异体角膜基质瓣在青光眼阀植入术中的应用  

Allogeneic corneal stromal flap applied in implantation of Ahmed glaucoma valve

作　　者：冯希敏 温臣婷 张凤妍[4] 祁颖[4] FENG Ximin;WEN Chenting;ZHANG Fengyan;QI Ying(Department of Ophthalmology,Xinxiang Central Hospital,The Fourth Clinical College of Xinxiang Medical College,Xinxiang,Henan Province 453000,China;Department of Ophthalmology,Shanghai Eighth People s Hospital,Shanghai 200035,China;Department of Ophthalmology,Affiliated Dongfeng Hospital,Hubei University of Medicine,Shiyan,Hubei Province 442008,China;Department of Ophthalmology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450002,China)

机构地区：[1]新乡市中心医院眼科,新乡医学院第四临床学院眼科,河南新乡453000 [2]上海市第八人民医院眼科,上海200035 [3]湖北医药学院附属东风医院眼科,湖北十堰442008 [4]郑州大学第一附属医院眼科,郑州450002

出　　处：《中华显微外科杂志》2022年第1期59-64,共6页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81970785);河南省医学科技攻关计划联合共建项目(LHGJ20210918)。

摘　　要：目的观察异体角膜基质瓣在青光眼阀植入术中对降低引流管暴露率的有效性及安全性.方法回顾分析从2017年1月至2019年4月收治的通过青光眼阀植入术治疗的53例61眼难治性青光眼,按照手术方式分为常规巩膜隧道组(常规组)和常规巩膜隧道加异体角膜基质瓣覆盖组(改良组),观察两组患者术后6、12及24个月的手术累计成功率、术前眼压(IOP)及术后末次门诊随访的IOP,术前最佳矫正视力(BCVA)及术后末次门诊随访BCVA、引流管暴露及手术并发症.两组数据进行统计学分析,P<0.05为差异有统计学意义.结果术后6、12、24个月累计成功率:常规组分别为89.7%、86.2%及69.0%,改良组分别为90.6%、90.6%及71.8%,两组间差异无统计学意义(P>0.05);两组内术后末次随访IOP及BCVA均较术前有明显好转,差异均有统计学意义(P<0.05);常规组4眼(13.8%)发生引流管暴露,暴露者再次行手术治疗,术中用异体角膜基质瓣和羊膜覆盖暴露的引流管,恢复良好.改良组未见引流管暴露,两组差异有统计学意义(χ^(2)=4.724,P=0.030);两组其他手术并发症比较,差异无统计学意义(χ^(2)=0.160,P=0.689).术中及术后未观察到与角膜基质瓣相关的并发症.结论青光眼引流阀植入术中应用异体角膜基质瓣覆盖引流管,可以有效降低术后引流管暴露率且临床安全性好.Objective To investigate the effectiveness and safety of the allogeneic corneal stromal flap in reducing the exposure of the drainage catheter in the implantation of Ahmed glaucoma valve.Methods Fifty-three patients(61 eyes)with refractory glaucoma treated by Ahmed glaucoma valve implantation from January 2017 to April 2019 were retrospectively analysed.The patients were divided into sclera tunnel group(routine group)and sclera tunnel with allogeneic corneal stroma flap covering(improved group).The cumulative success rate of surgery,preoperative intraocular pressure(IOP),IOP at the last outpatient follow-up,the best-corrected visual acuity(BCVA),BCVA at the last outpatient follow-up,drainage catheter exposure and other surgical complications were collected from both groups at 6,12 and 24 months after surgery.The data between the 2 groups were statistically analyzed,P<0.05 was statistically significant.Results The cumulative success rates of 6,12 and 24 months after operation were 89.7%,86.2%and 69.0%in the routine group,and 90.6%,90.6%and 71.8%in the improved group,respectively.There was no significant differences between the 2 groups(P>0.05).The IOP and BCVA at the final follow-up were significantly improved in both groups,with a statistical significant difference(P<0.05).In the conventional group,the exposure of drainage catheter occurred in 4 eyes(13.8%).Further surgeries were carried out to cover the exposed drainage catheters with allogeneic corneal stroma flaps and amniotic membrane and all had good recovery.There was no drainage catheter exposure in the improved group.The difference between the 2 groups was statistically significant(χ^(2)=4.724,P=0.030).There was no significant difference in other surgical complications between the 2 groups(χ^(2)=0.160,P=0.689).No intraoperative or postoperative complications regarding the corneal stromal flap were observed.Conclusion Implantation of Ahmed glaucoma valve with allogeneic corneal stromal flap sealing can effectively reduce the exposure of the drainage cath

关 键 词：角膜基质瓣 青光眼引流阀 难治性青光眼 眼显微手术 

分 类 号：R779.6[医药卫生—眼科]