Ex-press青光眼引流器植入术治疗难治性青光眼的疗效及并发症

发布时间：2018-04-02 08:13

本文选题：难治性青光眼　切入点：Ex-press青光眼引流器　出处：《国际眼科杂志》2016年05期

【摘要】：目的:探讨Ex-press青光眼引流器植入术治疗难治性青光眼的临床疗效及并发症。方法:随机选取本院2013-02/2014-08收治行Ex-press青光眼引流器植入术治疗的难治性青光眼53例56眼,男39例41眼,女14例15眼,平均年龄52.63±10.58岁;新生血管性青光眼25例26眼,滤过手术失败后青光眼16例18眼,玻璃体切除术后继发青光眼6例6眼以及复杂眼外伤后青光眼6例6眼。观察术后1、12mo视力、眼压、前房深度、角膜内皮细胞密度及并发症等情况,并与术前进行分析比较。结果:术后12mo,完全成功率为62%(35眼),部分成功率为14%(8眼),总成功率为77%。其中新生血管性青光眼有效率为85%,滤过手术失败后青光眼有效率为56%,复杂眼外伤后青光眼100%,玻璃体切除术后青光眼83%。术后1mo视力较术前提高者28眼(50%),视力不变18眼(32%),视力降低10眼(18%)。术后12mo视力较术前提高者19眼(34%),视力不变18眼(32%),视力降低19眼(34%)。术前平均眼压29.58±8.66mm Hg,术后1mo平均眼压12.75±5.66mm Hg,与术前比较差异有统计学意义(P0.05),其中56例患眼眼压均表现为降低(100%)。术后12mo眼压为9.8~28.4(平均15.42±4.09)mm Hg,与术前比较差异有统计学意义(P0.05),其中眼压较术前增高者2眼,眼压不变0眼,眼压降低54眼(96%)。术后1、12mo内皮细胞计数分别为1958.22±168.30、1793.99±201.55个/mm2,与术前的2113.47±80.56个/mm2比较,差异有统计学意义(P0.01)。术后总并发症发生率为29%,其中术后早期发生浅前房低眼压4眼,暂时性高眼压3眼,引流管阻塞5眼,前房出血3眼。后期并发症有局部隆起的包裹的囊状泡1眼。结论:Ex-press青光眼引流器植入术治疗难治性青光眼,虽然存在一定的术后并发症,但仍可取得较好的临床疗效,是目前治疗难治性青光眼的有效方法。
[Abstract]:Objective: to investigate the clinical effect and complications of Ex-press glaucoma drainage device implantation in refractory glaucoma. Methods: 53 cases (56 eyes) of refractory glaucoma treated by Ex-press glaucoma drainage device implantation in 2014-08 were randomly selected, including 39 cases (41 eyes) of males, and 53 cases (56 eyes) of refractory glaucoma. 15 eyes of 14 cases (mean age 52.63 卤10.58 years), 25 cases (26 eyes) of neovascular glaucoma and 16 cases (18 eyes) of glaucoma after the failure of filtration surgery. The visual acuity, intraocular pressure, anterior chamber depth, corneal endothelial cell density and complications were observed in 6 eyes of 6 cases of secondary glaucoma after vitrectomy and 6 eyes of 6 cases of complicated ocular trauma after vitrectomy, the visual acuity, intraocular pressure, anterior chamber depth, corneal endothelial cell density and complications were observed at 112mo after vitrectomy. Results: the complete success rate was 622 ~ 35 eyes, the partial success rate was 14 ~ 8 eyes and the total power was 77. The effective rate of neovascular glaucoma was 85 and that of glaucoma after filtration operation was 85. 56.100% of complicated ocular trauma glaucoma, 83% of post-vitrectomy glaucoma. Postoperative 1mo visual acuity improved in 28 eyes (50 eyes), visual acuity unchanged in 18 eyes (32 eyes), visual acuity decreased in 10 eyes (18 eyes). Postoperative 12mo visual acuity increased in 19 eyes (34 eyes), visual acuity remained unchanged in 18 eyes (18 eyes). The mean intraocular pressure (IOP) was 29.58 卤8.66mm Hg before operation and 12.75 卤5.66mm Hg after operation, which was significantly different from that before operation (P 0.05). The intraocular pressure of 56 cases was lower than that before operation. The intraocular pressure of 12mo was 9.828.4 (mean 15.42 卤4.09)mm Hg) after operation. The difference was statistically significant (P 0.05), in which IOP was higher in 2 eyes than that before operation. The number of endothelial cells was 1958.22 卤168.30 卤1793.99 卤201.55 / mm ~ (2), which was significantly higher than that of preoperative (2113.47 卤80.56) / mm ~ (2). The incidence of postoperative complications was 29.9% (4 eyes). Temporary high intraocular pressure in 3 eyes, drainage tube obstruction in 5 eyes, anterior chamber hemorrhage in 3 eyes. Although there are some postoperative complications, it can still obtain good clinical effect. It is an effective method to treat refractory glaucoma at present.
【作者单位】：喀什地区第一人民医院眼科;
【分类号】：R779.6

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