开角型青光眼EX-PRESS引流器植入联合羊膜移植手术疗效

Efficacy of EX-PRESS combined with amniotic membrane implantation for open angle glaucoma

摘要:

目的：探讨EX-PRESS青光眼引流器植入联合羊膜移植术治疗开角型青光眼的疗效。

方法：选取2014-01/2017-01于我院就诊的开角型青光眼患者43例43眼，随机分为羊膜组和丝裂霉素(MMC)组，所有患者均行EX-PRESS青光眼引流器植入术，羊膜组术中联合羊膜移植术，MMC组术中联合应用MMC，观察两组患者术后早期前房形成、滤过泡、眼压及并发症发生情况。

结果：术后1wk，1、6mo两组患者眼压较术前均明显降低，差异均有统计学意义(P<0.05)。术后1wk，两组患者最佳矫正视力分别与手术前比较，差异均无统计学意义(P>0.05)。术后1、6mo，羊膜组功能性滤过泡形成率分别为91%、73%，MMC组分别为90%、86%，两组间比较差异均无统计学意义(P>0.05)； 羊膜组手术总有效率分别为95%、86%，MMC组分别为95%、90%，两组间比较差异均无统计学意义(P>0.05)。术后1wk，羊膜组患者浅前房发生率为9%，MMC组为33%，差异有统计学意义(P<0.05)； 术后1mo，羊膜组患者滤过泡渗漏发生率为5%，MMC组为29%，差异有统计学意义(P<0.05)； 至随访结束，MMC组患者出现薄壁滤过泡4眼，羊膜组无薄壁滤过泡者。

结论：EX-PRESS青光眼引流器植入联合羊膜移植术治疗开角型青光眼降眼压效果良好，并发症较少。

Abstract:

AIM: To explore the efficacy of EX-PRESS combined with amniotic membrane implantation for open angle glaucoma.

METHODS: The data of 43 eyes of 43 patients with open angle glaucoma were enrolled from January 2014 to January 2017. The patients were randomly divided into amniotic group and mitomycin(MMC)group. All cases received EX-PRESS combined with amniotic membrane implantation(amniotic group)or with intraoperative application of mitomycin(MMC group). The early postoperative anterior chamber formation, filtering bleb, intraocular pressure(IOP)and complications were analyzed.

RESULTS: The intraocular pressure of the two groups were significantly lower at 1wk, 1 and 6mo after operation than those before operation(P<0.05). There was no significant difference in the best corrected visual acuity in the two groups at 1wk after operation compared with before operation(P>0.05). At 1 and 6mo postoperatively, the rate of functional bleb formation was 91% and 73% in amniotic group, and they were 90% and 86% in MMC group, respectively, the difference between the groups were not statistically significant(all P>0.05). At 1 and 6mo postoperatively, the total success rate was 95%, 86% in amniotic group, and they were 95%, 90% in MMC group, respectively, the difference between the groups were not statistically significant(all P>0.05). At 1wk postoperatively, the incidence of shallow anterior chamber was 9% in amniotic group and 33% in the MMC group, the difference was statistically significant(P<0.05). At 1mo postoperatively, the incidence of bleb leakage was 5% in amniotic group and 29% in MMC group, the difference was statistically significant(P<0.05). At the end of follow-up, there were 4 eyes of thin-wall bleb in MMC group and no cases in amniotic group.

CONCLUSION: EX-PRESS combined with amniotic membrane implantation for open angle glaucoma is good on lowering intraocular pressure with less complications than the combination of MMC.