自体节段式巩膜长隧道在白内障超声乳化联合青光眼阀植入术中的应用

The application of a novel modified long sectional scleral tunnel in Phacoemulsification combined with Ahmed glaucoma valve implantation

目的评价改良节段式自体巩膜长隧道在白内障超声乳化联合Ahmed青光眼阀植人术中应用的安全性及有效性。方法采用改良自体巩膜长隧道行Ahmed青光眼阀植入术联合白内障超声乳化吸除治疗合并白内障或浅前房的难治性青光眼患者21例(24眼),检测手术前后眼压,术后随访期间前房内引流管长度,管道走形及管径大小,阀盘位置,术后阀管暴露的情况。结果所有患者的平均随访时间为10.8个月(4~15个月)。术前患者平均眼压(36.83±12.63)mmHg,术后末次随访平均眼压(18.36±8.24)mmHg,术后眼压较术前明显降低(P<0.01)。术后第一天,阀体前缘距离角膜穿刺口内缘的距离为11.89±0.14mm,前房内管道长度为3.01±0.34mm,末次随访时距离为11.65±0.38mm,前房内管道长度为2.96±0.37mm;随访期间阀体位置及前房内管道长度未见明显改变(差异无统计学意义,P>0.05)。所有患者随访期间均未见阀体及阀管暴露。结论改良自体节段式巩膜长隧道应用于白内障超声乳化吸除联合Ahmed青光眼阀植人,具有管道不被压迫,管道走形笔直,不易发生管道退缩暴露等并发症、中长期眼压控制理想,是治疗难治性青光眼并发性白内障的有效方法。

Objective To observe the clinical efficacy and safety of Ahmed glaucoma valve implantation combined with phacoemulsification through the modified sectional scleral tunnel.Methods Retrospectively reviewed the records of 24 eyes of 21 cases with refractory glaucoma incorporated cataract or shallow anterior chamber who underwent phacoemulsification combined with placement of an Ahmed valve implant.In the operation, the drainage tubes were inserted into the anterior chamber via a long sectional scleral tunnel after the plates were fixed.Pre-and post operative intraocular pressure (IOP),the introcular length of tubes and placement of valve plates were evaluated during the follow up.Results The mean follow up was 10.8 months(4 to 15 months).Mean preoperative IOP was(36.83±12.63) mmHg and mean postoperative IOP at the last visit was(18.36±8.24)mmHg(P<0.01).1 day after operation,the length of introcular tubes was 3.01±0.34mm, the distance between plates and corneal incision was 11.89±0.14mm, and the length at the last visit was 2.96±0.37mm(P〉0.05),the distance was 11.65±0.38mm(P〉0.05).During the follow-up,there was no tube or plate exposure with the modified scleral tuunel.Conclusion The modified Ahmed glaucoma valve implantation via long sectional scleral tuunel combined with phacoemulsification is easy to be performed with less operation and safe in refractory glaucoma incorporated cataract or shallow anterior chamber.