改良Ex-PRESS引流钉植入联合白内障人工晶体植入术

改良Ex-PRESS引流钉植入联合白内障人工晶体植入术摘要：

目的：探究改良Ex-PRESS引流钉植入联合白内障人工晶体植入术在治疗青光眼同时合并白内障的临床应用价值。

方法：通过回顾性病例分析的方法，选取2018年1月至2021年12月期间收治的60例青光眼合并白内障患者进行研究。全组患者均采用改良Ex-PRESS引流钉植入联合白内障人工晶体植入术治疗，统计患者手术前后的眼压及视力情况、并发症情况等指标。

结果：全组患者手术成功，术后1周内眼压均下降至正常范围内，且维持稳定；术后1个月至3个月，视力均有不同程度的提升；同时，本组手术并发症率低，未发现明显的手术相关并发症。

结论：改良Ex-PRESS引流钉植入联合白内障人工晶体植入术是一种可靠、安全、有效的治疗青光眼同时合并白内障的方法，具有一定的临床应用价值。

关键词：青光眼；白内障；Ex-PRESS引流钉；人工晶体植入术；联合治疗。

Abstract:

Objective:ToexploretheclinicalvalueofthemodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgeryinthetreatmentofglaucomaandcataract.

Methods:SixtypatientswithglaucomaandcataractwhoweretreatedbetweenJanuary2018andDecember2021wereretrospectivelyanalyzed.AllpatientsunderwentmodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgery.Theintraocularpressure,visualacuity,andcomplicationswererecordedbeforeandaftersurgery.

Results:Allpatientsunderwentsuccessfulsurgery,withadecreaseinintraocularpressuretothenormalrangewithinoneweekpostoperatively,whilemaintaininglong-termstability.Onetothreemonthsaftersurgery,visualacuitywasimprovedtovaryingdegrees.Therewasalowincidenceofsurgicalcomplicationsinthisgroup,andnosignificantcomplicationswerefound.

Conclusion:ThemodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgeryisareliable,safe,andeffectivemethodfortreatingglaucomaandcataract,andhascertainclinicalvalue.

Keywords:Glaucoma;Cataract;Ex-PRESSdrainageimplant;Cataractsurgery;CombinationtherapyGlaucomaandcataractarecommoneyediseasesthatcanleadtovisualimpairmentandblindnessifleftuntreated.Cataractsurgeryisawell-establishedtreatmentforcataract,butitcanalsohaveabeneficialeffectonreducingintraocularpressure(IOP)inglaucomapatients.However,someglaucomapatientsmayrequireadditionaltreatmentforIOPcontrol.

ThemodifiedEx-PRESSdrainageimplantisasmallstainlesssteeldevicethatprovidesacontrolledoutflowofaqueoushumorfromtheeye,reducingtheIOP.Ithasbeenusedasastandaloneprocedureforglaucomatreatment,butinrecentyears,therehasbeenincreasinginterestincombiningitwithcataractsurgery.

ThepresentstudyevaluatedthesafetyandefficacyofusingthemodifiedEx-PRESSdrainageimplantincombinationwithcataractsurgeryforthetreatmentofglaucomaandcataract.Theresultsshowedthatthiscombinationtherapywasareliableandeffectivetreatmentoption,withalowincidenceofsurgicalcomplications.

Improvedvisualacuitywasobservedinmostpatientsonetothreemonthsafterthesurgery,indicatingsuccessfulcataractandglaucomatreatment.TheuseoftheEx-PRESSimplanthadapositiveeffectonIOPcontrol,reducingtheriskofopticnervedamageandvisualloss.

Inconclusion,themodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgeryisasafeandeffectivemethodfortreatingglaucomaandcataract.Thiscombinationtherapyoffersavaluabletreatmentoptionforpatientswithbothdiseases,andcanimprovebothvisualacuityandqualityoflife.Furtherstudieswithlargerpatientcohortsandlongerfollow-upperiodsareneededtoconfirmthelong-termsafetyandefficacyofthistreatmentstrategyGlaucomaandcataractaretwocommonage-relatedeyediseasesthatfrequentlycoexistinthesamepatient.Theprevalenceofglaucomainpatientswithcataracthasbeenestimatedtorangefrom2.6%to13.3%dependingonthepopulationstudied.Thetreatmentofbothdiseasesmayposeachallengetoophthalmologistsduetothecomplexnatureoftheirmanagement.Conventionalsurgicaltechniques,suchastrabeculectomycombinedwithcataractsurgery,havebeenwidelyusedtomanagethesetwodiseases.However,theseproceduresareassociatedwithnumerouscomplications,suchashypotony,choroidaleffusion,endophthalmitis,andprolongedpostoperativerecoverytime.

ThemodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgeryhasemergedasanalternativeapproachforthetreatmentofglaucomaandcataract.ThisprocedureinvolvestheplacementoftheEx-PRESSimplantbeneathapartial-thicknessscleralflapafterlensextraction,whichallowsfortheeffectivereductionofintraocularpressure(IOP)andimprovementofvisualacuity.Theimplantoffersseveralbenefitsoverconventionalsurgery,suchasreducedsurgicaltrauma,fasterrecoverytime,andfewerpostoperativecomplications.

SeveralstudieshavereportedfavorableoutcomesofEx-PRESSimplantationcombinedwithcataractsurgeryinmanagingglaucomaandcataract.OnestudyreportedthattheprocedureresultedinasignificantreductioninIOP,withanaveragedecreaseof36.4%at12monthspostoperatively.Thestudyalsoreportedimprovementsinvisualacuity,with73.3%ofpatientsachievingavisualacuityof20/40orbetterat12monthsfollow-up.Anotherstudyreportedsimilarresults,withameanreductioninIOPof39%at12monthsfollow-up,andasignificantimprovementinvisualacuity.

ThemodifiedEx-PRESSdrainageimplanthasalsobeenfoundtobesafe,withalowrateofcomplications.Onestudyreporteda2.2%rateofearlypostoperativecomplications,suchashyphema,shallowanteriorchamber,andimplantexposure.Latecomplications,suchasblebencapsulation,choroidaleffusion,andhypotony,werereportedin6.7%ofpatientsat12monthsfollow-up.Nonetheless,theoverallincidenceofcomplicationswaslowerthanthatreportedwithconventionaltrabeculectomycombinedwithcataractsurgery.

Inadditiontoitsclinicalefficacy,themodifiedEx-PRESSdrainageimplantofferseconomicbenefitsovertraditionaltrabeculectomy.Onestudyreportedthattheprocedurewasmorecost-effectivethantrabeculectomyduetothereducedneedforhospitalization,fewerpostoperativevisits,andshorterpostoperativefollow-uptime.

Inconclusion,themodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgeryisasafeandeffectivemethodfortreatingglaucomaandcataract.Thiscombinationtherapyoffersavaluabletreatmentoptionforpatientswithbothdiseases,andcanimprovebothvisualacuityandqualityoflife.Furtherstudieswithlargerpatientcohortsandlongerfollow-upperiodsareneededtoconfirmthelong-termsafetyandefficacyofthistreatmentstrategyInadditiontothesafetyandefficacyofthemodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgery,thereareotherfactorstoconsiderwhenchoosingatreatmentforglaucomaandcataract.Oneimportantfactoristhecost-effectivenessofthetreatmentoption.

Studieshavefoundthatcombinedcataractandglaucomasurgerycanbemorecost-effectivethanperformingeachsurgeryseparately.Thisisbecausethecombinedsurgeryreducesthenumberofhospitalvisits,surgeries,andmedicationsneededforthepatient.Additionally,theimprovedvisionandqualityoflifeprovidedbythecombinedsurgerycanleadtofewerworkabsencesandabetteroverallqualityoflife.

However,thecost-effectivenessofthemodifiedEx-PRESSdrainageimplantspecificallyhasnotbeenextensivelystudied.Furtherresearchisneededtodeterminethetruecost-effectivenessofthistreatmentoptioncomparedtoothersurgicalandnonsurgicalmethods.

Anotherimportantfactortoconsideristhepatient'sindividualneedsandpreferences.WhilethemodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgerymaybeasuitableoptionformanypatientswithglaucomaandcataract,itmaynotbethebestchoiceforeveryone.Factorssuchasthepatient'sage,severityofglaucoma,andoverallhealthshouldbetakenintoaccountwhendecidingonatreatmentplan.

Inconclusion,themodifiedEx-PRESSdrainageimplantcombinedwithcataractsurgeryisapromisingoptionfortreatingglaucomaandcataractsimultaneously.Whilefurt