Ex-press微型青光眼引流器植入联合生物羊膜植入术治疗原发性开角型青光眼

目的　观察Ｅｘ-ｐｒｅｓｓ微型青光眼引流器植入联合生物羊膜植入术与单纯Ｅｘ-ｐｒｅｓｓ微型青光眼引流器植入术治疗原发性开角型青光眼的效果。方法　根据手术方法不同，将原发性开角型青光眼患者４２例（７４眼）分为Ｅｘ-ｐｒｅｓｓ微型青光眼引流器植入联合生物羊膜植入术组（研究组）２５例４８眼和单纯Ｅｘ-ｐｒｅｓｓ微型青光眼引流器植入术组（对照组）１７例２６眼，观察术后前房、眼压、滤过泡、视力、手术成功率及并发症情况。结果　术后１周内发生浅前房者研究组为４眼（８．３３％），对照组２眼（７．６９％）（χ２＝２．９７，Ｐ＞０．０５）。术后１周研究组眼压为（１２．１７±１．０２）ｍｍＨｇ（１ｋＰａ＝７．５ｍｍＨｇ），对照组为（１２．６７±１．１４）ｍｍＨｇ（ｔ＝０．３７１，Ｐ＞０．０５）；术后１ａ研究组眼压为（１５．５３±２．６２）ｍｍＨｇ，对照组为（１９．６５±４．７１）ｍｍＨｇ（ｔ＝２．６４４，Ｐ＜０．０５）。２ａ后研究组总成功率为９５．８３％，对照组总成功率为６９．２３％（χ２＝５．９３，Ｐ＜０．０５）。术后１ａ研究组中功能性滤过泡占９３．７５％（４５／４８），对照组占７３．０８％（１９／２６），差异有统计学意义（Ｐ＜０．０５）。所有病例术后近期视力均不低于术前视力。研究组术后３０眼（６２．５％）出现并发症，对照组２１眼（８０．７７％）出现并发症，两组并发症发生率相比差异有统计学意义（Ｐ＜０．０５）。两组均未发生脉络膜脱离、低眼压性黄斑水肿等严重并发症。结论　Ｅｘ-ｐｒｅｓｓ微型青光眼引流器植入联合生物羊膜植入术治疗原发性开角型青光眼手术成功率高，术后并发症少，远期眼压控制效果好。

Ex-press glaucoma drainage device combined with biological amniotic membrane implantation for primary open-angle glaucoma

Objective To observe the curative effects of Ex-press miniature glaucoma drainage implant combined with biological amniotic membrane implantation and simple Ex-press miniature glaucoma drainage device implantation for primary open angle glaucoma. Methods Totally 74 eyes of 42 glaucoma patients were randomly divided int0 2 groups. In biological amniotic membrane implantation group ( observation group) ,25 cases ( 48 eyes) underwent Ex-press miniature glaucoma drainage combined with biological amniotic membrane implantation. In control group , 17 cases ( 26 eyes) underwent only Ex-press nuniature glaucoma drainage implantation. The postoperative intraocular pressure ( IOP) , anterior chamber depth, filtering bleb. visual acuity and complications were observed. Results The shallow anterior chamber within postoperative I week in the observation group appeared in 4 eyes (8. 33% ) .in the control group was 2 eyes (7. 6g% ) (X2 =2. 97 ,P >0. 05). IOP at postoperative I week in the observation group was( 12. 17 + 1. 02 ) mmHg ( I kPa = 7. 5 mmHg) , in the control group was ( 12. 67 + 1. 14) mmHg ( t = 0. 371 .P > 0. 05 ) . IOP at postoperative I year in the observation group was ( 15. 53 + 2. 62 ) mmHg , in the control group was ( 19. 65 + 4. 71 ) mm-Hg ( t = 2. 644 .P < 0. 05 ) . The total successful rate after 2 years in the observation group was 95 . 83% , the control group was 69. 23% (X2 = 5. 93 ,P < 0. 05 ) . The rate of functional filtering blebs at postoperative I year in the observation group was 93. 75% ( 45/48 ) .the control group was 73. 08% ( 19/26 ) ( P < 0. 05 ) . The postoperative visual acuity in all cases were not lower than pre-operation. The postoperative complications appeared in 30 eyes ( 62. 5% ) and 21 eyes (80. 77% ) in the observation group and control group(P < 0. 05 ) . Conclusion Ex-press miniature glaucoma drainage device combined with biological amniotic membrane implantation is an effective and security method for primary open angle glaucoma. This method can sigruficantly reduce the complications and effectively control long-term IOP.