Ex-PRESS引流器与Ahmed引流阀植入术治疗难治性青光眼的对比研究

Comparison of Ex-PRESS glaucoma shunt and Ahmed glaucoma valve implantation in the treatment of refractory glaucoma

目的评价和对比Ex-PRESS引流器与Ahmed引流阀治疗难治性青光眼的临床疗效和安全性。方法回顾性病例对照研究。共纳入32例(34只眼)难治性青光眼患者,予Ex-PRESS引流器(17只眼)或Ahmed引流阀植入术(17只眼)。记录术前及术后各随访时间点的眼压、最佳矫正视力、使用的降眼压药物种类及并发症,并分析手术的完全成功率(不使用药物眼压情况下≤21 mmHg)和相对成功率(使用降眼压药物情况下眼压≤21 mmHg)。结果患者术后的眼压及降眼压药物种类较术前显著下降(P<0.01)。Ex-PRESS组眼压由(38.4±9.9)mmHg降低至(20.3±6.2)mmHg,使用的药物种类由(3.2±0.4)减少为(1.5±1.4)种;Ahmed组眼压由(38.0±8.5)mmHg降低至(18.5±4.7)mmHg,使用的药物种类由(3.4±0.5)种减少为(1.4±1.2)种。术后12个月的相对成功率Ex-PRESS组为52.9%,Ahmed组为70.5%;术后12个月的完全成功率Ex-PRESS组为41.2%,Ahmed组为58.8%(P<0.05)。Ex-PRESS组有5只眼,Ahmed组有3只眼发生了并发症。结论 Ahmed引流阀植入术治疗难治性青光眼的效果优于Ex-PRESS引流器植入术,即能够更好的降低眼压,且并发症的发生率更低。

Objective To evaluate and compare the clinical efficacy and safety of Ex-PRESS glaucoma shunt and Ahmed glaucoma valve implantation in the treatment of refractory glaucoma.Methods This was a retrospective case-control study. A total of 32 patients(34 eyes) with refractory glaucoma were included, and Ex-PRESS glaucoma shunt(17 eyes) or Ahmed glaucoma valve implantation(17 eyes) were performed. Pre-and post-surgical intraocular pressure(IOP), best-corrected visual acuity, number of anti-glaucoma medications and complications were recorded. Complete success rate of the surgery(IOP ≤21 mmHg without medications) and qualified success rate(IOP ≤21 mmHg with medications) were analyzed.Results IOP and number of anti-glaucoma medications decreased significantly after the surgery(P<0.01). The IOP in the Ex-PRESS group decreased from 38.4± 9.9 mmHg(medications: 3.2±0.4 kinds) to 20.3± 6.2 mmHg(1.5±1.4), and the IOP in the Ahmed group decreased from 38.0± 8.5 mmHg(3.4±0.5) to 18.5± 4.7 mmHg(1.4±1.2). The qualified success rate was 52.9 % in the Ex-PRESS group and 70.5% in the Ahmed group at 12 months postoperatively. The complete success rate was 41.2% in the Ex-PRESS group and 58.8% in the Ahmed group(P<0.05). Complications occurred in 5 eyes in the Ex-PRESS group and 3 eyes in the Ahmed group. Conclusions Ahmed glaucoma valve implantation was more effective in treating refractory glaucoma than Ex-PRESS glaucoma shunt implantation, and associated with larger reduction in IOP and a lower incidence of complications.