改良无缝合青光眼引流阀植入术治疗难治性青光眼的临床观察  

Clinical observation on modified sutureless Ahmed glaucoma valve implantation in the treatment of refractory glaucoma

作　　者：朱大强[1] 王永成[1] 崔璨 Zhu Daqiang;Wang Yongcheng;Cui Can(Department of Ophthalmology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院眼科,郑州450000

出　　处：《中华眼外伤职业眼病杂志》2024年第8期578-584,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的观察改良无缝合Ahmed青光眼引流阀植入术治疗难治性青光眼的临床效果。方法回顾性病例对照研究。收集郑州大学第二附属医院2022年6月至2023年2月30例(32只眼)难治性青光眼患者的临床资料。按手术方法将患者分成试验组和对照组。试验组14例(16只眼)行改良无缝合固定的Ahmed青光眼引流阀植入术;对照组16例(16只眼)行常规Ahmed青光眼引流阀植入术。观察两组术后1 d、1周、1、3及6个月的最佳矫正视力(BCVA,logMAR)、眼压及并发症的情况。结果术前、术后1 d、1周、1、3及6个月,试验组BCVA分别为0.85±0.16、0.90±0.32、0.87±0.26、0.86±0.29、0.86±0.15、0.82±0.22,对照组分别为0.82±0.19、0.89±0.28、0.85±0.33、0.85±0.24、0.82±0.21、0.81±0.18,两组患者手术前后不同时间点的BCVA比较差异无统计学意义(F_(组间)=0.68,P=0.327;F_(时间)=0.91,P=0.602;F_(交互)=2.37,P=0.083);术前、术后1 d、1周、1个月、3个月、6个月,试验组眼压分别为(39.56±10.26)、(14.38±2.78)、(16.56±3.28)、(18.67±4.02)、(17.67±3.96)、(19.27±4.25)mmHg(1 mmHg=0.133 kPa),对照组分别为(40.28±10.37)、(11.65±4.73)、(14.67±5.97)、(19.26±6.17)、(19.76±6.13)、(20.19±6.37)mmHg,两组患者术后各时间点的眼压较术前均有下降,差异有统计学意义,但组间差异无统计学意义(F_(组间)=7.64,P=0.160;F_(时间)=26.33,P<0.001;F_(交互)=0.51,P=0.852);试验组术后6个月出现浅前房者1只眼(6.25%),引流阀体包裹者2只眼(12.50%);对照组术后6个月浅前房者5只眼(31.25%),引流管蚀出者1只眼(6.25%),脉络膜脱离者1只眼(6.25%),引流阀体包裹者4只眼(25.00%),试验组术后并发症的发生率低于对照组,差异有统计学意义(P=0.006)。结论改良无缝合Ahmed青光眼引流阀植入术治疗难治性青光眼安全有效,可简化手术步骤,降低并发症的发生率。Objective To observe the clinical efficacy of modified Ahmed glaucoma valve implantation with sutureless fixation in the treatment of refractory glaucoma.Methods This was a retrospective case-control study.The clinical data of 30 cases(32 eyes)with refractory glaucoma treated with Ahmed glaucoma valve implantation from Jun.2022 to Feb.2023 in the Second Affiliated Hospital of Zhengzhou University were analyzed,and the patients were divided into two groups based on different surgical methods.The trial group with 14 cases(16 eyes)underwent modified suture-free Ahmed glaucoma valve implantation,and the control group with 16 cases(16 eyes)underwent traditional Ahmed glaucoma valve implantation.Best corrected visual acuity(BCVA,logMAR),intraocular pressure and complications were observed at 1 day,1 week,1,3 and 6 months after surgery.Results BCVA preoperatively and at 1 day,1 week,1,3 and 6 months postoperatively were 0.85±0.16,0.90±0.32,0.87±0.26,0.86±0.29,0.86±0.15 and 0.82±0.22 in the trial group,respectively,and were 0.82±0.19,0.89±0.28,0.85±0.33,0.85±0.24,0.82±0.21 and 0.81±0.18 in the control group,respectively.BCVA of the two groups were stable at different time points before and after surgery,and there was no statistically significant difference between the two groups(F_(group)=0.68,P=0.327;F_(time)=0.91,P=0.602;F_(interaction)=2.37,P=0.083).Intraocular pressure preoperatively,and at 1 day,1 week,1,3 and 6 months postoperatively in the trial group were(39.56±10.26),(14.38±2.78),(16.56±3.28),(18.67±4.02),(17.67±3.96),and(19.27±4.25)mmHg(1 mmHg=0.133 kPa),respectively,and were(40.28±10.37),(11.65±4.73),(14.67±5.97),(19.26±6.17),(19.76±6.13)and(20.19±6.37)mmHg in the control group,respectively.The intraocular pressure of the two groups at 1 day,1 week,1,3 and 6 months after surgery were lower than those before surgery,and the difference was statistically significant,however,there was no statistically significant difference in intraocular pressure between the two groups(F_(group)=7.64,P=0.1

关 键 词：青光眼引流植入物 青光眼 难治性 植入术 引流阀 青光眼 Ahmed 缝合固定 无 

分 类 号：R779.6[医药卫生—眼科]