改良巩膜隧道Ahmed阀植入术的临床观察

The observation on modified Ahmed glaucoma valve implantation through the scleral tunnel

目的观察经改良巩膜隧道Ahmed阀植入术的临床疗效。方法20例（20眼）难治性青光眼植入Ahmed引流阀，术中引流盘固定后用改良方法植入引流管。结果手术总成功率85％。前房引流管位置良好，巩膜部无暴露。术后3d浅前房低眼压1例，前房出血1例，术后4d出现脉络膜脱离1例，1例糖尿病性视网膜病变继发新生血管性青光眼，未及时完成视网膜光凝术，眼压再次升高，最终摘除眼球。滤过泡包裹2例，行睫状体光凝术。结论改良巩膜隧道Ahmed阀引流管植入术易掌握，创伤小，能够预防术后浅前房及低眼压等并发症。

Objective To observe the clinical efficacy of modified Ahmed glaucoma valve （AGV） implantation through the seleral tunnel. Methods The modified AGVs were implantated in 20 eyes of 20 cases with refractory glaucoma. In the operation, the drainage tubes were inserted into the anterior chamber via scleral tunnel after the plates were fixed. Results The total success rate was 85%. All drainage tubes in anterior chamber were placed in the right position and there was no eonjunctival tube exposure. At 3 days postoperatively, 1 case had shallow anterior chamber, 1 case was noticed wtih hypotony, l case encountered wtih hyphema. At 4 days postoperatively, 1 patient had choroidal detachment. At final follow-up, the intraocular pressure of 1 patient with proliferative diabetic retinopathy persistently retained very hight level because of ineompletion of panretinal photoeoagaulation in time, and enculeation of eyeball was operated on him finally. The encapsulated cystic blebs aroud the plate occurred in 2 patients and cyelophotocoagulation surgery were performed on them. Conclusion The modified AGV implantation via seleral tunnel is easy to be performed with less operation-side injury, which has low incidence of surgical complication, such as shallow anterior chamber and hopotony.