小梁切除术与Ahmed植入术治疗穿透性角膜移植术后继发青光眼的疗效比较  

Comparison in clinical outcomes of trabeculectomy and Ahmed glaucoma valve implantation in patients with penetrating keratoplasty

作　　者：李海军 任静 董良 杨潇远[1] 祝磊[1] LI Haijun;REN Jing;DONG Liang;YANG Xiaoyuan;ZHU Lei(Henan Provincial People’s Hospital and Henan Eye Institute,Henan Clinic Research Center of Ophthalmology,Zhengzhou 450000,Henan Province,China)

机构地区：[1]河南省眼科研究所,河南省人民医院,河南眼科临床研究中心,河南省郑州市450000

出　　处：《眼科新进展》2021年第2期149-153,共5页Recent Advances in Ophthalmology

基　　金：国家自然科学基金项目(编号U1904166);河南省省部共建项目(编号SBGJ2018072)。

摘　　要：目的探讨小梁切除(TRA)术与Ahmed阀(AGV)植入术治疗穿透性角膜移植术后继发青光眼(post-penetrating keratoplasty glaucoma,PKG)的临床疗效与角膜植片安全性。方法回顾分析我院2015年4月至2018年4月PKG患者47例47眼,按手术方式分TRA组与AGV组,TRA组22例,AGV组25例,随访(24.3±5.2)个月。观察两组患者眼压、并发症、角膜植片状态,以及多因素Cox比例风险回归分析角膜植片预后危险因素。结果TRA组与AGV组均以感染性角膜病变居多,所占百分比分别为45.45%、52.00%(χ^(2)=0.201,P=0.654);烧伤次之,所占百分比分别为18.18%、16.00%(P>0.05)。TRA组与AGV组基线眼压分别为(34.95±5.36)mmHg(1 kPa=7.5 mmHg)、(33.93±4.88)mmHg(P=0.231);末次随访时分别为(21.83±5.14)mmHg、(17.23±3.93)mmHg,TRA组与AGV组眼压组内术后均较术前降低,术后3个月、1 a、2 a,AGV组较TRA组眼压更低,差异均有统计学意义(均为P<0.05)。TRA组与AGV组总有效率分别为63.64%、88.00%(P=0.033)。术后早期以TRA浅前房发生为主,晚期以滤过泡包裹常见,总发生率差异无统计学意义(P=0.057),无严重并发症发生;眼压失控患眼联合睫状体光凝,角膜植片总存活率分别为90.90%、96.00%,组间比较差异无统计学意义(P=0.123)。多因素Cox比例风险模型分析提示,仅感染性病变及眼压反复升高是植片愈合不良风险因素。结论AGV植入术较TRA术更利于PKG术后眼压控制,且浅前房发生率低,但角膜植片混浊与手术方式无关,感染性病变、术后眼压反复升高是角膜植片混浊的危险因素。Objective To observe the clinical outcomes of trabeculectomy and Ahmed glaucoma valve(AGV)implantation in penetrating keratoplasty glaucoma(PKG)patients and the safety of corneal grafts.Methods A retrospective interventional comparative study was designed.Forty-seven PKG(47 eyes)patients in Henan Provincial People's Hospital from April 2015 to April 2018 were divided into two group,22 patient(22 eyes)in trabeculectomy group(TRA group)and 25 patients(25 eyes)in Ahmed glaucoma valve implantation group(AGV group).The follow time was(24.3±5.2)months.The intraocular pressure(IOP),complications,corneal graft survival rates were analyzed,and the risk factors for corneal graft were performed using multivariate Cox regression analysis.Results Infectious keratitis was the most common primary disease in TRA group and AGV group(45.45%vs.52.00%,respectively,χ^(2)=0.201,P=0.654),burning followed(18.18%vs.16.00%,respectively,P>0.05).The preoperative IOPs were(34.95±5.36)mmHg(1 kPa=7.5 mmHg)vs.(33.93±4.88)mmHg(P=0.231),and the last postoperative IOPs were(21.83±5.14)mmHg vs.(17.23±3.93)mmHg.Postoperative mean IOP decreased significantly in both groups,and which in AGV group was more lower than TRA group at 3rd months,1st year and 2nd years,respectively(all P<0.05).The total success rate was 63.64%vs.88.00%,respectively(P=0.033).No server complication occurred,but the early shallow anterior chamber and the later filtering bleb encapsulated occured(χ2=3.166,P=0.075).Transscleral cyclophotocoagulation was performed for eyes with poor IOP control in both groups,and the overall survival rate of corneal grafts was 90.90%,96.00%,and the comparison between groups was not statistically significant(Z=-1.544,P=0.123).Although the shallow anterior chamber affected the transparency of corneal implantation,the analysis of the multi-factor cox proportional hazard model suggested that only infectious keratitis,recurrent increased IOP were risk factors for poor graft healing.Conclusion AGV implantation is more effective to control IOP tha

关 键 词：穿透性角膜移植术后继发青光眼 小梁切除术 Ahmed阀植入术 角膜植片存活率 

分 类 号：R775.4[医药卫生—眼科]