目的：评价改良的青光眼引流阀植入术治疗水眼(玻璃体切除术后)难治性青光眼患者的效果及其安全性。

方法：手术术式改良：在角膜缘后5～7mm处以月形刀做宽约2mm、长约3mm的巩膜套袖，在距角膜缘3.5mm处以月形刀做长约1.5mm以角膜缘为基底的巩膜隧道，经该巩膜隧道以一次性矛形刀穿刺入后房，引流管修剪至合适长度后经巩膜套袖巩膜隧道穿入虹膜和人工晶状体之间的后房内，缩小瞳孔后可在瞳孔缘看见引流管口，引流管口斜面朝向瞳孔缘。将2016-03/2017-08入住我院行玻璃体切除和人工晶状体植入术后继发青光眼的患者26例26眼纳入本研究。所有患者均采用改良术式行青光眼引流阀植入术。术后随访时间：1、3d，1wk，1、6mo，此后每6mo随访1次。对手术前后眼压和术中术后并发症及其相关的处理方式进行分析。

结果：术前、术后第1d、末次随访平均眼压分别为42.5±8.1、12.1±11.2、14.3±5.9mmHg。术前与术后第1d眼压和末次随访眼压比较，差异均有统计学意义(P<0.001)。术后第1d与末次随访眼压比较，差异无统计学意义(P=0.89)。术后第1d眼压<6mmHg者有8眼，术后第1d眼压>6mmHg、术后第3d降到6mmHg以下者6眼，术后早期低眼压率54%。予玻璃体腔注气(空气)、注药(曲安奈德)或前房注入黏弹剂等处理后眼压逐渐恢复正常。随访期间无角膜内皮失代偿、引流管暴露、爆发性脉络膜出血、眼内炎等严重并发症。

结论：改良的青光眼引流阀植入术是治疗玻璃体切除术后难治性青光眼的一种安全、有效、并发症少的手术方式。前房注黏弹剂、玻璃体腔注气是治疗青光眼阀植入术后早期低眼压的简单、有效、可重复、操作简便的方法。

METHODS: The improved procedure: the surgeon used a crescent knife to make a scleral sleeve with a width of about 2mm and a length of about 3mm behind the limbus 5mm to 7mm; maked a length of about 1.5mm scleral tunnel at a distance of 3.5mm from the limbus; piercing the posterior chamber by a one-time spear knife through the scleral tunnel; the drainage tube was trimmed to the proper length, then placed between the iris and intraocular lens in the posterior chamber through the scleral sleeve and scleral tunnel. Reduce the pupil, we could see the drainage tube port in the pupil margin, drainage tube mouth beveled toward the pupil edge. All patients underwent modified surgical glaucoma drainage valve implantation. Patients incorporated into the study who had secondary glaucoma after vitrectomy and intraocular lens implantation admitted to our hospital from March 2016 to August 2017. Follow-up time: 1, 3d, 1wk, 1 and 6mo, followed up every 6mo. The intraocular pressure, intraoperative and postoperative complications and related treatment methods were analyzed before and after surgery. Intraocular pressure(IOP)at different time points before and after surgery was compared using repeated measures of variance analysis.

RESULTS: A total of 26 patients were enrolled in the study. The average IOP was 42.5±8.1 mmHg preoperatively, 12.1±11.2mmHg on the first day after surgery, 14.3±5.9mmHg in the last follow-up. There was a statistically significant difference between preoperative IOP and that on the first postoperative day(P<0.001). There was no significant difference in intraocular pressure between the first day after surgery and the last follow-up(P=0.89). There were 8 eyes with IOP less than 6mmHg on the first postoperative day. There were 6 eyes with IOP higher than 6mmHg on the first postoperative day, then dropped below 6mmHg on the third postoperative day. The rate of early postoperative low intraocular pressure was 54%. IOP returned to normal after intravitreal injection of air, injection of drug(triamcinolone acetonide), or injection of viscoelastic into the anterior chamber. During the follow-up no corneal endothelial decompensation, drainage tube exposure, explosive choroidal hemorrhage, endophthalmitis and other serious complications.

CONCLUSION: Improved glaucoma drainage valve implantation is a safe, effective and less-complicated surgical procedure for the treatment of refractory glaucoma. Anterior chamber injection of viscoelastic, vitreous cavity gas injection is a simple, effective, repeatable, and easy-to-use method for the treatment of early hypotony after glaucoma valve implantation.