Ahmed青光眼引流阀植入联合1．8mm微切口白内障超声乳化术治疗合并白内障的难治性青光眼

Ahmed glaucoma valve implantation combined with 1.8mm-incision phacoemulsification for refractory glaucoma coexisting cataract

目的观察Ahmed青光眼引流阀植入联合1．8mm微切口白内障超声乳化手术治疗合并白内障的难治性青光眼的疗效硬安全性。方法对21例接受Ahmed青光眼引流阀植入联合1．8mm微切口白内障超声乳化手术的合并白内障的难洁性青光眼患者进行回顾性分析，总结术前术后眼压，最佳娇正视力，角膜散光变化及术中、术后并发症的发生情况。结果所有患者的平均随访时间为11．7个月（8～21个月）。所有患者术后眼压较术前均有不同程度下降，术前平均眼压为（37．9±10．2）mmHg，末次随访时平均眼压为（14．3±5．8）mmHg（t=9．19，P〈0．01）。2例患者术后仍需使用抗青光眼药物。所有患者术后最佳娇正视力均有提高，平均景佳娇正视力自术前（0．19±0．11）提高至术后（0．57±0．14），（t=11．45，P〈0．01）。患者角膜散光术前平均为（0．80±0．21）D，术后散光平均为（0．78±0．3）D（t=0．19，P=0．85）。1例患者术后第一天出现一过性低眼压合并脉络模脱离，药物控制一周内恢复。2例患者术后第一天出现少许前房出血，第二天出血自行吸收。2例患者求次随访时发生包裹性囊肿，眼压再次升高。结论Ahmed青光眼引流阀植入联合1．8mm微切口超声乳化手术是治疗难治性青光眼的一种较安全、有效的方法。

Objective To evaluate the efficacy and safety of Ahmed valve implantation combined with 1.8 mm incision phaco- emulsification in the treatment of patients with medically uncontrolled glaucoma coexisting cataract. Methods The authors retrospectively reviewed the records of 21 consecutive patients with refractory glaucoma incorporated cataract who underwent a 1.8 mm incision phacoemulsification combined with placement of an Ahmed valve implant. Control of intraocular pressure （IOP） ,pre and postoperative best corrected visual acuity,corneal curvature and the development of intra and postoperative complications were evaluated during the follow up. Results The mean follow up was 11.7 months （range,8 to 21 months）. Mean preoperative IOP was （37.9 ± 10.2） mmHg and mean postoperative IOP at the last visit was （14.3±5.8） mmHg （t= 9.19, P〈0. 01）. Two patients needed antiglaucoma medication. Postoperative visual acuity improved in all 21 eyes, and the best corrected visual acuity in these eyes improved from （0.19±0.11） to （0.57 ±0.14） （t= 11. 45,P〈0. 01）. The preoperative corneal curvature was （0.80±0.21） D while the postoperative corneal curvature was （0.78±0.3） D （t= 0.19,P= 0.85）.The early complications occurred were transient hypotony with choroidal detachment in one case, which amended within 1 week and microscopic hyphema in 2 patients which disappeared the second day. The main late postoperative complication was an encapsulated bleb, which occurred in 2 patients and led to high IOP. Conclusion The combination of 1.8 mm incision phacoemulsification combined with placement of an Ahmed valve implant is safe and effective in uncontrolled glaucoma incorporated cataract.