方法：随机选取本院2013-02/2014-08收治行Ex-press青光眼引流器植入术治疗的难治性青光眼53例56眼，男39例41眼，女14例15眼，平均年龄52.63±10.58岁； 新生血管性青光眼25例26眼，滤过手术失败后青光眼16例18眼，玻璃体切除术后继发青光眼6例6眼以及复杂眼外伤后青光眼6例6眼。观察术后1、12mo视力、眼压、前房深度、角膜内皮细胞密度及并发症等情况，并与术前进行分析比较。

结果：术后12mo，完全成功率为 62%(35眼)，部分成功率为14%(8眼)，总成功率为77%。其中新生血管性青光眼有效率为85%，滤过手术失败后青光眼有效率为56%，复杂眼外伤后青光眼100%，玻璃体切除术后青光眼83%。术后1mo视力较术前提高者28眼(50%)，视力不变18眼(32%)，视力降低10眼(18%)。术后12mo视力较术前提高者19眼(34%)，视力不变18眼(32%)，视力降低19眼(34%)。术前平均眼压29.58±8.66mmHg，术后1mo平均眼压12.75±5.66mmHg，与术前比较差异有统计学意义(P<0.05)，其中56例患眼眼压均表现为降低(100%)。术后12mo眼压为9.8～28.4(平均15.42±4.09)mmHg，与术前比较差异有统计学意义(P<0.05)，其中眼压较术前增高者2眼，眼压不变0眼，眼压降低54眼(96%)。术后1、12mo内皮细胞计数分别为1958.22±168.30、1793.99 ± 201.55个/mm²，与术前的2113.47±80.56个/mm²比较，差异有统计学意义(P<0.01)。术后总并发症发生率为29%，其中术后早期发生浅前房低眼压4眼，暂时性高眼压 3眼，引流管阻塞5眼，前房出血3眼。后期并发症有局部隆起的包裹的囊状泡1眼。

结论：Ex-press青光眼引流器植入术治疗难治性青光眼，虽然存在一定的术后并发症，但仍可取得较好的临床疗效，是目前治疗难治性青光眼的有效方法。

METHODS: Fifty-three cases(56 eyes)were randomly selected in our hospital from February 2013 to August 2014 who received Ex-press glaucoma drainage device implantation for refractory glaucoma, 39 males(41 eyes)and 14 females(15 eyes), 52.63±10.58 years old; 25 cases(26 eyes)with neovascular glaucoma, 16 patients(18 eyes)with failure of glaucoma filtration surgery, 6 cases(6 eyes)with secondary glaucoma after vitrectomy, and 6 cases(6 eyes)with glaucoma secondary to complicated ocular trauma. Postoperative visual acuity, intraocular pressure(IOP), anterior chamber depth, corneal endothelial cell density and complications, etc. at 1 and 12mo were analyzed and compared with the preoperative.

RESULTS: At 12mo after operation, the complete success rate was 62%(35 eyes), the partial success rate was 14%(8 eyes), and the total success rate was 77%. The effective rate was 85% in patients with neovascular glaucoma, 56% in patients with failure of glaucoma filtration surgery, 100% in patients with glaucoma secondary to complicated ocular trauma, 83% in patients with secondary glaucoma after vitrectomy. At 1mo after surgery, visual acuity improved in 28 eyes(50%), unchanged in 18 eyes(32%), decreased in 10 eyes(18%). At 12mo after surgery, visual acuity improved in 19 eyes(34%), unchanged in 18 eyes(32%), decreased in 19 eyes(34%). Preoperative IOP was 29.58±8.66 mmHg, that at 1mo after surgery was 12.75±5.66mmHg, and the difference was significant(P<0.05). There were 56 eyes with decreased IOP(100%). IOP at 12mo after surgery was 9.8-28.4(mean 15.42±4.09)mmHg, which was lower than that before surgery(P<0.05). IOP were increased in 2 eyes, unchanged in 0, decreased in 54 eyes(96%)at 12mo. The corneal endothelial cells was 1958.22±168.30 and 1793.99±201.55/mm², respectively, both decreased compared to that before surgery(2113.47±80.56/mm², P<0.01). The total occurrence of postoperative complications was 29%, of which the early postoperative shallow anterior chamber with ocular hypotension was in 4 eyes, transient high IOP in 3 eyes, drainage tube obstruction in 5 eyes, and hyphema in 3 eyes. Late complication of cystic bubble with local doming was found in 1 eye.

CONCLUSION: Ex-press glaucoma drainage device implantation for refractory glaucoma, although has some complications, still achieve better clinical efficacy, and is an effective method for refractory glaucoma.