Ahmed青光眼阀植入术后盘周包裹囊状泡的手术疗效

The efficacy of surgical treatment for encapsulated cystic blebs around the plate after Ahmed glaucoma valve implantation

目的评价Ahmed青光眼阀植入术后盘周包裹囊状泡的手术疗效。方法回顾性系列病例研究。收集13例经Ahmed青光眼阀植入术后盘周纤维增殖形成并包裹囊壁致眼压升高患者的临床资料，进行回顾性分析。患者眼压升高时间为青光眼阀植入术后3周至5个月，平均2个月，经检查Ahmed青光眼阀的引流盘和管位置均正常，管口无堵塞物，于眼球赤道部引流盘所在位置发现局限隆起包裹的囊状泡。所有患者均行包裹囊壁切除术，术中结膜瓣下使用丝裂霉素C治疗，并将剪除的纤维组织送病理检查，观察术后早期和中晚期患者的眼压和病程转归情况。结果引流盘周包裹囊壁切除术后1个月，所有患者眼压均在正常范围内，手术成功率100％。术后随访3～20个月，3例患者在未加用任何降眼压药物的情况下，眼压控制在正常范围内；6例患者在使用2或3种降眼压药物的情况下，眼压控制在正常范围内；3例患者用药物仍无法控制眼压，需要进一步手术治疗。其中，57岁及以上患者的手术完全成功率为75％（3／4），37岁及以下患者的手术完全成功率为0（0／8）。结论手术切除包裹囊壁是治疗Ahmed青光眼阀植入术后引流盘周包裹囊状泡的一种有效方法，老年患者的中、长期手术疗效相对好于年轻患者。

Objective To evaluate the efficacy of surgical treatment for encapsulated cystic blebs around the plate after Ahmed glaucoma valve implantation. Methods This was a retrospective observational ease series. Thirteen cases with elevated intraoeular pressure （lOP） induced by fibrous proliferation around Ahmed valve were retrospectively studied. The intraocular pressure increased at 3 weeks to 5 months post- operation （2 months in average）. The plates and tubes of Ahmed valve were in good position. No obstruction was seen in the tubes. Localized, encapsulated, cystic blebs were found in the equator of eyeball in which the plates were located. All cases underwent encapsulated cysts resection combined with mitomycin-C usage under conjunctival flaps. The excised tissues were sent for pathological examination. The changes of lOP and the outcome of the diseases were observed. Results lOP was normal one month after surgery in all cases. The success rate was 100%. In the 3-20 months follow-up period, the IOP level kept normal in 3 cases without any anti-glaucoma medications. The lOP level was in normal range in 6 cases using two or three different kinds of anti-glaucoma medications. Three cases needed further surgical treatment because of uncontrolled IOP even with anti-glaucoma medications. Among them, the complete success rate was 75% （3/4） in patients more than 57 years old, while the complete success rate was 0 （0/8） in patients less than 37 years old. Conclusions It was considered an effective method of surgical treatment for encapsulated blebs around Ahmed glaucoma valve. The result was better in elderly patients than in younger patients relatively.