在中国Ex-PRESS青光眼微型引流器植入术是否可以取代小梁切除术?

摘要

Ex-PRESS青光眼微型引流器植入术的开展,为青光眼的手术治疗提供了新的选择.与小梁切除术相比,Ex-PRESS青光眼微型引流器植入术具有操作简单、疗效相当、术后并发症少的优点.研究表明,Ex-PRESS青光眼微型引流器植入术在小梁切除术高风险病例中具有相对安全的优势,但在小梁切除术容易失败的病例中却并没有突出的优势,术后瘢痕化仍然是影响手术成功率的关键问题.这种微型青光眼引流器植入术须满足前房角有足够空间的条件,以避免伤及角膜内皮、虹膜或晶状体,因此Ex-PRESS青光眼微型引流器植入术不适用于闭角型青光眼,这是欧美国家较少考虑的问题,此外,这种手术成本效应比相对较低的缺点在中国患者中也是值得考虑的问题.因此,Ex-PRESS青光眼微型引流器植入术在中国尚不能取代小梁切除术,其优缺点有待中国研究者总结的中长期临床观察和循证医学依据来评估.%Ex-PRESS miniature implantation is a new alternative of anti-glaucoma surgeries due to its advantages,such as simpler operation,similar efficacy to trabeculectomy and less complications.Could Ex-PRESS miniature implantation replace the trabeculectomy? Studies showed that Ex-PRESS implantation has more significant advantages to those patients with high risk for trabeculectomy but dose not has dominant benefits to those prone to failure of trabeculectomy from bleb scarring.The Ex-PRESS implantation requires a relative wide angle so as to have enough space to avoid the device accessing to corneal endothelium,iris or lens.So it is unsuitable for angle-closure glaucoma with higher incidence in China.In addition,the cost-effect for Ex-PRESS implantation should also be fully considered when this method could be put into practice in the near future in China.Ex-PRESS implantation seems to be unable to displace trabeculectomy.The merits and demerits for Chinese patients still need to verify by Chinese own evidence-based studies.