Ahmed青光眼引流阀植入术两种术式的临床对比研究

A comparative study on the two types of operation of Ahmed glaucoma valve implantation

目的比较Ahmed青光眼引流阀植入术两种术式（引流管植入采用自体巩膜瓣下穿刺法和角巩膜缘隧道穿刺法）对难治性青光眼治疗的临床疗效和并发症。方法回顾性分析2013年01月～2014年12月的57例采用青光眼引流阀植入术的难治性青光眼的临床资料，随访2年。33例（33眼）术中引流管植入采用自体巩膜瓣下穿刺法（A组），24例（24眼）引流管植入采用角巩膜缘隧道穿刺法（B组），进行术前、术后眼压，手术成功率及并发症发生率的临床对比研究。结果A组术前平均眼压（46．73±9．82）mmHg，术后2年平均眼压（15．13±8．45）mmHg，差异有统计学意义（t=14．67，P〈0．05）；B组术前和术后2年平均眼压分别为（44．21±11．32）mmHg、（17．36±8．23）mmHg，差异有统计学意义（t=13．21，P〈0．05）。2年后平均眼压组间差异无统计学意义（t=0．99，P〉0．05）。A组术后2年绝对成功率63．64％，相对成功率15．15％，总成功率78．79％；B组分别为66．67％、12．50％、79．17％，差异无统计学意义（x^2=0．0011，P〉0．05）。A组发生并发症的总眼数16眼（48．49％），B组发生并发症的总眼数11眼（45．83％），差异无统计学意义（x^2=0．0419，P〉0．05）。结论青光眼引流阀植入术治疗难治性青光眼的两种术式手术成功率均较高，但并发症的发生都不容忽视。

Objective To observe the efficacy and drainage tube implantation was applied to the puncture piercing at corneoscleral tunnel）of Ahmed glaucoma valve complications of the two types of operation（the method of autologous sclera flap insertion and implantation in treatment of refractory glaucoma. Methods 57 cases of intractable glaucoma treated in our hospital from January 2013 to December 2014 and being followed-up for 2 year are analyzed,including 33 cases（33 eyes）drainage tube implantation in glaucoma valve implantation with autologous scleral flap insertion method （group A）and 24 cases （24 eyes）drainage tube implantation with piercing at corneoscleral tunnel. The intraocular pressure before and after surgery, incidence rate of complications and success rate of operation of the two groups were compared and analyzed. Results In group A, the average preoperative intraocular pressure （IOP）was （46. 73±9. 82）mmHg. Two years postoperative average IOP was （ 15. 13 ± 8. 45） mmHg. There was significant difference between preoperative and postoperative IOP in group A（t= 14.67, P〈0.05）. In group B, average preoperative IOP was（44.21±11.32） mmHg. Two years postoperative average IOP was （ 17.36 ± 8.23） mm Hg. There was significant difference between preoperative and postoperative IOP in group B（t= 13. 21, P〈0.05）. There was no significant difference between two groups in postoperative lOP （t = 0. 99, P〉 0. 05）. In group A, 63.64% were complete successes,and 15. 15% were relative successes,and the total success rate was 78. 79 %. In group B, 66.67 % were complete successes, and 12.50% were relative successes, and the rate of total success was 79. 17%. There was no significant difference between two groups rate of total success（x^2 = 0. 0011, P〉 0. 05）. In group A, 16 eyes （48. 49%） had postoperative complications; in group B, 11 eyes （45.83%） had complications. There was no significant difference between two groups in postoperative complications（x^2 =0. 0419,P〉0.05）. Conclusion The success rate of both operations of Ahmed glaucoma valve implantation in treatment of refractory glaucoma was high, but the occurrence of complications cannot be ignored.