CAJ | 학술논문

背景新生血管性青光眼是难治性青光眼之一,病因复杂,病情多变,疗效较差.羊膜联合减压阀植入术是目前治疗新生血管性青光眼的主要手术方法,其疗效一直受到眼科医师的关注.目的探讨羊膜联合减压阀植入术治疗新生血管性青光眼的中远期疗效.方法回顾性系列病例对照研究.收集分别施行羊膜联合减压阀植入术和单纯减压阀植入术患者的病例资料进行比较分析,2组纳入患者的年龄、性别和病因基本匹配,其中羊膜联合减压阀植入术组44例44眼,单纯减压阀植入术组43例43眼.患者随访24个月.手术成功的判断标准为术后眼压控制在21 mmHg以内.结果随访期内,2组术后眼压均控制在21 mmHg以内,术后1周2组患者的眼压差异无统计学意义(t=-5.34,P=0.60),术后3、12、24个月2组眼压比较,差异均有统计学意义(t=6.64、t=5.00、t=7.81,P<0.01).羊膜联合减压阀植入术组术后1周时的手术成功率为97.73%.术后3个月为93.18%,术后12个月为90.24%,术后24个月为82.05%.单纯减压阀植入术组术后1周手术成功率为95.35%,术后3个月为71.43%,术后12个月为65.00%,术后24个月为60.53%.术后3、12、24个月2组间手术成功率的差异均有统计学意义(χ2=7.06、χ2=7.47、χ2=4.37,P<0.05).2组间术后前房出血、低眼压、引流管内口阻塞、脉络膜脱离、引流阀脱出的并发症发生率比较差异均无统计学意义(χ2=0.12、χ2=0.44、χ2=0.18、χ2=0.37、χ2=0.00,P>0.05).结论羊膜联合减压阀植入术能较安全、有效地治疗新生血管性青光眼,特别是在中远期疗效上优于单纯减压阀植入术.
배경 신생혈관성청광안시난치성청광안지일,병인복잡,병정다변,료효교차.양막연합감압벌식입술시목전치료신생혈관성청광안적주요수술방법,기료효일직수도안과의사적관주.목적 탐토양막연합감압벌식입술치료신생혈관성청광안적중원기료효.방법 회고성계렬병례대조연구.수집분별시행양막연합감압벌식입술화단순감압벌식입술환자적병례자료진행비교분석,2조납입환자적년령、성별화병인기본필배,기중양막연합감압벌식입술조44례44안,단순감압벌식입술조43례43안.환자수방24개월.수술성공적판단표준위술후안압공제재21 mmHg이내.결과 수방기내,2조술후안압균공제재21 mmHg이내,술후1주2조환자적안압차이무통계학의의(t=-5.34,P=0.60),술후3、12、24개월2조안압비교,차이균유통계학의의(t=6.64、t=5.00、t=7.81,P<0.01).양막연합감압벌식입술조술후1주시적수술성공솔위97.73%.술후3개월위93.18%,술후12개월위90.24%,술후24개월위82.05%.단순감압벌식입술조술후1주수술성공솔위95.35%,술후3개월위71.43%,술후12개월위65.00%,술후24개월위60.53%.술후3、12、24개월2조간수술성공솔적차이균유통계학의의(χ2=7.06、χ2=7.47、χ2=4.37,P<0.05).2조간술후전방출혈、저안압、인류관내구조새、맥락막탈리、인류벌탈출적병발증발생솔비교차이균무통계학의의(χ2=0.12、χ2=0.44、χ2=0.18、χ2=0.37、χ2=0.00,P>0.05).결론양막연합감압벌식입술능교안전、유효지치료신생혈관성청광안,특별시재중원기료효상우우단순감압벌식입술.
Background Neovascular glaucoma is a type of refractory glaucoma.Biological amnion combined with glaucoma valve implantation is a primary therapy and its long-term effectiveness is noticeable. Objective The goal of this Survey was to evaluate the effectiveness of biological amnion combined with glaucoma valve implantation for neovascular glaucoma and compare the clinical outcome with simple glaucoma valve implantation. Methods This was a retrospective observational case series.The clinical data of 44 eyes of 44 patients received biological amnion combined with glaucoma valve implantation for neovascular glaucoma and 43 eyes of 43 patients received simple glaucoma valve implantation for neovascular glaucoma were retrospectively analyzed and compared.The age,sex and disease-cause were matched between these two groups.Patients were followed-up for 24 months after operation.Surgery success was identified as the intraocular pressure(IOP)<21 mmHg after operation.Written informed consent was obtained from each patient prior to the operation.Results The IOP was<21 mmHg throughout the follow-up duration in both groups.No significant difierence was found in the IOP value in 1 week after operation between two groups(t=-5.34,P=0.60).However,IOP values were lower in biological amnion combined with glaucoma valve implantation group in 3,12 and 24 months after operation than those of simple glaucoma valve implantation(t=6.64,t=5.00,t=7.81,P<0.01).Operation successful rates in biological amnion combined with glaucoma valve implantation group were 97.73％.93.18％。90.24％and 82.05％in 1 week,3 months,12 months and 24 months respectively after operation.and those in simple glaucoma valve implantation were 95.35％,71.43％,65.00％and 60.53％in corresponding time points,showing considerably significant differences between two groups (χ2=7.06,χ2=7.47,χ2=4.37,P<0.05).There was no significant difference in Ihe number of eyes with complication between the two groups(P>0.05). Conclusion The biological amnion combined with glaucoma valve implantation surgery may be more effective and safe for the treatment of neovascular glaucoma than with glaucoma va]ve only.