难治性青光眼的Ahmed青光眼阀植入治疗:并发症与生物相容性

Ahmed glaucoma valve implantation in the treatment of refractory glaucoma:Complication and biocompatibility

背景:近年来房水引流物的出现在治疗难治性青光眼上已经取得了较好的效果,但植入后会出现一些与材料有关的并发症,如炎症反应导致房水生成减少等原因引起低眼压及浅前房等。目的:观察Ahmed青光眼阀植入治疗难治性青光眼的效果及其生物相容性。方法:对32例(32眼)难治性青光眼实施Ahmed阀植入治疗,其中包括新生血管性青光眼12例,无晶状体眼青光眼6例,葡萄膜炎性青光眼4例,外伤性青光眼4例,有滤过手术失败史的青光眼6例,术后随访6～24个月。结果与结论:术前眼压4.655～9.044kPa,平均(5.61±1.29)kPa,末次随访时平均眼压(2.85±1.16)kPa,总有效率84.4%,其中新生血管性青光眼有效率83.3%,其他类型有效率85%。术后10眼视力较前有不同程度提高,最好视力达0.3。出现短暂性低眼压6例,浅前房6例,前房积血4例,内流管堵塞3例,经对症治疗后好转。结果表明Ahmed青光眼阀植入后降低眼压效果较好,但出现并发症比率较大,可能为引流装置设计和材料上的不足引起。

BACKGROUND：In recent years,the emergence of aqueous drainage has achieved good results in the treatment of refractory glaucoma,but some complications related to the materials may occur after implantation,such as the inflammatory reaction leads to reduced formation of aqueous humor,thus resulting in low intraocular pressure and shallow anterior chamber.OBJECTIVE：To evaluate the therapeutic effect and biocompatibility of Ahmed glaucoma valve implantation for refractory glaucoma.METHODS：Thirty-two cases（32 eyes）with refractory glaucoma underwent Ahmed glaucoma valve implantation,including 12 cases of neovascular glaucoma,6 cases of aphakic glaucoma,4 cases of uvetic glaucoma,4 cases of traumatic glaucoma and 6 cases of failed filtering operation.The follow-up period was 6-24 months.RESULTS AND CONCLUSION：The preoperative intraocular pressure was 4.655-9.044 kPa with the average of（5.61±1.29）kPa.After the operation,the average level of intraocular pressure was（2.85±1.16）mmHg at the last follow-up visit.The total success rate was 84.38%,including 83.3%for neovascular glaucoma and 85%for the others.The visual acuity was improved in 10 eyes at different levels with the best visual acuity of 0.3.The common postoperative complications included transient ocular hypotension in 6 cases,shallow of anterior chamber in 6 cases,hyphema in 4 cases,obstruction of the inflow tube in 3 cases.The complications were improved after symptomatic treatment.Ahmed glaucoma valve implantation is a safe and effective method for reducing the intraocular pressure,but the complication incidence is increasing,which may be result from the insufficiency of drainage device design and materials.