Ex-press青光眼微型引流钉联合丝裂霉素C治疗难治性青光眼

Clinical observation of Ex-press miniature glaucoma device combined with mitomycin C for refractory glaucoma

目的:观察Ex-press青光眼微型引流钉植入联合丝裂霉素C对难治性青光眼的疗效与安全性。方法:回顾性分析2014-01/2015-05在荆州市中心医院确诊为难治性青光眼并行Ex-press青光眼微型引流钉植入手术联合术中使用丝裂霉素C患者18例18眼的资料。所有患者至少随访12mo,分析手术前后视力、眼压变化、手术并发症以及滤过泡情况等。结果:治疗前平均眼压43.83±7.99mmHg,术后1d,1、2wk,1、6、12mo时平均眼压分别为8.72±3.29、11.56±1.86、13.33±2.30、13.67±2.03、14.78±3.64、16.61±7.19mmHg,与术前相比,差异均有统计学意义(t=16.475、15.324、14.761、14.172、12.140、11.412,P均<0.01);术后12mo时手术成功率为89%,18例患者中有3例视力提高,12例无明显改变,3例视力下降;术后并发症:早期并发症主要为前房出血及术后浅前房,晚期为滤过泡功能不良,无严重并发症发生。结论:Ex-press青光眼微型引流钉植入术联合丝裂霉素C是治疗难治性青光眼安全且有效的方法,手术并发症少,对视力损伤小,且能稳定控制术后眼压。

·AIM： To observe the clinical efficacy and safety of the Ex-press miniature glaucoma device placed under scleral flap combined mitomycin C for the treatment of refractory glaucoma. ·METHODS： This retrospective analysis comprised 18 eyes of 18 patients who suffered from refractory glaucoma and treated with Ex-press miniature glaucoma device implantation combined mitomycin C in January 2014 to May 2015 in Jingzhou Central Hospital. All patients were followed at least 12mo. The visual acuity, intraocular pressure （ IOP ） , complications and filtering bleb were recorded and statistically analyzed preoperative and 1d, 1, 2wk, 1, 6 and 12mo after operation. ·RESULTS： Average intraocular pressure was 43. 83 ±7. 99mmHg preoperative and decreased significantly at every time point postoperative（8. 72±3. 29, 11. 56±1. 86, 13. 33±2. 30, 13. 67±2. 03, 14. 78±3. 64, 16. 61±7. 19mmHg respectively）, the difference was statistically significant （ t=16. 475, 15. 324, 14. 761, 14. 172, 12. 140, 11. 412, P〈0. 05）. The successful rate was 89% at 12mo after operation, and 3 eyes with improved vision, 12 eyes with unchanged vision, 3 eyes with decreased vision. Early complications were mainly anterior chamber bleeding and postoperative shallow anterior chamber, and late complications were non -functional bleb. There were no serious or unexpected complications in our group of patients. ·CONCLUSION：The Ex-press miniature glaucoma device implantation combined mitomycin C in the treatment of refractory glaucoma is a safe and effective method, which has few surgical complications and less damage to eyesight, and make the stability control of postoperative intraocular pressure.