-press青光眼引流钉植入术治疗不同类型青光眼的长期临床观察  

Long-term efficacy and safety of Ex-press glaucoma shunt implantation in the treatment of different types of glaucoma

作　　者：郑蓥蓥 张玉秋 王晓蕾 孙兴怀 ZHENG Yingying;ZHANG Yuqiu;WANG Xiaolei;SUN Xinghuai(Department of Ophthalmology,Eye Ear Nose and Troat Hospital of Fudan University,NHC Laboratory of Myopia(Fudan University),Laboratory of Myopia,Chinese Academy of Medical Sciences,Shanghai 200031,China;Department of Ophthalmology,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科国家卫生健康委员会近视眼重点实验室及中国医学科学院近视眼重点实验室,上海200031 [2]兰州大学第二医院眼科,兰州730030

出　　处：《中国眼耳鼻喉科杂志》2020年第4期283-289,共7页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市重中之重临床医学中心-上海市眼部疾病临床医学中心(2017ZZ01020)。

摘　　要：目的评价Ex-press青光眼引流钉植入术治疗不同类型青光眼的有效性和安全性。方法回顾分析于我院行P50型Ex-press青光眼引流钉植入术的不同类型青光眼患者209例(283眼),包括原发性开角型青光眼(POAG)组135眼、原发性闭角型青光眼(PACG)组12眼、发育性青光眼(DG)组94眼、继发性青光眼(SG)组42眼,比较了手术成功率,术后眼压、视力,抗青光眼药物使用数量及并发症。结果术后平均随访(26.7±10.7)个月。术后36个月,POAG组的完全成功率(68.8%)明显高于PACG组(40.0%)和SG组(47.6%),DG组的完全成功率(65.1%)明显高于SG组(47.6%),以上P值均<0.05。各组青光眼术后眼压较术前均明显下降(P<0.05),术后不同随访时间各组间平均眼压差异无统计学意义(P>0.05)。各组视力均在术后1周明显下降(P<0.05),术后1个月恢复至术前水平。SG组术后抗青光眼药物使用数量(1.05±1.13)明显高于POAG组(0.51±1.22)、PACG组(0.83±0.84)及DG组(0.63±0.90),P值均<0.05。SG组术后并发症总发生率(40.48%)高于POAG组(15.56%)和DG组(21.28%),P值均<0.05。结论Ex-press青光眼引流钉植入术治疗POAG和DG有较好的有效性和安全性,对于PACG和SG的治疗则需根据临床情况谨慎选择。Objective To evaluate the long-term efficacy and safety of Ex-press mini glaucoma shunt in the management of different types of medically uncontrolled glaucoma.Methods A total of 283 eyes of 209 patients underwent Ex-press P50 glaucoma shunt implantation were included in this retrospective study.Information was collected from the charts of 135 eyes of primary open angle glaucoma(POAG),12 eyes of primary angle closure glaucoma(PACG),94 developmental glaucoma(DG)and 42 eyes of secondary glaucoma(SG).Success rates,intraocular pressure(IOP),visual acuity(VA),reduction of dependence on medication,and postoperative complication rates were compared between groups.Results Average follow-up was 26.7±10.7 months.At the 36-month followup,complete success rate of POAG(68.8%)was significantly higher than PACG(40.0%)and SG(47.6%;P<0.05),complete success rate of DG(65.1%)was significantly higher than SG(47.6%;P<0.05).There was a significant reduction of IOP from baseline in different types of glaucoma(P<0.05),with no difference of average IOP between groups at any postoperative follow-up(P>0.05).VA was significantly reduced on week 1 following surgery(P<0.05)and no longer different from baseline at the 1-month follow-up in each group(P>0.05).The mean number of glaucoma medications postoperatively used in SG(1.05±1.13)was significantly greater than POAG(0.51±1.22),PACG(0.83±0.84)and DG(0.63±0.90;P<0.05).There was a significantly higher incidence of postoperative complications in SG(40.48%)compared with the POAG(15.56%)and DG(21.28%;P<0.05).Conclusions Ex-press glaucoma shunt implantation appears to be a safe and effective method for treating POAG and DG,and a surgery option for PACG and SG with cautious consideration of the specific clinical characteristics.

关 键 词：Ex-press青光眼引流钉 原发性开角型青光眼 原发性闭角型青光眼 发育性青光眼 继发性青光眼 青光眼手术 

分 类 号：R779.6[医药卫生—眼科]