EX-PRESS引流钉植入术和小梁切除术对青光眼视野和RNFLT的影响

Surgical efficacy after two different surgical methods on visual field and RNFL thickness in patients with glaucoma

摘要:

目的：观察两种手术对青光眼患者的视野和视网膜神经纤维层厚度的影响。

方法：收集2015-12/2017-05我院行抗青光眼手术患者69例82眼的临床资料，根据手术方法分为EP组(EX-PRESS引流钉植入术)和XQ组(小梁切除术)。于术前和术后1、3mo观察眼压、前房深度(anterior chamber depth，ACD)、前房容量(anterior chamber volume，ACV)、前房角宽度(anterior chamber angle，ACA)、瞳孔直径(pupil diameter，PD)、视力、视野光敏感度平均缺损(mean defect，MD)、视野指数矫正模式标准差(correct pattern standard deviation，CPSD)、周边视野的光敏感度(mean sensitivity，MS)、视网膜神经纤维层厚度(retinal nerve fiber layer thickness，RNFLT)，并对比术后并发症情况。

结果：EP组住院时间(3.08±0.42d)明显低于XQ组(4.53±1.28d)，差异有统计学意义(t=6.124，P<0.05)。EP组视力恢复时间(3.26±0.30d)明显低于XQ组(4.96±1.36d)，差异有统计学意义(t=6.920，P<0.05)。两组患者术后的ACA、ACD、ACV均明显高于术前，PD低于术前，且两组患者间术后ACA、ACD、ACV、PD比较，差异无统计学意义(P>0.05)。两组患者术后RNFLT、MD、CPSD均降低，MS升高，差异有统计学意义(P<0.05)； 与XQ组对比，EP组术后的CPSD明显降低，差异有统计学意义(P<0.05)。EP组术后并发症总发生率为38%，明显低于XQ组(70%)，差异有统计学意义(χ²=8.094，P=0.004)。

结论：与小梁切除术对比，EX-PRESS引流钉植入术更有效地减缓视野进展，更有利于患者术后视力的恢复，安全性更高，而其在RNFLT改善程度与小梁切除术效果一致。

Abstract:

AIM:To compare the effects after two different surgical methods on visual field and retinal nerve fiber layer(RNFL)thickness in patients with glaucoma.

METHODS: Clinical data of 69 cases patients(82 eyes )with glaucoma between December 2015 to May 2017 in our hospital for anti-glaucoma surgery were collected. According to operation method, they were divided into EP group(EX-PRESS glaucoma shunt implantation)and XQ group(trabeculectomy). Intraocular pressure, anterior chamber depth(ACD), anterior chamber capacity(ACV), anterior chamber angle width(ACA), optical pupil diameter(PD), visual acuity, visual sensitivity index mean defect(MD), visual correction pattern standard deviation(CPSD), mean sensitivity(MS)and retinal nerve fiber layer thickness(RNFLT)were observed in the preoperative, postoperative 1mo and postoperative 3mo, and the postoperative complications were compared.

RESULTS: Hospitalization time of 3.08±0.42d in the EP group was significantly lower than 4.53±1.28d in the XQ group(t=6.124, P<0.05). The visual recovery time of 3.26±0.30d in the EP group was significantly lower than 4.96±1.36d in the XQ group(t=6.920, P<0.05). The ACA, ACD and ACV after surgery of two groups were significantly higher than those before operation, and the PD after surgery was lower than before operation, and the differences were not statistically significant between two groups after surgery(P>0.05).The postoperative RNFLT, MD and CPSD were all decreased in both groups(P<0.05), and postoperative MS increased(P<0.05); compared with XQ group, the postoperative CPSD after surgery in EP group was significantly reduced(P<0.05).The total incidence of postoperative complications of EP group was 38%, which was significantly lower than 70% in XQ group, the difference was statistically significant(χ²=8.094, P=0.004).

CONCLUSION: Compared with trabeculectomy, EX-PRESS glaucoma shunt implantation is more effective to slow the progress of vision, and it is more conducive to recovery of the patient's vision after surgery with higher security. The improvement of the thickness of the retinal nerve fibers after EX-PRESS glaucoma shunt implantation is consistent with trabeculectomy.