Ahmed青光眼阀植入术的中远期疗效评价

Intermediate-term and long-term clinical evaluation of the Ahmed glaucoma valve implantation

目的评价Ahmed青光眼阀(AGV)植入术治疗难治性青光眼的中远期临床疗效。方法回顾性分析206例(221只眼)难治性青光眼患者应用AGV及其联合手术治疗的临床效果及其手术并发症。根据AGV植入术手术成功判断标准,采用寿命表法统计不同时间点的累积成功率,以Cox比例风险模型分析各种预测变量对不同时间点失败的影响。结果术后随访6～86个月,平均37个月。术后半年,1、2、3、4年的累积完全成功率分别为(88.5±2.2)%、(85.0±2.5)%、(76.4±3.1)%、(66.2±3.7)%、(55.5±4.7)%,累积总成功率分别为(91.2±1.9)%、(88.6±2.2)%、(88.6±2.2)%、(86.8±2.5)%、(86.8±2.5)%。术前平均眼压(44.59±13.04)mmHg(1mmHg=0.133kPa),术后平均眼压(16.52±4.61)mmHg,差异有统计学意义(P<0.01)。早期常见并发症为一过性低眼压43只眼(19.5%),浅前房32只眼(14.5%),引流管口堵塞25只眼(11.3%),眼内出血16只眼(7.2%)等。中晚期常见并发症为引流盘周纤维包裹24只眼(10.9%),引流管暴露11只眼(5.0%),引流管前移10只眼(4.5%),角膜失代偿5只眼(2.3%),引流盘脱出3只眼(1.4%)等。结论采用AGV植入术及其联合手术治疗难治性青光眼是比较有效和相对安全的治疗方法。及时并有效处理并发症可提高手术成功率。

Objective To evaluate the Intermediate-term and long-term clinical results of Ahmed glaucoma valve（AGV） implantation in refractory glaucoma. Methods A retrospective study was conducted to document 221 eyes from 206 patients with refractory glaucoma who undergone AGV implantation or combined AGV implantation with other intraocular surgery. The subject had a minimum 6 months of follow- up after surgery. According to the successful definition of AGV implantation, life table＇s analysis was used to assess the cumulative probabilities of success in different follow-up time. Cox regression analysis was performed to estimate the relationships between survival outcomes and multiple predictors. Results The follow-up ranged from 6. 03 to 86. 30 months （ mean 36. 86 months）. The cumulative probabilities of success at 0. 5,1, 2, 3, and4 years were （88.5 ±2.2）%, （85.0 ±2.5）%, （76.4 ±3. 1）% , （66. 2 ±3.7）% , （55.5 ± 4. 7） % and of total success at 0. 5, 1, 2, 3, and 4 years were （91.2 ± 1.9） %, （88. 6 ± 2. 2） % , （88.6 ± 2. 2） % , （86.8 ± 2.5 ） % , （86. 8 ± 2. 5 ） % , respectively. Intraocular pressure was reduced from a preoperative mean of （44. 59 ± 13.04）mm Hg（ 1 mm Hg =0. 133 kPa） to a postoperative mean of （ 16. 52 ± 4. 61 ）mm Hg （P 〈0. 01 ）. The early major complications included transient hypotony （ 19. 5% ）, shallow anterior chamber （ 14. 5% ）, tube blockage （ 11.3% ）, hemorrhage （7.2%）. The late major complications were encapsulated bleb （ 10. 9% ） , exposure of tube （ 5. 0% ）, tube malposition （ 4. 5% ） , corneal decompensation（ 2. 3% ）, extrusion of implant （ 1.4% ）. Conclusions AGV or combined AGV with other intraocular surgery is effective and relatively safe method for treating refractory glaucoma. The rates of success can be increased by means of effective management of the complications. （Chin J Ophthalmol, 2005 ： 41 ： 796-802 ）