| Objective:To investigate the safety and clinical efficacy of a modified Ex-Press miniature implant surgery in the treatment of primary open-angle glaucoma and refractory glaucoma.To compare the effect of lowering intraocular pressure and the occurrence of complications between two different types of glaucoma.Method:A prospective clinical study..The subjects were 36 patients(45 eyes),who were diagnosed as primary open-angle glaucoma(POAG)or refractory glaucoma(RG)in the first affiliated hospital of Fujian Medical University from January2020 to December 2020,were treated with modified Ex-Press miniature implantation.According to the type of glaucoma,the patients were divided into POAG group(17cases,24 eyes)and RG group(19 cases,21 eyes).RG group includes glaucoma after failed filtering surgery,glaucoma after intraocular lens implantation,neovascular glaucoma,pigmentary glaucoma,uveitic glaucoma,and iridocorneal endothelial syndrome.The intraocular pressure(IOP),best corrected visual acuity(BCVA),use of anti-glaucoma drugs,depth of anterior chamber,filtering bleb,success rate of operation and postoperative complications were recorded and analyzed before operation,1 day,1 week,1 month,2 months and 3 months after operation.Results:The preoperative IOP and age of the two groups were comparable.The IOP of the two groups at each follow-up time was significantly lower than that of the preoperative IOP(P<0.001),and IOP of both groups tended to stabilize about 1month after operation.Three months after operation,the average IOP in POAG group decreased from(30.30±6.29)mmHg to(14.13±3.08)mmHg in mmHg;RG group from(31.90±6.43)mmHg to(16.05±4.63)mmHg.Compared with the postoperative IOP,it was found that there was no significant difference in IOP between the two groups at 1 month,2 months and 3 months after operation(P>0.05).Three months after operation,the number of anti-glaucoma drugs used in both groups decreased significantly(P<0.001).The BCVA of patients in POAG group and RG group did not decrease at each time point after operation compared with that before operation(P>0.05).Three months after operation,functional filtering blebs accounted for 95.83% in the POAG group and 85.71% in the RG group.There was no significant difference between the two groups(P>0.05).Postoperative complications: in POAG group,3 eyes had transient low-tension shallow anterior chamber and 2 eyes had encapsulated filtering bleb.In RG group,transient low-tension shallow anterior chamber occurred in 3 eyes,encapsulated filtering bleb in 3 eyes,and hypotony maculopathy in 1 eye.During the follow-up period,no other serious complications occurred in all patients.At the end of the follow-up period,22 eyes(91.67%)in the POAG group met the criteria of complete success of the operation,and 2 eyes(8.33%)were partially successful.The overall success rate of the operation reached 100%.Three months after operation,in the RG group,the operation was completely successful in 16 eyes(76.19%)and partially successful in 2 eyes(9.52%).The total success rate was 85.71%.Conclusion:The modified Ex-Press miniature implantation is a simple,minimally invasive,safe and effective surgical method,which has a curative effect in the treatment of POAG and RG. |
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