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[摘要]
目的:探讨Ahmed青光眼阀植入术治疗新生血管性青光眼(neovascular glaucoma,NVG)术中联合前房内注入透明质酸钠对手术疗效及术后并发症发生率的影响。
方法:回顾性病例对照研究。选择我院2009/2011年因新生血管性青光眼住院手术的患者49例49眼,按病历号奇偶随机分为两组。对照组行单纯Ahmed青光眼阀植入术,术中前房内不予注入透明质酸钠,研究组术中在将Ahmed青光眼阀硅胶管置入前房前往前房内注入透明质酸钠0.2~0.3mL,术后定期随访1mo,比较两组间术后眼压、最佳矫正视力变化及术后浅前房、前房出血、脉络膜脱离等并发症发生情况。组间手术前后眼压对比采用独立样本秩和检验(非正态分布),组间并发症比较采用χ2检验。
结果:新生血管性青光眼术后随访1mo,研究组27眼眼压由42.8±5.56mmHg降至17.7±3.77mmHg,对照组22眼由42.5±5.36mmHg降至18.6±5.39mmHg; 术后并发症:研究组术后浅前房2例,术后出血1例; 对照组术后浅前房4例,术后出血5例,研究组前房硅胶管位置欠佳1例。
结论:Ahmed青光眼阀植入术治疗新生血管性青光眼术中联合前房内注入透明质酸钠,可有效减少术后前房出血的发生,术后短期内会导致患者眼压升高,而对患者远期眼压无明显影响。
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[Abstract]
AIM: To investigate the effect and complication of sodium hyaluronate combined with Ahmed glaucoma valve implantation on neovascular glaucoma(NVG).
METHODS: This was a retrospective observational case series. Forty-nine patients(49 eyes)with NVG in our hospital from 2009 to 2011 were randomly divided into two groups according to the odd-even of medical record number. Ahmed glaucoma valve implantation proceeded separately in control group, while in control group combined with 0.2-0.3mL sodium hyaluronate, regularly follow-up after operation at 1mo, comparing the complications such as postoperative intraocular pressure(IOP), the changes of best corrected visual acuity(BCVA), the hemorrhage of shallow anterior chamber, hyphema and choroidal detachment, etc. IOP before and after operation between the two groups was examined by independent sample test(non-normal distribution), the complications were compared by χ2 text.
RESULTS: Postoperative follow-up time was 1mo. IOP in research group was declined from 42.8±5.56mmHg preoperatively to 17.7±3.77mmHg, IOP in control group was declined from 42.5±5.36mmHg preoperatively to 18.6±5.39mmHg. Postoperative complications: shallow anterior chamber occurred in 2 patients(2 eyes)in research group and 4 patients(4 eyes)in control group. Hyphema occurred in 1 patient(1 eye)in research group and in 5 patients(5 eyes)in control group. Poor location of the anterior chamber silicone tube occurred in 1 patient in research group.
CONCLUSION:Sodium hyaluronate combined with Ahmed glaucom avalve can effectively reduce IOP in patients with NVG and decrease the postoperative hyphema, which will lead to short-term increasing IOP in patients after operation, but had no significant effect in the long run.
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