改良的巩膜隧道青光眼阀植入术治疗难治性青光眼的效果观察  

Observation on the efficacy of modified scleral tunnel in Ahmed glaucoma valve implantation for the treatment of refractory glaucoma

作　　者：张竖[1] 李大鹏 孙秋月[1] 蒋燕玲[1] Zhang Shu;Li Dapeng;Sun Qiuyue;Jiang Yanling(Department of Ophthalmology,the Second People’s Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]连云港市第二人民医院眼科,连云港222000

出　　处：《中华眼外伤职业眼病杂志》2023年第1期6-10,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察难治性青光眼行巩膜改良的巩膜隧道Ahmed青光眼阀植入术的效果。方法回顾性队列研究。纳入连云港市第二人民医院2017年1月至2022年4月收治的难治性青光眼22例(23只眼)。所有患者行改良巩膜隧道Ahmed青光眼阀植入术,分析术前术后眼压、使用抗青光眼药物种类、术后视盘参数变化及并发症。结果术后1周和6个月,眼压分别为(10.53±4.41)mmHg、(14.69±5.64)mmHg,与术前(45.52±7.39)mmHg(1 mmHg=0.133 kPa)相比差异均有统计学意义,(F=321.27,P<0.001)。术前23只眼需用降眼压药物3.0(3.00,4.00)种,术后6个月6只眼需用降眼压药物1.5(1.00,2.25)种,差异有统计学意义(Z=-4.26,P<0.001)。术后1周及6个月的视盘盘沿面积分别为(0.51±0.11)mm^(2)、(0.52±0.12)mm^(2),差异无统计学意义(t=-1.38,P=0.181)。术后1周及6个月的平均神经纤维层厚度分别为(78.87±12.30)μm及(80.48±10.60)μm,差异无统计学意义(t=-1.99,P=0.059)。术后1周内有3只眼并发脉络膜脱离,发生率为13.04%(3/23),术后6个月完全有效率为73.91%(17/23),部分有效率为26.09%(6/23)。结论改良的巩膜隧道Ahmed青光眼阀植入术是难治性青光眼的有效手术方式,手术成功率高,并发症较少。Objective To observe the efficacy of modified scleral tunnel in Ahmed glaucoma valve implantation for the treatment of refractory glaucoma.Methods This was a retrospective cohort study.A total of 23 eyes of 22 cases with refractory glaucoma who underwent modified scleral tunnel in Ahmed glaucoma valve implantation from Jan.2017 to Apr.2022 in the Second People’s Hospital of Lianyungang were included.Intraocular pressure,the use of anti-glaucoma drugs,optic disc structure parameters and postoperative complications were observed after the operation.Results The intraocular pressure at 1 week and 6 months after operation was(10.53±4.41)mmHg and(14.69±5.64)mmHg(1 mmHg=0.133 kPa)respectively,significantly reduced from(45.52±7.39)mmHg preoperatively(F=321.27,P<0.001).Before operation,23 eyes needed 3.00(3.00,4.00)kinds of anti-glaucoma medications;at 6 months after operation,6 eyes needed 1.5(1.00,2.25)kinds of anti-glaucoma medications(Z=-4.26,P<0.001).At 1 week and 6 months after operation,the optic disc rim area was(0.51±0.11)mm^(2) and(0.52±0.12)mm^(2) respectively,which was not statistically significant different(t=-1.38,P=0.181).The nerve fiber layer thickness was(78.87±12.30)μm and(80.48±10.60)μm respectively.The difference was not statistically significant(t=-1.99,P=0.059).Choroidal detachment occurred in 3 eyes(13.04%,3/23)within 1 week after operation.At 6 months after operation,the complete success rate was 73.91%(17/23),conditional success rate was 26.09%(6/23).Conclusion The modified Ahmed glaucoma valve implantation through scleral turnel is an effective way to treat refractory glaucoma with high success rate and less complications.

关 键 词：青光眼 青光眼引流植入物 治疗效果 

分 类 号：R779.6[医药卫生—眼科]