Frączkiewicz-Skok Marietta, Konopińska Joanna, Mariak Zofia, Rękas Marek
Department of Ophthalmology, Military Institute of Medicine, Szaserów 128 STR, 04-141 Warsaw, Poland.
Department of Ophthalmology, Medical University of Białystok, M. Sklodowska-Curie 24A STR, 15-276 Białystok, Poland.
J Ophthalmol. 2019 Nov 28;2019:7424376. doi: 10.1155/2019/7424376. eCollection 2019.
To compare the effectiveness and safety profile of ExPress implantation versus partial deep sclerectomy combined with ExPress implantation and simultaneous phacoemulsification.
A prospective, randomized control study with 24-month follow-up was performed. 114 eyes were included, of which 42 eyes underwent phacoemulsification with simultaneous implantation of the Ex-Press device (ExPress), and deep sclerectomy with phacoemulsification and simultaneous implantation of the Ex-Press device (DS-ExPress) was performed in 72 eyes. The main outcome measures were intraocular pressure (IOP), corrected distance visual acuity (CDVA), the number of antiglaucoma medications, and the rate of complications. Surgical success was defined as complete (without antiglaucoma medications) with IOP ≤18 mmHg in criterion A, IOP ≤16 mmHg in criterion B, and IOP ≤12 mmHg in criterion C. Satisfactory success was defined as the same IOP levels for individual criteria with a maximum of 2 antiglaucoma medications.
Before the procedure, mean IOP in the ExPress group was 17.5 ± 4.7 mmHg; after 24 months, it decreased by 13% to 16.0 ± 3.0 mmHg ( < 0.05). In the DS-ExPress group, mean IOP reduced from 16.3 ± 4.4 mmHg to 14.3 ± 3.3 mmHg ( < 0.05), which was a 9% reduction compared to the initial value. In the DS-ExPress group, 65.9% of the patients did not use topical pharmacotherapy, and the same is true for 29.2% of the ExPress group (=0.004).
This modification is efficient in surgical treatment of glaucoma, especially when very low postoperative IOP is needed. A less amount of antiglaucoma medicines are needed.
比较ExPress植入术与部分深层巩膜切除术联合ExPress植入术及同期超声乳化术的有效性和安全性。
进行了一项为期24个月随访的前瞻性随机对照研究。纳入114只眼，其中42只眼接受了超声乳化术并同期植入Ex-Press装置（ExPress组），72只眼接受了深层巩膜切除术联合超声乳化术并同期植入Ex-Press装置（DS-ExPress组）。主要观察指标为眼压（IOP）、矫正远视力（CDVA）、抗青光眼药物使用数量及并发症发生率。手术成功定义为：标准A中IOP≤18 mmHg且无需使用抗青光眼药物；标准B中IOP≤16 mmHg；标准C中IOP≤12 mmHg。满意成功定义为各标准下IOP水平相同且最多使用2种抗青光眼药物。
术前，ExPress组平均IOP为17.5±4.7 mmHg；24个月后，降至16.0±3.0 mmHg，下降了13%（P<0.05）。DS-ExPress组平均IOP从16.3±4.4 mmHg降至14.3±3.3 mmHg（P<0.05），较初始值下降了9%。DS-ExPress组中，65.9%的患者未使用局部药物治疗，ExPress组为29.2%（P=0.004）。
这种改良方法在青光眼手术治疗中有效，尤其是需要极低术后眼压时。所需抗青光眼药物数量较少。
