Yu Teng-Chieh, Tseng Gow-Lieng, Chen Chun-Chen, Liou Shiow-Wen
Department of Ophthalmology, Taipei City Hospital, Renai Branch Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University Institute of Clinical Medicine, National Yang-Ming University Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2017 Sep;96(35):e7845. doi: 10.1097/MD.0000000000007845.
Neovascular glaucoma (NVG) is one of the most aggressive types of glaucoma, and its abnormal fibrovascular tissue growth on the iris and trabecular meshwork may create difficulties to control the intraocular pressure (IOP) and perform the operation such as trabeculectomy.
Ex-PRESS glaucoma shunt has been introduced to serve as one alternative operation for glaucoma, and is thought to have the potential advantage of being less traumatic than traditional trabeculectomy. The purpose of our study is to evaluate the efficacy and safety of primary Ex-PRESS implantation in eyes with NVG.
This was a retrospective study of four patients with NVG in whom primary Ex-PRESS implantation was performed between January 2012 and October 2016.
After a mean follow-up of 20.8 ± 8.9 months (range, 15-34 months), three of four NVG patients (75.0%) receiving primary Ex-PRESS implantation had postoperative IOP under 21 mmHg without any antiglaucoma medication control at the last follow-up, but shunt reposition had been performed due to failed blebs or recurrent NVG. Besides, the best corrected visual acuity at the last follow-up was stabilized or improved in three of four NVG patients (75.0%), accompanied with the regression of iris neovascularization. Only one patient had self-resolved postoperative hyphema; otherwise, there were no other perioperative complications.
Primary Ex-PRESS implantation might constitute a safe and alternative treatment for patients with NVG. In spite of the possible reoperations, the final outcomes were still shown effective after shunt reposition.
新生血管性青光眼（NVG）是最具侵袭性的青光眼类型之一，其虹膜和小梁网异常的纤维血管组织生长可能给控制眼压（IOP）以及进行小梁切除术等手术带来困难。
Ex-PRESS青光眼引流器已被引入作为青光眼的一种替代手术，并且被认为具有比传统小梁切除术创伤更小的潜在优势。我们研究的目的是评估原发性Ex-PRESS植入术治疗NVG患眼的疗效和安全性。
这是一项对4例NVG患者的回顾性研究，这些患者于2012年1月至2016年10月期间接受了原发性Ex-PRESS植入术。
平均随访20.8±8.9个月（范围15 - 34个月）后，4例接受原发性Ex-PRESS植入术的NVG患者中有3例（75.0%）在最后一次随访时眼压在21 mmHg以下，无需任何抗青光眼药物控制，但因滤过泡失败或NVG复发而进行了引流器复位。此外，4例NVG患者中有3例（75.0%）在最后一次随访时最佳矫正视力稳定或提高，同时虹膜新生血管消退。仅1例患者术后前房积血自行吸收；除此之外，无其他围手术期并发症。
原发性Ex-PRESS植入术可能是NVG患者一种安全的替代治疗方法。尽管可能需要再次手术，但引流器复位后的最终结果仍显示有效。
