[1]周妍丽,钱志刚,毛晓春.采用1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障[J].眼科新进展,2020,40(11):1070-1073.[doi:10.13389/j.cnki.rao.2020.0239]
　ZHOU Yanli,QIAN Zhigang,MAO Xiaochun.Combined 1.8 mm coaxial micro-incision phacoemulsification and Ahmed implantation for patients with refractory glaucoma and cataract[J].Recent Advances in Ophthalmology,2020,40(11):1070-1073.[doi:10.13389/j.cnki.rao.2020.0239]
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采用1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
40卷
期数:
2020年11期
页码:
1070-1073
栏目:
应用研究
出版日期:
2020-11-05

文章信息/Info

Title:
Combined 1.8 mm coaxial micro-incision phacoemulsification and Ahmed implantation for patients with refractory glaucoma and cataract
作者:
周妍丽; 钱志刚; 毛晓春
441021　湖北省襄阳市，湖北文理学院附属医院,襄阳市中心医院
Author(s):
ZHOU Yanli; QIAN Zhigang; MAO Xiaochun
Department of Ophthalmology,Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science，Xiangyang 441021,Hubei Province,China
关键词:
微切口; 晶状体超声乳化术; Ahmed引流阀; 小梁切除术; 难治性青光眼
Keywords:
micro-incision;  ultrasonic phacoemulsification;  Ahmed glaucoma drainage;  trabeculectomy;  refractory glaucoma
分类号:
R775
DOI:
10.13389/j.cnki.rao.2020.0239
文献标志码:
A
摘要:
目的　探讨采用1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障的有效性和安全性。方法　选取2016年4月至2019年3月在我院就诊的难治性青光眼合并白内障患者 61 例 61 眼。随机分为观察组和对照组，观察组31例(31眼)，对照组30例(30眼)。观察组患者行1.8 mm同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术；对照组患者行1.8 mm 同轴微切口晶状体超声乳化术联合小梁切除术。所有患者随访时间均大于6个月，观察并记录两组患者的眼压、最佳矫正视力（best corrected visual acuity，BCVA）、功能性滤过泡、中央前房深度、角膜内皮细胞密度、抗青光眼药物种数、手术成功率以及并发症，对两组各指标进行统计学分析。结果　两组患者术后各时间点眼压与术前比较均明显降低，差异均有统计学意义(均为P<0.01)。术后１个月、3个月及６个月时观察组眼压均较对照组低，差异均有统计学意义(均为P<0.05)。术后各时间点两组患者BCVA均较术前提高，差异均有统计学意义(均为P<0.01)；在术后随访1周后的各个时间点，观察组的BCVA均较对照组提高，差异均有统计学意义(均为P<0.05)。在术后6个月时，观察组31眼有功能性滤过泡，对照组25眼有功能性滤过泡。两组患者术后6个月时中央前房深度均较术前加深,差异均有统计学意义(均为P<0.01)。两组患者术前、术后6个月时角膜内皮细胞密度相比，差异均无统计学意义(P术前=0.949，P术后=0.401)。术后6个月时观察组患者使用的抗青光眼药物种数少于对照组，差异有统计学意义(P<0.05)。无论按照传统标准或优化标准，观察组手术成功率均高于对照组（均为P<0.05）。观察组有1眼术后出现低眼压。对照组有2眼术中出现少许前房出血；术后有3眼出现低眼压、浅前房；有1眼术后出现脉络膜脱离。给予患者对症治疗后均恢复正常。结论　1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障是一种安全、有效的手术方式。
Abstract:
Objective　To evaluate the safety and efficacy of Ahmed implantation combined with 1.8 mm coaxial micro-incision phacoemulsification in refractory glaucoma patients with cataract.Methods　This was a prospective, randomized and parallel control study which included sixty-one patients (61 eyes) of refractory glaucoma with cataract in our hospital from April 2016 to March 2019. These patients were randomly divided into observation group (31 eyes) and control group (30 eyes). The observation group was treated with Ahmed glaucoma valve implantation combined with 1.8 mm coaxial micro-incision phacoemulsification and intraocular lens implantation, while the control group was treated with trabeculectomy combined with 1.8 mm coaxial micro-incision phacoemulsification and intraocular lens implantation. All patients were followed up for more than 6 months, and the intraocular pressure (IOP), best corrected visual acuity (BCVA), filtering bleb, central anterior chamber depth, corneal endothelium density, the number of antiglaucoma medications, success rate and postoperative complications were recorded and compared.Results　The postoperative IOP of the two groups at each time point was significantly lower than that before operation, with significant differences (all P<0.01), but the observation group had a lower IOP level than the control group postoperatively at 1 month, 3 months and 6 months, with significant differences (all P<0.05). The BCVA (log MAR) of the two groups of patients at each time point after operation was significantly improved compared with that before operation (all P<0.01), and the observation group was better than that of the control group at each time points after 1-week follow-up (all P<0.05). At 6 months after operation, functional filtering blebs were found in 31 eyes of the observation group and 25 eyes of the control group , the depth of the central anterior chamber in the two groups was significantly deeper than that before operation (P<0.01), and the number of antiglaucoma medications of the observation group was significantly lower than that of the control group (P<0.05). However, there was no significant difference in corneal endothelial cell density between the two groups before and 6 months after surgery (Ppreoperation=0.949, Ppostoperation=0.401). No matter the traditional standard or optimized standard, the surgical success rate of the observation group was higher than that of the control group at the end of follow-up (all P<0.05). One eye in the observation group had postoperative hypotony. In the control group, 2 eyes had a little hyphema, 3 eyes had hypotony and shallow anterior chamber,1 eye had choroidal detachment. All these patients returned to normal after symptomatic treatment.Conclusion　Combined 1.8 mm coaxial micro-incision phacoemulsification and Ahmed glaucoma drainage implant surgery seems to be a safe and effective surgical option.

参考文献/References:

［1］　RAMULU P Y,CORCORAN K J,CORCORAN S L,ROBIN A L.Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004［J］.Ophthalmology，2007，114（12）:2265-2270.
［2］　NASSIRI N,KAMALI G,RAHNAVARDI M,MOHAMMADI B,NASSIRI S,RAHMANI L,et al.Ahmed glaucoma valve and single-plate Molteno implants in treatment of refractory glaucoma: a comparative study［J］.Am J Ophthalmol,2010,149(6): 893-902.
［3］　SAHYOUN M A,FARHAT R G,NEHME J C B,JALKH A E,AZAR G G.Ahmed glaucoma valve in various etiologies of refractory glaucoma: Surgical outcomes and success factors［J］.J Fr Ophtalmol,2017,40(9):770-776.
［4］　JOSHI A B,PARRISH R K,FEUER W F.2002 survey of the American Glaucoma Society: practice preferences for glaucoma surgery and antifibrotic use［J］.J Glaucoma,2005,14(2): 172-174.
［5］　黄毅，钱志刚，史慧敏.AGV植入联合MMC及视网膜光凝治疗NVG［J］.国际眼科杂志,2012,12(12):2358-2360.
HUANG Y，QIAN Z G ，SHI H M.Effect of Ahmed glaucoma valve implantation with mitomycin C for treatment of neovascular glaucoma［J］.Int Eye Sci，2012,12(12):2358-2360.
［6］　CHAN P P，LI E Y,TSOI K K F,KWONG Y Y,THAM C C.Cost-effectiveness of phacoemulsification versus combined phacotrabeculectomy for treating primary angle closure glaucoma［J］.J Glaucoma,2017,26(10):911-922.
［7］　DONOSO R,RODRIGUEZ A.Combined versus sequential phacotrabeculectomy with intraoperative 5-fluorouracil［J］.J Cataract Refract Surg,2000,26(1):71-74.
［8］　SHINGLETON B J，WOOLER K B,BOURNE C I,O’DONOGHUE M W.Combined cataract and trabeculectomy surgery in eyes with pseudoexfoliation glaucoma［J］.J Cataract Refract Surg,2011,37(11):1961-1970.
［9］　PARIHAR J K S,KAUSHIK J,JAIN V K,TREHAN H S,MISHRA A,BARANWAL V K.Combined Ahmed valve and phacoemulsification with intraocular lens implantation under infliximab in refractory uveitic glaucoma［J］.Eur J Ophthalmol,2018,28(3):294-298.
［10］　HOFFMAN K B,FELDMAN R M,BUDENZ D L,GEDDE S J,CHACRA G A,SCHIFFMAN J C.Combined cataract extraction and Baerveldt glaucoma drainage implant: indication and outcomes［J］.Ophthalmology,2002,109(10):1916-1920.
［11］　CHUNG A N,AUNG T,WANG J C,CHEW P T K.Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract［J］.Am J Ophthalmol,2004,137(2):294-300.
［12］　CHRISTAKIS P G,TSAI J C,KALENAK J W,ZURAKOWSKI D,CANTOR L B,KAMMER J A,et al.The Ahmed versus Baerveldt study: three-year treatment outcomes［J］.Ophthalmology,2013,120(11):2232-2240.
［13］　姚克,王玮,吴炜,汤霞靖,李兆春,金冲飞.同轴1.8 mm 微切口超声乳化白内障手术临床效果评价［J］.中华眼科杂志，2011，47（10）：903-907.
YAO K,WANG W，WU W,TANG X J,LI Z C,JIN C F.Clinical evaluation on the coaxial 1.8 mm microincision cataract surgery［J］.Chin J Ophthalmol，2011，47(10): 903-907.
［14］　CHEN C， ZHU M J， SUN Y，QU X H,XU X.Bimanual microincision versus standard coaxial small-incision cataract surgery：Meta-analysis of randomized controlled trials［J］.Eur J Ophthalmol，2015，25（2）:119-127.
［15］　崔巍,刘志英,路强,马晓程.1.8 mm和3.0 mm透明角膜切口白内障超声乳化术后泪膜和眼表变化对比研究［J］.中国实用眼科杂志,2014,32(12):1424-1427.
CUI W,LIU Z Y,LU Q,MA X C.Clinical comparative study of changes in the tear film and ocular surface after 1.8 mm and 3.0 mm clear corneal incision phacoemulsification［J］.Chin J Pract Ophthalmol,2014,32(12):1424-1427.
［16］　BUDENZ D L,FEUER W J,BARTON K,SCHIFFMAN J,COSTA V P,GODFREY D G，et al.Postoperative complications in the Ahmed Baerveldt comparison study during five years of follow-up［J］.Am J Ophthalmol,2016,163(3):75-82.
［17］　CHOO J Q H,CHEN Z D,KOH V,LIANG S,AQUINO C M,SNG C，et al.Outcomes and complications of Ahmed tube implantation in Asian eyes［J］.J Glaucoma,2018，27(8):733-738.

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备注/Memo

备注/Memo:
N/A
更新日期/Last Update: 2020-11-05