改良巩膜隧道术在青光眼阀植入术中的应用

摘要

目的 评价改良巩膜隧道在Ahmed青光眼阀植入术中防止青光眼阀引流管暴露的安全性及有效性.方法 回顾分析未改良巩膜隧道与改良巩膜隧道联合青光眼阀植入术治疗的72例(74眼)难治性青光眼患者.其中行未改良巩膜隧道手术者38例38眼(未改良巩膜隧道组),行改良巩膜隧道手术者34例36眼(改良巩膜隧道组).观察术后眼压、视力改变情况,对比两组植入青光眼阀后引流管暴露及其他并发症的发生率.术后随访6 ～ 36个月,平均18个月.结果 未改良巩膜隧道组术后眼压为(16.30±5.73)mm-Hg(1 kPa=7.5 mmHg),改良巩膜隧道组术后眼压为(15.80±6.12) mmHg,两组比较差异无统计学意义(P＞0.05);与术前(48.40±5.79) mmHg相比,差异均有统计学意义(均为P =0.000).未改良巩膜隧道组有3眼发生引流管暴露,发生率为7.9％,改良巩膜隧道组未见发生引流管暴露,发生率相比差异有统计学意义(P＞0.05).结论 改良巩膜隧道青光眼阀植入比未改良巩膜隧道手术安全性更高,可以防止引流管暴露,提高青光眼阀手术的安全性及成功率.%Objective To evaluate the effectiveness and safety of modified scleral tunnel for the prevention of Ahmed valve tube exposure in Ahmed valve implantation for refractory glaucoma.Methods A retrospective study was conducted in 72 patients with Ahmed glaucoma valve implantation for refractory glaucoma.All the patients were divided into unmodified and modified scleral tunnel group.In the unmodified scleral tunnel group,38 patients (38 eyes) underwent traditional scleral tunnel in Ahmed valve implantation,while in the modified scleral tunnel group,34 patients (34 eyes) received modified scleral tunnel in the procedures.The changes in intraocular pressure and visual acuity after operation were observed,and the incidence of drainage tube exposure and other complications were compared between the two methods after Ahmed valve implantation.The patients were followed up for 6 to 36 months with an average of 18 months.Results The intraocular pressure was (16.30 ±5.73) mmHg (1kPa =7.5 mmHg) in the unmodified scleral tunnel group and (15.80 ± 6.12)mmHg in the modified scleral tunnel group,with no significant difference between the two groups (P ＞ 0.05),but there was significant difference with the preoperative data (48.4 ± 5.79) mmHg (P ＜ 0.01).During the follow-up,conjunctival tube exposure was seen in 3 eyes (7.9％) in the unmodified scleral tunnel group,whereas there was no tube exposure in the modified scleral tunnel group.Conclusion The modified scleral tunnel is capable to prevent conjunctival tube exposure in patients with refractory glaucoma,which is more efficient and safe than traditional scleral tunnel in Ahmed glaucoma valve implantation.