EX-PRESS引流钉植入术治疗开角型青光眼的疗效分析

Effects of EX-PRESS implantation on open-angle glaucoma

目的 对比分析EX-PRESS引流钉植入术和小梁切除术治疗开角型青光眼的临床疗效和安全性。方法 连续收集本院2013年1月至2014年12月收治的开角型青光眼患者63例（85眼）为研究对象,其中,29例（35眼）行EX-PRESS引流钉植入术治疗的患者纳入引流钉组,34例（50眼）行小梁切除术治疗的患者纳入小梁组。引流钉组：男19例（24眼）,女10例（11眼）,平均年龄为（40.05±9.50）岁;小梁组：男23例（35眼）,女11例（15眼）,平均年龄为（38.60±14.51）岁;分析并比较两组患者手术前后的视力、眼压、滤过泡形态及并发症发生情况。结果 两组患者平均随访（18.0±4.5）个月。引流钉组和小梁组患者术前眼压分别为（38.13±5.26）mm Hg和（39.50±5.21）mm Hg,组间比较无显著差异（P〉0.05）,术后6个月和12个月,引流钉组患者眼压分别降至（16.25±3.42）mm Hg和（16.31±3.92）mm Hg,小梁组分别降至（16.50±4.31）mm Hg和（16.63±3.80）mm Hg,与术前比较差异均具有显著性（P〈0.001）,但术后组间比较差异均无显著性（P〉0.05）。术后1、3、12个月,引流钉组患者功能滤过泡分别为94.29%、85.71%、80.00%,小梁组分别为92.00%、82.00%、76.00%,组间比较无显著差异（P〉0.05）。引流钉组患者术后1周视力恢复至术前水平;小梁组患者术后1周视力较术前下降（P〈0.05）,术后1个月逐渐恢复至术前水平。术后早期,引流钉组4眼、小梁组9眼出现前房延缓形成;其他并发症包括前房出血、脉络膜脱离、低眼压性黄斑病变等,两组患者并发症发生率比较具有显著差异（χ^2=5.07,P〈0.05）。随访过程中并未发现引流钉暴露和移位等并发症。结论 EX-PRESS引流钉植入术是治疗开角型青光眼的一种安全、有效的手术方式,患者术后早期并发症少、视力恢复快,远期手术疗效与小梁切除术相似。

Objective To evaluate the clinical efficacy and safety of EX-PRESS implantation compared with trabeculectomy for open angle glaucoma. Method A total of 85 eyes of 63 open-angle glaucoma patients consecutively recruited from January 2013 to December 2014 were randomly divided into EX-PRESS group and Trab group. 35 eyes of 29 cases were treated with EX-PRESS implantation and 50 eyes of 34 cases were intervened with trabeculectomy. In EX-PRESS group, there were 19 males （24 eyes） and 10 females （11 eyes）, the average age was （40.05±9.50） years old, while in Trab group, there were 23 males （35 eyes） and 11 females （15 eyes）, the average age was （38.60±14.51） years old. The visual acuity, intraocular pressure （IOP）, bleb morphologic features and complications were compared between the two groups. At last, the statistical analysis was conducted. Result The mean follow-up period was （18.0±4.5） months. The preoperative IOP in EX-PRESS group and Trab group was （38.13±5.26） mmHg and （39.50±5.21） mmHg, respectively. The difference between the two groups was not significant （P 〉 0.05）. Following the postoperative 6 months and 12 months,＆amp;nbsp;the IOP declined to （16.25±3.42） mmHg and （16.31±3.92） mmHg in EX-PRESS group, and it reduced to （16.50±4.31） mmHg and （16.50±4.31） mmHg in Trab group, respectively. Compared with preoperative IOP, there was significant decrease after surgery （P 〈 0.001）. There was no statistically significant difference between the two groups after surgery （P 〉 0.05）. After surgery for 1 month, 3 months and 12 months, the functional bleb in EX-PRESS group accounted for 94.29%, 85.71% and 80.00%, and it possessed 92.00%, 82.00% and 76.00%in Trab group, respectively. The difference was not significant between the two groups （P 〉 0.05）. The visual activity in the EX-PRESS group was recovered to the preoperative level after surgery for 1 week and no obvious change was found when compared to preoperation （P 〉 0.05）. Also, after surgery for 1 week, the visual activity in the Trab group decreased compared to its preoperation （P 〈 0.05）. And then, it returned to the baseline after surgery for 1 month and the change was not notable relative to its preoperation （P 〉 0.05）. The 4 eyes in EX-PRESS group and 9 eyes in Trab group encountered the shallow anterior chamber, the complications also included hyphema, choroidal effusion and hypotony and so on, the difference was significant between the two groups after surgery （χ^2 = 5.07, P 〈 0.05）. There were no EX-PRESS device exposure and migration of the EX-PRESS drainage during the follow-up. Conclusion The EX-PRESS implantation is an effective and safe treatment for patients with open angle glaucoma, the quicker visual recovery and the fewer complications occur in early postoperation, its long-term ecacy of decreasing the IOP is similar with trabeculectomy.