Ex-PRESS引流钉植入术治疗Sturge-Weber综合征继发性青光眼的中期疗效和安全性分析  

Medium-term efficacy and safety analysis of Ex-PRESS shunt implantation for the treatment of secondary glaucoma in Sturge-Weber syndrome

作　　者：吴越 黄璐璐 顾梦杨 郭文毅[1] Wu Yue;Huang Lulu;Gu Mengyang;Guo Wenyi(Department of Ophthalmology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院眼科、上海市眼眶病眼肿瘤重点实验室,上海200011

出　　处：《中华眼科杂志》2023年第9期716-722,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(82101114,81970796,82171046);上海市卫生和计划生育委员会科研课题(201940330);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ201904)。

摘　　要：目的评估Ex-PRESS引流钉植入术治疗Sturge-Weber综合征(SWS)继发性青光眼的中期疗效和安全性。方法回顾性病例系列研究。收集2013年1月至2020年2月就诊于上海交通大学医学院附属第九人民医院并接受Ex-PRESS引流钉植入术的SWS继发性青光眼患者的病历资料,累及双眼的患者仅纳入右眼。随访时点为术后1周、3个月、6个月、1年、2年、3年。对患者术前和术后的眼压、视杯与视盘垂直直径比(杯盘比)、角膜水平直径、视野、前房情况、降眼压药物使用情况以及再次手术等临床资料进行评估与分析,并分析各随访时点的手术成功情况和手术相关并发症。采用t检验、Mann-WhitneyU检验和χ2检验进行统计学分析。结果共纳入患者21例(21只眼),10例为女性,11例为男性;其中右眼15只,左眼6只。患者年龄为8.1(6.3,11.9)岁(范围为3~51岁),随访时间为11(6,24)个月(范围为3~53个月)。术前21只术眼眼压为(32.9±9.1)mmHg(1 mmHg=0.133 kPa),19只健眼眼压为(17.1±4.3)mmHg,差异有统计学意义(t=5.80,P<0.001)。术前术眼杯盘比为(0.75±0.13),健眼为(0.32±0.10),差异有统计学意义(t=11.22,P<0.001)。在术后1年、2年、3年随访时,16只术眼中的8只眼,9只术眼中的6只眼以及10只术眼中的7只眼取得了手术总体成功(完全成功+条件成功),3个随访时点的手术完全成功眼数分别是3只眼、2只眼以及4只眼。手术后所有随访时点的术眼眼压均较术前降低(均P<0.05),术眼杯盘比较术前差异均无统计学意义(均P>0.05)。2只术眼在术后出现了视网膜脱离或脉络膜渗漏,均在保守治疗后恢复。1只术眼出现了术后Ⅰ度浅前房,在术后第3天自行恢复。未发现术后滤过泡相关并发症、恶性青光眼、爆发性脉络膜上腔出血、眼内炎等严重手术并发症。结论 Ex-PRESS引流钉植入术治疗SWS继发性青光眼具较高的安全性,术眼中期眼压较术前显著降低,但大多数�Objective To evaluate the medium-term efficacy and safety of Ex-PRESS shunt implantation in the treatment of secondary glaucoma associated with Sturge-Weber Syndrome(SWS).Methods This was a retrospective case series study.Medical records of patients diagnosed with secondary glaucoma due to SWS who underwent Ex-PRESS shunt implantation at Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,between January 2013 and February 2020 were collected.Only the right eye were included in the analysis when both eyes were affected.Follow-up visits were scheduled at postoperative week 1,3 months,6 months,1 year,2 years,and 3 years.Clinical data including intraocular pressure(IOP),vertical cup-to-disc(C/D)ratio,corneal horizontal diameter,visual field,anterior chamber condition,anti-glaucoma medication usage,and additional surgeries were evaluated and analyzed before and after the procedure.Surgical success rates and procedure-related complications at each follow-up time point were assessed.Statistical analyses were performed using t-test,Mann-Whitney U test,andχ2 test.Results A total of 21 patients(21 eyes)were included in the study,comprising 10 females and 11 males.Among them,15 eyes were on the right side,and 6 eyes were on the left side.The patients′ages ranged from 3 to 51 years,with a median age of 8.1(6.3,11.9)years.The follow-up period ranged from 3 to 53 months,with a median of 11(6,24)months.Preoperatively,the IOP in the 21 operated eyes was(32.9±9.1)mmHg(1 mmHg=0.133 kPa),significantly higher than the IOP in the 19 healthy eyes,which was(17.1±4.3)mmHg(t=5.80,P<0.001).The C/D ratio in the operated eyes was(0.75±0.13),also significantly higher than that in the healthy eyes,which was(0.32±0.10)(t=11.22,P<0.001).At the 1-year,2-year,and 3-year follow-up,8 eyes out of 16 operated eyes,6 eyes out of 9 operated eyes,and 7 eyes out of 10 operated eyes achieved overall surgical success(complete success+conditional success),respectively.The number of eyes with complete success at the thr

关 键 词：STURGE-WEBER综合征 青光眼 青光眼引流植入物 假体植入 手术后并发症 

分 类 号：R779.6[医药卫生—眼科]