e-PTFE膜植入手术治疗难治性青光眼的临床经验
Clinical experience of e-PTFE membrane implant surgery for refractory glaucoma.
作者信息
Kim C, Kim Y, Choi S, Lee S, Ahn B
机构信息
Department of Ophthalmology, College of Medicine, Chungnam National University, Taejon, South Korea.
出版信息
Br J Ophthalmol. 2003 Jan;87(1):63-70. doi: 10.1136/bjo.87.1.63.
AIMS
To evaluate the clinical efficacy of membrane tube implant made of expanded polytetrafluoroethylene (e-PTFE, Gore-Tex) membrane and silicone tube in treating refractory glaucoma.
METHODS
A retrospective chart review was performed on 43 eyes of 40 patients who underwent glaucoma tube shunt implant surgery using double layered e-PTFE membrane and silicone tube to treat refractory glaucoma. The surgeries were performed from May 1991 to September 1995, and the subjects were patients with terminal glaucoma without useful vision on the study eye.
RESULTS
The mean follow up period was 32.9 months. The Kaplan-Meier survival for intraocular pressure (IOP) control (IOP between 6 and 21mm Hg without significant complication) was 80.9% at 1 year, 73.9% at 2 years, and 62.2% at 3 years after surgery. After excluding three eyes of three patients who were dropped within 3 months after surgery and did not have any serious complication or problem in IOP control, the average preoperative IOP was 42.5 (SD 14.6) mm Hg and IOP on the last visit was 17.3 (10.2) mm Hg (p = 0.000, n = 40). The number of antiglaucoma medications before surgery (2.2 (0.6)) was reduced to 0.5 (0.8) on the last visit (p = 0.000). The IOP was controlled within the range of 6-21 mm Hg in 26 eyes (65.0%). In the remaining 14 eyes (35%), we could not control the IOP or additional surgery was needed to control the IOP or to treat severe complications. Two cases of endophthalmitis and three of phthisis were found as serious complications. The other complications were similar to those of other commercially available glaucoma implants.
CONCLUSION
A comparable clinical result was obtained with this new implant as with the other commercially available implants. This implant with a thin and non-rigid reservoir has a potential to reduce some complications associated with the large volume and rigid consistency of the other implants, although it is not yet proved. This membrane tube implant may be considered as another substitute in the surgery of refractory glaucoma.
目的
评估由膨体聚四氟乙烯（e-PTFE，戈尔特斯）膜和硅胶管制成的膜管植入物治疗难治性青光眼的临床疗效。
方法
对40例患者的43只眼睛进行回顾性病历审查，这些患者接受了使用双层e-PTFE膜和硅胶管的青光眼引流管植入手术以治疗难治性青光眼。手术于1991年5月至1995年9月进行，研究对象为患眼视力无用的晚期青光眼患者。
结果
平均随访期为32.9个月。眼压（IOP）控制（IOP在6至21mmHg之间且无明显并发症）的Kaplan-Meier生存率在术后1年为80.9%，2年为73.9%，3年为62.2%。排除术后3个月内失访且在眼压控制方面无任何严重并发症或问题的3例患者的3只眼睛后，术前平均眼压为42.5（标准差14.6）mmHg，最后一次随访时眼压为17.3（10.2）mmHg（p = 0.000，n = 40）。术前抗青光眼药物数量（2.2（0.6））在最后一次随访时降至0.5（0.8）（p = 0.000）。26只眼睛（65.0%）的眼压控制在6至21mmHg范围内。在其余14只眼睛（35%）中，我们无法控制眼压或需要额外手术来控制眼压或治疗严重并发症。发现2例眼内炎和3例眼球痨为严重并发症。其他并发症与其他市售青光眼植入物的并发症相似。
结论
这种新型植入物与其他市售植入物获得了可比的临床结果。这种具有薄且非刚性储液器的植入物有可能减少与其他植入物的大体积和刚性稠度相关的一些并发症，尽管尚未得到证实。这种膜管植入物可被视为难治性青光眼手术中的另一种替代物。
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