EX-PRESS引流钉植入术与小梁切除术后早期对角膜内皮细胞的影响

Comparison of the effects between EX-PRESS glaucoma shunt and trabeculectomy on corneal endothelial cells

关键词:  EX-PRESS青光眼引流钉  小梁切除术  原发性开角型青光眼  角膜内皮细胞

Key words:  EX-PRESS shunt  trabeculectomy  primary open-angle glaucoma  corneal endothelium cells

摘要:

目的　观察EX-PRESS引流钉植入术及小梁切除术后早期对原发性开角型青光眼患者角膜内皮细胞（corneal endothelial cell density,CECD）的影响。方法　收集南通市第一人民医院眼科2015年2月至2016年9月收治的36例（72眼）原发性开角型青光眼患者。根据患者采用的不同手术方法分为EX-PRESS青光眼引流钉植入术组（16例20眼）和小梁切除术组（20例25眼）。所有患者于术前1天和术后1个月、3个月行角膜内皮镜检查，记录角膜内皮细胞的数量、密度、形态。结果　小梁切除术后1个月、3个月角膜内皮细胞数分别为(2115±249) 个/mm^{2和(2092±251)个/mm2，与术前的(2221±262)个/mm2比较，差异有统计学意义（P<0.05）。EX-PRESS引流钉植入术后1个月、3个月角膜内皮细胞数分别为(2329±250) 个/mm2和(2316±231)个/mm2，与术前的(2339±248)个/mm2比较，差异无统计学意义（P>0.05）。术后1个月、3个月角膜内皮细胞数在小梁切除术组与EX-PRESS组间比较，差异有统计学意义（P<0.05）。结论　EX-PRESS引流钉植入术后早期对角膜内皮细胞影响较小。}

Abstract:

Objective To observe and compare the early changes of corneal endothelial cells after Express glaucoma shunt and trabeculectomy in patients with primary open angle glaucoma (POAG). Methods The clinical data of 36 patients with POAG treated with EX-PRESS implantation (16 cases, 20 eyes) or trabeculectomy (20cases, 25 eyes) in our hospital during the same period were retrospectively analyzed. The density, number and morphology of the corneal endothelium cells density (CECD) were assessed by a noncontact specular microscope preoperatively and at 1 and 3month after surgery. Results Compared to a preoperative value of （2221±262 ）cells/mm^{2, the CECD was （2115±249） cells/mm2 at 1 month, and （2092±251） cells/mm2 at 3 month after trabeculectomy（P<0.05）. Compared to a preoperative value of （2339±248） cells/mm2 , the CECD was （2329±250） cells/mm2 at 1 month and （2316±231） cells/mm2 at 3 month after EX-PRESS implantation（P>0.05）. Conclusion EX-PRESS shunt seems to be a safer procedure regarding to the risk of early endothelial cell loss.}