Ex-press引流钉植入术治疗原发性开角型青光眼

Evaluation of Ex-press implantation in primary open angle glaucoma

目的:探讨Ex-press引流钉植入术治疗原发性开角型青光眼的有效性和安全性。方法:回顾性研究2013-08/2015-07在我院诊断原发性开角型青光眼并行Ex-press引流钉植入术的患者28例37眼,术后随访至少6(平均15.0±5.5)mo。手术成功评判标准:为术后在不用或用降压药物的情况下,眼压控制在6~21mmH g之间同时无严重并发症。根据上述手术成功判断标准,采用寿命表法统计不同时间点的累积成功率,以Cox比例风险模型分析各种预测变量对不同时间点失败的影响。结果:原发性开角型青光眼患者28例37眼纳入研究,术后随访6~24(平均15.0±5.5)mo。术前视力与术后末次随访视力比较,差异有统计学意义(z=-2.40,P=0.016<0.05)。术前、术后1 d,1 wk,1、3、6 mo,1、1.5、2 a的眼压分别为37.4±12.7、11.9±7.0、9.4±3.9、12.2±9.2、1 1.5±6.4、1 0.9±3.6、1 1.5±5.8、1 0.7±2.9、9.6±2.3mmH g;术前术后眼压差异有统计学意义(F=24.45,P<0.05)。术前、术后末次随访应用抗青光眼药物种类数目分别为2.24±1.21、0.05±0.23,差异比较有统计学意义(Z=-2.02,P<0.05)。术后1d,1wk,1、3、6mo,1、1.5、2 a的累积完全成功率分别为86.5%、78.4%、64.9%、62.2%、59.5%、56.8%、56.8%、56.8%。Cox比例风险模型分析显示术前使用抗青光眼药物的种类是影响手术失败的危险因素(P=0.02)。结论:采用Ex-press引流钉植入术治疗原发性开角型青光眼是比较有效和相对安全的治疗方法,手术操作简单,治疗效果理想,术后并发症较少。

AIM：To evaluate the safety and efficacy of Ex-press implantation in primary open angle glaucoma（POAG）patients.METHODS：This was a retrospective study of 37 eyes in28 POAG patients who were treated with Ex- press implantation in Changsha Aier Hospital from August 2013 to July 2015.All subjects had a minimum 6-month follow-up（mean 15.0±5.5mo）.Success was defined as intraocular pressure（IOP） was 6- 21 mmHg without complications,with or without glaucoma medicines.Lifetable analysis was used to assess the cumulative probabilities of success in different follow-up time.Cox regression analysis was performed to estimate the relations between survival outcomes and multiple predictors.· RESULTS：The follow-up ranged from 6-24mo（mean15.0 ± 5.5mo）.Visual acuity was significantly different between preoperation and the final follow-up（z=-2.40,P=0.016）.The preoperative IOP was 37.4±12.7mmHg,and the postoperative IOP at 1d,1wk,1,3,6mo,1,1.5,2a were 11.9＋7.0,9.4±3.9,12.2±9.2,11.5±6.4,10.9±3.6,11.5±5.8,10.7±2.9 and 9.6±2.3m mHg,respectively.IOP was significantly different between preoperation and the final follow-up（F=24.45,P〈0.05）.The number of antiglaucoma medications was significantly reduced from2.24±1.21 at preoperation to 0.05±0.23 postoperative（Z=-2.02,P〈0.05）.The cumulative probabilities of success at1 d,1 wk,1,3,6mo,1,1.5,2a were 86.5%,78.4%,64.9%,62.2%,59.5%,56.8%,56.8%and 56.8%.The number of anti-glaucoma medications was identified as a risk factor for surgical failure by the Cox hazard model（P=0.02）.CONCLUSION：Ex-press implantation is effective and relatively safe for controlling the IOP in the POAG eyes.The procedure is simple and has fewer postoperative complications.