XEN凝胶引流管植入术及其联合超声乳化白内障吸除人工晶状体植入术治疗青光眼的临床效果观察  

Clinical effect of XEN gel stent implantation or combined with phacoemusification and intraocular lens implantation on glaucoma

作　　者：张彬 申晓丽 王晓鹏 龚迪 郭俊宏 汪建涛 Zhang Bin;Shen Xiaoli;Wang Xiaopeng;Gong Di;Guo Junhong;Wang Jiantao(Shenzhen Eye Hospital,Shenzhen Eye Institute,Shenzhen Eye Hospital affiliated to Jinan University,School of Optometry,Shenzhen University,Shenzhen 518040,China)

机构地区：[1]深圳市眼科医院,深圳市眼病防治研究所,暨南大学附属深圳眼科医院,深圳大学眼视光学院,深圳518040

出　　处：《中华眼科杂志》2024年第9期746-756,共11页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(82070961);深圳市医学重点学科建设基金(SZXK037);深圳市自然科学基金面上项目(JCYJ20220530153415034)。

摘　　要：目的探讨XEN凝胶引流管植入术及其联合超声乳化白内障吸除人工晶状体植入术(Phaco+IOL)治疗青光眼的有效性和安全性。方法回顾性病例系列研究。收集2021年12月至2023年6月于深圳市眼科医院行XEN凝胶引流管植入术的45例(52只眼)不同类型青光眼患者的临床资料,男性28例,女性17例。分为单纯组(行XEN凝胶引流管植入术)和联合组(行XEN凝胶引流管植入联合Phaco+IOL)。术后随访时间为18个月,观察指标包括最佳矫正视力(以最小分辨角的对数表示)、眼压、降眼压药物使用数量、引流管植入象限、角膜内皮细胞计数、手术成功率及手术并发症。采用单因素重复测量方差、LSD-t检验、秩和检验进行统计学分析。结果单纯组28例(33只眼),联合组17例(19只眼)。单纯组术后最佳矫正视力较术前无明显变化,而联合组术后最佳矫正视力(术后6个月为0.21±0.30)较术前(0.47±0.46)明显提高,差异有统计学意义(P<0.05)。两组术后眼压均较术前明显降低,单纯组和联合组术前眼压分别为(22.1±8.5)和(19.4±10.2)mmHg(1 mmHg=0.133 kPa),术后18个月分别为(12.2±3.1)和(11.9±3.9)mmHg,差异均有统计学意义(P<0.05)。全部患者术前降眼压药物使用数量为3(2,3)种,术后18个月为0(0,0)种,差异有统计学意义(P<0.05)。单纯组术前角膜内皮细胞计数为(2387.37±478.22)个/mm²,术后12个月为(2193.89±311.96)个/mm²,差异无统计学意义(P>0.05)。XEN凝胶引流管植入鼻上象限8只眼(15.4%),鼻下象限36只眼(69.2%),颞下象限8只眼(15.4%)。手术成功率为96.2%(50/52),其中手术完全成功率为86.5%(45/52),手术条件成功率为9.6%(5/52)。滤过泡瘢痕化的占比为9.6%(5/52),少量前房出血、术后浅前房、一过性高眼压和术中引流管断裂的占比均为7.7%(4/52);少量结膜下出血和术中引流管再次植入的占比为5.8%(3/52);术中结膜组织裂开、术后低眼压黄斑水肿和引流管暴露占比为ObjectiveTo evaluate the efficacy and safety of internal XEN gel stent implantation or combined with phacoemusification and intraocular lens(IOL)implantation in the treatment of glaucoma.MethodsIt was a retrospective case series study.Forty-five patients(28 males and 17 females;52 eyes)who had different types of glaucoma treated at the Shenzhen Eye Hospital from December 2021 to June 2023 were included.XEN gel stent implantation(the XEN group)or XEN implantation combined with phacoemusification and IOL implantation(the combined group)were performed in these patients.The postoperative follow-up was 18 months.The observational indexes included the best corrected visual acuity(recorded as the logarithm of the minimum angle of resolution),intraocular pressure(IOP),XEN implantation quadrant,number of IOP-lowering medications,corneal endothelial cell count,operation success rate and surgical complications.The one-way repeated measures of variance,LSD-t test,and rank sum test were used for statistical analysis.ResultsThere were 28 patients(33 eyes)in the XEN group and 17 patients(19 eyes)in the combined group.The postoperative best corrected visual acuity had no significant change in the XEN group,but improved significantly(0.21±0.30 at 6 months;P<0.05)in the combined group,compared with the preoperative value.The IOP of the two groups at 18 months after surgery[(12.2±3.1)and(11.9±3.9)mmHg(1 mmHg=0.133 kPa)]was significantly lower than that before surgery[(22.1±8.5)and(19.4±10.2)mmHg;P<0.05].The average number of IOP-lowering medications in all patients was 3(2,3)before surgery and 0(0,0)at 18 months after surgery.The difference was statistically significant(P<0.05).In the XEN group,the corneal endothelial cell count was(2387.37±478.22)cells/mm²preoperatively and(2193.89±311.96)cells/mm²at 12 months.The decrease showed no statistical significance.The XEN gel stent was implanted in the supranasal quadrant in 8 eyes(15.4%),in the inferonasal quadrant in 36 eyes(69.2%),and in the infratemporal quadrant in 8 eyes(1

关 键 词：青光眼 青光眼引流植入物 超声乳化白内障吸除术 晶体植入 眼内 支架 治疗结果 

分 类 号：R779.6[医药卫生—眼科]