针刺分离EX-PRESS引流钉植入术后无功能滤过泡的疗效分析

Effects of needle revision on the dysfunctional filtering blebs after EX-PRESS implantation

目的对比分析针刺分离治疗EX-PRESS引流钉植入术后和小梁切除术后无功能滤过泡的临床疗效和安全性。方法 2015年10月至2016年12在石家庄市第一眼科医院行青光眼滤过性手术后随访中连续出现的无功能滤过泡者69例(81只眼),其中,30例(34只眼)为EX-PRESS引流钉植入术后(引流钉组);39例(47只眼)为复合小梁切除术后(小梁组)。分别对青光眼术后无功能滤过泡者行滤过泡旁结膜下注射丝裂霉素或氟尿嘧啶联合针刺分离。观察针刺分离前后视力、眼压、滤过泡形态、角膜内皮细胞计数及并发症情况,行统计学分析。结果针刺分离前引流钉组和小梁组的眼压分别为(33.96±4.10)mmHg和(32.50±3.63)mmHg,组间比较无统计学差异(P>0.05),针刺分离后1个月和6个月,引流钉组患者眼压分别降至(12.15±3.53)mmHg和(13.56±3.15)mmHg,小梁组分别降至(12.64±3.08)mmHg和(14.60±4.27)mmHg,与针刺分离前比较差异均具有显著性(P<0.001),针刺分离后组间比较无统计学意义(P>0.05)。针刺分离前后两组患者角膜内皮变化无统计学意义(P>0.05),针刺分离后功能滤过泡组间比较无显著性差异(P>0.05)。针刺分离后早期并发症主要有结膜下出血、前房延缓形成、前房出血、脉络膜脱离和低眼压性黄斑病变,引流钉组明显低于小梁组,差异有显著性(χ~2=6.26,P=0.01)。随访过程中未发现滤过泡渗漏、滤过区结膜糜烂等并发症。结论结膜下注射丝裂霉素或氟尿嘧啶联合针刺剥离对EX-PRESS引流钉植入术后无功能滤过泡的修复是一种安全、有效的治疗方法。

Objective To investigate the clinical efficacy and safety of needle revision on dysfunctional filtration blebs after EX-PRESS implantation and trabeculectomy. Methods 81 eyes of 69 patients with dysfunctional filtering blebs after glaucomatous filtering surgery were consecutively enrolled from October 2015 to December 2016 at the Shi Jia Zhuang First Hospital. 34 eyes of 30 patients after EX-PRESS implantation were defined as the EX-PRESS group and 39 eyes of 47 cases after trabeculectomy were considered as the Trab group. Patients with non-functional filtration blebs received mitomycin or fluorouracil subconjunctival injection combined with acupuncture after glaucomatous surgery. Visual acuity,intraocular pressure（ IOP）,bleb morphologic features,corneal endothelial cell density and complications were measured. The statistical analysis was conducted between the two groups. Results The IOP in EXPRESS group and Trab group was 33. 96 ±4. 10 mmHg and 32. 50 ± 3. 63 mmHg before needling revision,respectively. The difference between the two groups was not significant. Following the needling revision at 1 and 6 months,IOP declined to 12. 15 ± 3. 53 and 13. 56 ± 3. 15 mmHg in EX-PRESS group and 12. 64 ± 3. 08 and 14. 60 ± 4. 27 mmHg in Trab group,respectively. Compared with pre-treatment IOP,IOP significantly decreased after the needling revision（ P 0. 001）. There was no statistically significant difference between the two groups. The corneal endothelial cell density between the two groups was not obviously changed before and after needling reversion. Early stage complications included subconjunctival hemorrhage,shallow anterior chamber,hyphemia,choroidal effusion and hypotony,and the difference was significant between the two groups after needling（ χ^2= 6. 26,P = 0. 01）. There were no filtering bleb leakage or conjunctival erosion in the filtering area during the follow-up. Conclusions Subconjunctival injection of mitomycin or fluorouracil combined with needle reversion is a safe and effective treatment to remove dysfunctional filtering blebs after Express drainage implantation.