CAJ | 학술논문

目的探讨以异体和自体巩膜及生物硬脑膜材料作为引流管覆盖物在房水引流阀植入术中治疗难治性青光眼的疗效及其并发症.方法回顾性系列病例研究.对2009年1月至2011年6月,行FP-7 Ahmed阀植入术的35例(35只眼)难治性青光眼患者的临床资料进行回顾性分析.术后各组间各个随访时间点的平均眼压比较采用方差分析；采用Kaplan-Meier生存曲线,分析3种不同引流管覆盖物(自体巩膜、异体巩膜、生物硬脑膜补片)的手术成功率；采用log-rank法分析手术成功率差异；建立Cox比例风险模型,预测手术失败的危险因素.结果生物硬脑膜补片(MⅡ型)组有6只眼发生结膜后退,致覆盖物暴露；异体和自体巩膜组分别有1只眼和2只眼发生晚期引流盘周纤维组织包裹,致眼压升高；异体巩膜组有1只眼发生引流管暴露.Kaplan-Meier生存曲线分析,显示随访至第12个月时,35例(35只眼)患者中,有25例(25只眼)手术成功,手术总成功率达71.4％；其中异体巩膜组、生物硬脑膜补片组及自体巩膜组手术成功率分别为8/10、3/9及14/16,组间手术成功率差异有统计学意义(P=0.009).房水引流阀植入术失败的相关危险因素分析,显示生物硬脑膜补片覆盖物是手术失败的危险因素(HR=10.844,P=0.015).3个组患者术后各随访时间点的平均眼压均较术前明显降低,但组间各检测时间点的平均眼压差异均无统计学意义(F=0.028～1.218,P＞O.05).结论房水引流阀植入联合自体或异体巩膜覆盖治疗难治性青光眼的疗效相当,手术成功率高.生物硬脑膜补片与结膜组织相容性差,最终导致并发症,致手术成功率低,不适合用于房水引流阀植入术中.
목적 탐토이이체화자체공막급생물경뇌막재료작위인류관복개물재방수인류벌식입술중치료난치성청광안적료효급기병발증.방법 회고성계렬병례연구.대2009년1월지2011년6월,행FP-7 Ahmed벌식입술적35례(35지안)난치성청광안환자적림상자료진행회고성분석.술후각조간각개수방시간점적평균안압비교채용방차분석；채용Kaplan-Meier생존곡선,분석3충불동인류관복개물(자체공막、이체공막、생물경뇌막보편)적수술성공솔；채용log-rank법분석수술성공솔차이；건립Cox비례풍험모형,예측수술실패적위험인소.결과 생물경뇌막보편(MⅡ형)조유6지안발생결막후퇴,치복개물폭로；이체화자체공막조분별유1지안화2지안발생만기인류반주섬유조직포과,치안압승고；이체공막조유1지안발생인류관폭로.Kaplan-Meier생존곡선분석,현시수방지제12개월시,35례(35지안)환자중,유25례(25지안)수술성공,수술총성공솔체71.4％；기중이체공막조、생물경뇌막보편조급자체공막조수술성공솔분별위8/10、3/9급14/16,조간수술성공솔차이유통계학의의(P=0.009).방수인류벌식입술실패적상관위험인소분석,현시생물경뇌막보편복개물시수술실패적위험인소(HR=10.844,P=0.015).3개조환자술후각수방시간점적평균안압균교술전명현강저,단조간각검측시간점적평균안압차이균무통계학의의(F=0.028～1.218,P＞O.05).결론 방수인류벌식입연합자체혹이체공막복개치료난치성청광안적료효상당,수술성공솔고.생물경뇌막보편여결막조직상용성차,최종도치병발증,치수술성공솔저,불괄합용우방수인류벌식입술중.
Objective To evaluate the efficacy and complication of glaucoma drainage implant surgery with scleral graft,scleral flap and artificial biological dural graft as the tube coverage.Methods Thirty-five cases (35 eyes) with refractory glaucoma who underwent FP-7 Ahmed glaucoma drainage implantation from January 2009 to June 2011 were retrospectively studied.Kaplan-Meier survival curve was applied to analyze the probability of success rate of three different tube coverage,the log-rank test used to compare the difference between tubes,and Cox proportional hazards regression analysis performed to predict the risk factors for failure.Results Conjunctival shrink back leading to exposure of tube coverage occurred in 6 eyes in artificial biological dural graft group.Intraocular pressure (IOP) elevation by encapsulated cystic blebs around the plate was seen in scleral flap group (2 eyes) and scleral graft group (1 eyes),respectively.The drainage tube exposure occurred in 1 eye in scleral graft group.Kaplan-Meier survival curve analysis showed that the success rate was 8/10,3/9 and 14/16 in scleral graft group,artificial biological dural graft group and scleral flap group,respectively,at 12 month and 15 month.There was a significant difference among three groups (P =0.009).The proportional hazards regression showed that artificial biological dural graft was statistically significant risk factors for failure (HR =10.844,P =0.015).Compared with pre-operation,the post-operative mean IOP was significantly decreased in all three groups.Postoperative IOP was not significantly different among three groups in different follow-up time point (F =0.028-1.218,P ＞ 0.05).Conclusions Both of scleral flap group and scleral graft group are comparable in the efficacy and complication of glaucoma drainage implant surgery and have a high success rate.However,artificial biological dural graft has poor compatibility with conjunctiva resulting in severe complications,which is not recommended to be used in glaucoma drainage implant surgery.