微型Ex-PRESS引流器植入术与复合式小梁切除术治疗青光眼的疗效比较

  本文关键词：微型Ex-PRESS引流器植入术与复合式小梁切除术治疗青光眼的疗效比较，由笔耕文化传播整理发布。

        背景和目的青光眼是一种伴有眼压升高、神经节细胞凋亡致视野缺损不断进展的慢性视神经性病变。流行病学资料显示，预计到2020年全世界青光眼人数达8000万，其中我国青光眼的发病人数高达600万人。随着社会、环境、生活习惯的改变及现代眼科技术的发展，我国青光眼的类型比例也发生改变，其中开角型青光眼的发病人数在增长。关于原发性青光眼致病基因的研究报道很多[1][2]，但致病基因导致青光眼的发病机制尚不十分清楚，目前基因治疗仍处于动物试验阶段。青光眼发病的危险因素有眼压、家族史、吸烟、高血压、糖尿病、炎症反应等，其中高眼压是视功能受损最具预测性的危险因素，也是青光眼治疗过程中的唯一可校正因素[3]。目前降低眼压的方法主要有药物、手术和激光。小梁切除术依然是主要的抗青光眼手术[4]，但其远期的高失败率和潜在的并发症很多，不是最为理想的手术方式。近年来国外不断报道“微型”引流装置植入术治疗青光眼，具有操作简单、并发症少、降压效果明确等优点。目前国内关于植入Ex-PRESS引流器治疗青光眼的疗效和并发症的报道很少。本研究的目的是观察Ex-PRESS引流器和复合式小梁切除术治疗开角型青光眼的临床疗效，并比较两种手术方式的治疗效果。方法本研究为前瞻性研究。选择于我院就诊的青光眼患者53例（55眼），随机分组为试验组23例（25眼）采取Ex-PRESS引流器植入术；对照组30例（30眼）采取复合式小梁切除术。分别于术后1天、1周、1月、3月、6月记录两组的平均眼压、视力、使用抗青光眼药物数量、手术时间、手术成功率、和并发症情况，并进行两组间比较。所有数据用均数±标准差表示，数据统计分析由SPSS17.0软件处理，以P<0.05为差异有统计学意义。结果1.Ex-PRESS组术后1天、1周、1月、3月、6月平均眼压较术前相比，差异均有统计学意义（P<0.001）。2.Ex-PRESS组和小梁切除组的术后6月平均眼压分别为（17.3±1.4）mm Hg，（17.5±1.1）mm Hg，两组间相比差异无统计学意义。3.Ex-PRESS组和小梁切除组的手术时间分别为（23.5±2.3)min，（34.8±2.3）min，两组间差异有统计学意义（P<0.001）；应用降眼压药物的数量分别为（0.3±0.6）,（0.4±0.7），两组间差异无统计学意义。4.Ex-PRESS组和小梁切除组术后6个月的手术成功率分别为80.0%：76.7%，差异无统计学意义。5.Ex-PRESS组和小梁切除组总并发症发生率分别为12.0%：36.7%，两组相比差异有统计学意义（P<0.05）。结论1.微型Ex-PRESS引流器植入术具有明显的降眼压作用。2.微型Ex-PRESS引流器植入术的降低眼压水平与复合式小梁切除术相当。3.与复合式小梁切除术相比，微型Ex-PRESS引流器植入术操作简单，，手术时间短，对眼内组织骚扰小，术后并发症更少，安全性更高。

    Background and objectivesGlaucoma was one of progressive optic neuropathies that were associated withelevated intraocular pressure, characteristic visual field defects following the ganglioncell apoptosis.Epidemiological data indicated that the number of glaucoma was80million by2020, including up to6million in China.With the change of the society,environment and living habits and the development of modern technology ofophthalmology, the proportion of glaucoma type in China also changed, including theprevalence of open-angle glaucoma increased. There were a lot of researches on geneof glaucoma[1][2], but the mechanism of disease genes resulting in glaucoma was notyet clear, the gene therapy was still in the experimental animals. The risk factors forglaucoma were intraocular pressure, family history, smoking, high blood pressure,diabetes, inflammatory reaction, etc., Elevated intraocular pressure was the mostpredictive risk factor for visual function damage, and was the only correction factorsof glaucoma treatment process[3]. At present the methods to reduce intraocularpressure were drugs, laser and surgery. Trabeculectomy was still the main glaucomasurgery[4]. As its long-term high failure rate and many potential complications, it wasnot the ideal operation. Research abroad in recent years had reported micro drainage device implantation treatment,with showing simple operation, less complications, ef-fective pressure reduction.We were unaware of any reported postoperative outcomeof the EX-PRESS in chinese patients.The purpose of this study was to compare theoutcome of the Ex-PRESS drainage versus trabeculectomy in open-angle glaucoma.MethodsA prospective study.53cases(55eyes) open-angle glaucoma patients withpreviously failed in the study.23cases(25eyes) were randomly divided into groupwich were treated by mini Ex-PRESS drainage implantation,the other30cases(30eyes)were treated by trabeculectomy. All of the eyes were measured the visualacuities, intraocular pressure, number of glaucoma medications, operation time,surgical success rate and complications at pre-operation,1day,1week,and1,3,6months after surgery.Results1.In Ex-PRESS group,the average IOP at1day,1week,1,3and6months aftersurgery was significant different from the preoperative level(P <0.001).2. In Ex-PRESS group and TE group,the average intraocular pressure at6months postoperatively was（17.3±1.4） mm H g,（17.5±1.1）mm Hg respectively,there had no statistically significant differences between the two groups.3. In Ex-PRESS group and TE group,the operation time was (23.5±2.3) min,(34.8±2.3) min respectively, there had statistically significant differences betweenthe two groups (P <0.001); The number of glaucoma medications was (0.3±0.6),(0.4±0.7), there had no difference between the two groups.4. In Ex-PRESS group and TE group, success rate at6months after surgery was80.0%,76.7%respectively.5.In Ex-PRESS group and TE group,total complication rates were12.0%,36.7%respectively,and there had significant differences between the two groups.(P <0.037). Conclusion1.The micro Ex-PRESS implantation can reduce intraocular pressure effectively.2.Trabeculectomy and the micro Ex-PRESS implantation provioded similar IOPcontrol.3.The micro Ex-PRESS drainage implantation had lower rates of hypotony andother post-complications compared to trabeculectomy.The first had shorter operationtime, and the higher level of security.

微型Ex-PRESS引流器植入术与复合式小梁切除术治疗青光眼的疗效比较

摘要4-6Abstract6-8中英文缩略词对照10-11引言11-131 资料与方法13-152 研究方法15-173 结果17-204 讨论20-255 结论25-26参考文献26-28附图28-29综述29-49    参考文献44-49个人简介、在学期间发表的学术论文集研究成果49-50致谢50

  本文关键词：微型Ex-PRESS引流器植入术与复合式小梁切除术治疗青光眼的疗效比较，由笔耕文化传播整理发布。