XEN引流管植入联合丝裂霉素C治疗开角型青光眼

XEN drainage tube implantation combined with mitomycin C for open angle glaucoma

摘要:

目的：探讨XEN引流管植入联合丝裂霉素C(MMC)治疗开角型青光眼(OAG)的临床疗效和安全性。

方法：回顾性纳入OAG患者37例37眼，按初始接受抗青光眼手术治疗与否分为初次青光眼手术组17例17眼，多次青光眼手术组20例20眼，记录各随访时间点眼压、降眼压药物种类及并发症，术后随访时间大于1 a。

结果：术后1 a，初次与多次青光眼手术组眼压分别从术前27.56±9.94、28.43±14.18 mmHg降至15.16±3.65、17.18±5.83 mmHg，分别下降55.01%和60.43%(t=4.863，P<0.001； t=3.255，P=0.004)。术后不同时间点两组眼压均较术前降低，时间有差异(F_时间=6.876，P_时间<0.001)，组间及交互均无差异(F_组间=0.242，P_组间=0.626； F_{时间×组间}=0.959，P_{时间×组间}=0.458)。两组手术完全成功率分别为47%、45%，条件成功率为76%、75%(Z=-0.115，P=0.909)，完全成功与条件成功累积生存率分析均无差异(χ²=0.042，P=0.838； χ²=0.004，P=0.949)。术后1 a随访时两组降眼压药物均由术前的3(2，3)种减少为1(0，2)种(Z=-3.289、-3.796，均P<0.001)，组间无差异(Z=-0.581，P=0.561)。术后短期并发症以低眼压为主，前房出血次之，远期并发症以滤过泡包裹为主，除外引流管暴露及脱落各1眼，无其他严重并发症发生。

结论：XEN引流管植入联合MMC治疗初次与多次青光眼手术OAG患眼均安全有效，但多次青光眼手术组滤过泡包裹发生率高。

Abstract:

AIM: To investigate the clinical efficacy and safety of XEN drainage tube implantation combined with mitomycin C(MMC)for open angle glaucoma(OAG).

METHODS:A total of 37 OAG patients(37 eyes)were retrospectively included, grouped by anti-glaucoma surgical treatment as the first choice or not, with 17 patients(17 eyes)in the group with primary surgical treatment, and 20 patients(20 eyes)in the group with the numerous surgeries. The intraocular pressure(IOP), kinds of IOP-lowering drugs, and complications were collected and analyzed in 1 a follow-up postoperatively.

RESULTS:Upon the one-year follow-up, IOP had decreased from 27.56±9.94, 28.43±14.18 mmHg to 15.16±3.65, 17.18±5.83 mmHg in both groups, respectively, representing a reduction of 55.01% and 60.43%, respectively(t=4.863, P<0.001; t=3.255, P=0.004). The IOP at various follow up points were lower than preoperative points in both groups(F_time=6.876, P_time<0.001; F_intergroup=0.242, P_intergroup=0.626; F_{time×intergroup}=0.959, P_{time×intergroup}=0.458). The complete success rate was 47% and 45%, the qualified success rate was 76% and 75%(Z=-0.115, P=0.909), respectively, and there was no significant difference in the cumulative survival rate between two groups(χ²=0.042, P=0.838; χ²=0.004, P=0.949). At the last follow up, IOP-lowering drugs were reduced from 3(2, 3)to 1(0, 2)in both groups(Z=-3.289, -3.796, all P<0.001), and no significant difference between groups(Z=-0.581, P=0.561). Hypotony is the most common short-term complications, anterior chamber haemorrhage followed, while, filtering bleb encapsulation is the most frequent long-term complication, no serious complications occurred, but with XEN drainage tube exposure in 1 eye and drop in 1 eye.

CONCLUSION:Initial XEN drainage tube implantation combined with MMC and numerous glaucoma surgeries are both safe and effective treatment for OAG patients, while the incidence of filtering bleb encapsulation is high in those with numerous glaucoma surgeries.