Ahmed青光眼阀植入联合丝裂霉素C治疗难治性青光眼的疗效观察

The effects of Ahmed valve implantation combined with adjunctive mitomycin C for refractory glaucoma

目的 观察Ahmed青光眼阀植入联合丝裂霉素C（MMC）治疗难治性青光眼的中远期疗效,探讨手术并发症的预防及处理.设计回顾性病例系列.研究对象2006年2月至2009年1月间于邢台市眼科医院住院治疗的难治性青光眼162例165眼.方法 所有患者均行Ahmed青光眼阀植入联合MMC手术.分别观察手术前、手术后12个月时患者的视力、眼压及并发症的变化情况.主要指标眼压,术后视力,术后并发症.结果 术后最后一次随访（术后36个月）时,眼压由术前的（49.06±7.52）mm Hg降至（19.86±6.88）mm Hg.手术成功率达到82.45%,其中23眼需加用1～3种降眼压药物控制眼压.新生血管性青光眼疗效较差,原发性开角型青光眼疗效最佳.术后早期并发症为浅前房、低眼压,中远期并发症为引流管口阻塞、引流管裸露及盘周纤维包裹等.结论 Ahmed青光眼阀植入联合MMC是治疗难治性青光眼的一种较为安全有效的手术方法.

Objective To observe the long-term outcomes of Ahmed valve implatation combined with adjunctive mitomycin C （MMC） in patients with refractory glaucoma, and discuss clinical prevention and treatment of postoperation complications. Design Retrospective case series. Participants 162 patients （165 eyes） with refractory glaucoma from Xingtai Eye Hospital in 2006-2009. Methods All participants were performed Ahmed valve combined with adjunctive MMC operation. The visual acuity, intraocular pressure（IOP）, complications were observed, before and 12 months ＇after operation. Main Outcome Measures lOP, visual acuity and complications. Results The average level of lOP was decreased from （49.06±7.52） mm Hg to （19.86±6.88） mm Hg. The effective rate of the operation for complicated glaucoma was 82.45%. 23 eyes needed 1-3 antiglaucomatous agents to maintain the normal IOP. The therapeutic effective for neovascular glaucoma is poor, while the effects for primary open angle glaucoma is good. The shallow charmer and hypotension were the common complications in the early time ＇after operation. However, the obstruction and exposure of implantation, large encapsulation around Ahmed valve were main complications in the relative long term after operation. Conclusion The Ahmed valve implantation with adjuntive mitomycin C is a safe and effective method in treatment for complicated glaucoma.