两种不同型号的Ahmed阀治疗难治性青光眼的疗效评价

Evaluation of two different types of Ahmed valve in the treatment of refractory glaucoma

目的探讨两种不同型号Ahmed青光眼阀治疗难治性青光眼的有效性和安全性。设计回顾性病例对照研究。研究对象 2010年7月至2015年7月行Ahmed阀植入术治疗难治性青光眼的患者106例。方法根据患者植入Ahmed青光眼阀的型号分为FP8组(睑裂相对小的患者,46例)和FP7组(睑裂相对大的患者,60例)。患者接受FP8或者FP7Ahmed房水引流物植入术。术后1天,1周,1、3、6、12个月随访,观察并比较两组患者眼压,术后抗青光眼用药的数目,手术成功率,术后最佳矫正视力以及并发症。主要指标眼压,术后抗青光眼用药的数目,手术成功率,术后最佳矫正视力以及并发症。结果 FP8组和FP7组术前眼压分别为(39.78±7.37)mmHg和(41.68±9.60)mmHg,术后随访各时间点平均眼压分别为(15.13±7.41)mmHg和(16.32±6.94)mmHg。FP8组和FP7组术后每个随访时间点分别与术前比较,眼压均明显下降(P均<0.001)。两组之间比较,每个随访时间点差异均无统计学意义。FP8组、FP7组术前抗青光眼用药数目分别为(3.44±0.78)种和(3.35±0.66)种,术后随访各时间点用药数目均明显下降,平均分别为(0.28±0.67)种和(0.33±7.36)种(P均<0.001)。随访结束时,FP8组末次检查22眼视力不同程度提高,19眼视力不变,5眼视力下降;FP7组术后30眼视力改善,22眼视力不变,8眼视力下降。两组术后随访一年视力比较,差异无统计学意义(χ~2=0.049, P=0.824)。Kaplan-Meier生存曲线显示,随访1年时,FP8组和FP7组手术总成功率分别为69.6%和78.3%,差异无统计学意义(P=0.499)。结论 Ahmed青光眼阀植入是治疗难治性青光眼安全有效的方法。不同型号的Ahmed青光眼阀治疗难治性青光眼有效性和安全性相当。

Objective To evaluate the efficacy and safety of two different types of Ahmed Glaucoma Valve （AGV） in the treatment of refractory glaucoma. Design Retrospective case control study. Participants Patients with refractory glaucoma in whom AGV implan- tation was performed in our hospital between July 2010 and July 2015. Methods The patients were divided into two groups according to the different type of AGV： FP8 group and FP7 group. Patients underwent FP8 or FP7 Ahmed Glaucoma Valve implantation. Patients were followed at post-operative day 1, week 1, month 1, month 3, month 6, and month 12. Main Outcome Measures The intraocular pressure （IOP）, number of antiglaucoma medication used, surgical success rate, best correct visual acuity （BCVA）, and postoperative complications. Results The preoperative IOP of FP8 and FP7 groups was 39.78±7.37 mmHg and 41.68±9.60 mmHg respectively. The post-operative mean IOP of FP8 and Fir？ groups at all follow-up time point was 15.13±7.41 mmHg and 16.32±6.94 mmHg respectively, significantly lower than preoperative value （all P〈0.001）. The mean number of antiglaucoma medication of FP8 and FP7 groups before operation was 3.44±0.78 and 3.35±0.66 respectively. It was 0.28±0.67 and 0.33±7.36 respectively post-operatively （all P〈0.001）. At the 12-month follow-up visit, the BCVA was decreased in 5 eyes of the FP8 group and in 8 eyes of the FP7 group, unchanged in 19 eyes of the FP8 group and in 22 eyes of the FP7 group, and improved in 22 eyes of the FP8 group and in 30 eyes of the FP7 group. There were no significant differences in visual changes between the 2 groups at post-operative 12 months （x^2=0.O49, P=0.824）. Kaplan-Meier sur- vival curves showed that the success rate was 69.6% for FP8 group and 78.3% for the FP7 group at follow-up endpoint. There was no significant difference between the two groups （P=-0.499）. Conclusions The AGV implantation may be an effective method in managing refractory glaucoma. The two different types of AGV had similar efficacy in treatment of refractory glaucoma. （Ophthalmol CHN, 2018, 27：367-371 ）