AlM:To explore the clinical efficacy of Ex - PRESS drainage device implantation for refractory glaucoma and related complications. METHODS:Fifty-three cases (56 eyes) were randomly selected in our hospital from February 2013 to August 2014 who received Ex - press glaucoma drainage device implantation for refractory glaucoma, 39 males (41 eyes) and 14 females (15 eyes), 52. 63±10. 58 years old;25 cases (26 eyes) with neovascular glaucoma, 16 patients (18 eyes) with failure of glaucoma filtration surgery, 6 cases (6 eyes) with secondary glaucoma after vitrectomy, and 6 cases ( 6 eyes ) with glaucoma secondary to complicated ocular trauma. Postoperative visual acuity, intraocular pressure ( lOP ) , anterior chamber depth, corneal endothelial cell density and complications, etc. at 1 and 12mo were analyzed and compared with the preoperative. RESULTS: At 12mo after operation, the complete success rate was 62% (35 eyes), the partial success rate was 14% (8 eyes), and the total success rate was 77%. The effective rate was 85% in patients with neovascular glaucoma, 56% in patients with failure of glaucoma filtration surgery, 100% in patients with glaucoma secondary to complicated ocular trauma, 83% in patients with secondary glaucoma after vitrectomy. At 1mo after surgery, visual acuity improved in 28 eyes ( 50%) , unchanged in 18 eyes ( 32%) , decreased in 10 eyes (18%). At 12mo after surgery, visual acuity improved in 19 eyes ( 34%) , unchanged in 18 eyes ( 32%) , decreased in 19 eyes ( 34%). Preoperative lOP was 29. 58 ± 8. 66 mmHg, that at 1mo after surgery was 12. 75 ± 5. 66mmHg, and the difference was significant (P<0. 05). There were 56 eyes with decreased lOP (100%). lOP at 12mo after surgery was 9.8-28. 4(mean 15. 42±4. 09)mmHg, which was lower than that before surgery (P<0. 05). lOP were increased in 2 eyes, unchanged in 0, decreased in 54 eyes (96%) at 12mo. The corneal endothelial cells was 1958. 22± 168. 30 and 1793. 99 ± 201. 55/mm2 , respectively, both decreased compared to that before surgery ( 2113. 47 ± 80. 56/mm2, P < 0. 01 ). The total occurrence of postoperative complications was 29%, of which the early postoperative shallow anterior chamber with ocular hypotension was in 4 eyes, transient high lOP in 3 eyes, drainage tube obstruction in 5 eyes, and hyphema in 3 eyes. Late complication of cystic bubble with local doming was found in 1 eye. CONCLUSlON: Ex- press glaucoma drainage device implantation for refractory glaucoma, although has some complications, still achieve better clinical efficacy, and is an effective method for refractory glaucoma.%目的：探讨Ex-press青光眼引流器植入术治疗难治性青光眼的临床疗效及并发症。 方法：随机选取本院2013-02/2014-08收治行 Ex-press青光眼引流器植入术治疗的难治性青光眼53例56眼,男39例41眼,女14例15眼,平均年龄52.63±10.58岁；新生血管性青光眼25例26眼,滤过手术失败后青光眼16例18眼,玻璃体切除术后继发青光眼6例6眼以及复杂眼外伤后青光眼6例6眼。观察术后1、12 lo视力、眼压、前房深度、角膜内皮细胞密度及并发症等情况,并与术前进行分析比较。 结果：术后12lo,完全成功率为62%(35眼),部分成功率为14%(8眼),总成功率为77%。其中新生血管性青光眼有效率为85%,滤过手术失败后青光眼有效率为56%,复杂眼外伤后青光眼100%,玻璃体切除术后青光眼83%。术后1 lo视力较术前提高者28眼(50%),视力不变18眼(32%),视力降低10眼(18%)。术后12lo视力较术前提高者19眼(34%),视力不变18眼(32%),视力降低19眼(34%)。术前平均眼压29.58±8.66llHg,术后1lo平均眼压12.75±5.66llHg,与术前比较差异有统计学意义(P<0.05),其中56例患眼眼压均表现为降低(100%)。术后12lo 眼压为9.8~28.4(平均15.42±4.09)llHg,与术前比较差异有统计学意义(P<0.05),其中眼压较术前增高者2眼,眼压不变0眼,眼压降低54眼(96%)。术后1、12lo 内皮细胞计数分别为1958.22±168.30、1793.99±201.55个/ll2,与术前的2113.47±80.56个/ll2比较,差异有统计学意义(P<0.01)。术后总并发症发生率为29%,其中术后早期发生浅前房低眼压4眼,暂时性高眼压3眼,引流管阻塞5眼,前房出血3眼。后期并发症有局部隆起的包裹的囊状泡1眼。 结论：Ex-press青光眼引流器植入术治疗难治性青光眼,虽然存在一定的术后并发症,但仍可取得较好的临床疗效,是目前治疗难治性青光眼的有效方法。
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