软性分离在Ahmed引流阀植入术后早期包裹性滤过泡处理中的应用

Application of soft separation on the early bleb encapsulation separation after Ahmed glaucoma valve implantation

目的探讨应用黏弹剂联合抗代谢药物分离(软性分离)Ahmed引流阀植入术后早期包裹性滤过泡的有效性和安全性。设计回顾性病例系列。研究对象2018年4月至2019年9月温州眼视光医院之江院区Ahmed引流阀植入术患者79例(84眼)。方法在裂隙灯下,选择引流盘巩膜固定两根缝线后2 mm处针刺进入滤过泡并注入黏弹剂0.4 ml,必要时注射完毕后用手指向后挤压,随后在后部引流盘周围结膜下注入抗代谢药物5-FU或MMC。不使用抗青光眼药物眼压<21 mmHg定义为完全成功。主要指标眼压≥21 mmHg的时间、发生包裹时的眼压、注射后随访点的眼压、注射后前房深度、注射次数、使用青光眼药物种类。结果84眼中Ahmed引流阀植入术后48眼发生早期眼压升高(57.14%),平均升高时间为术后(24.6±14.5)天。黏弹剂分离单独或联合抗代谢药物(5-FU或MMC)注射48眼,末次随访完全成功38.9%(14眼),条件成功75%(36眼)。分离后出现短暂浅前房15眼(31.25%),前房消失5眼(10.41%)。多因素分析提示引流阀术后发生早期包裹时的眼压是影响软性分离效果的因素(P=0.026)。结论黏弹剂软性分离联合抗代谢药物治疗Ahmed引流阀植入术后早期包裹性滤过泡安全有效。(眼科,2021,30:25-29)

Objective To investigate the efficacy and safety of combined viscoelastic and antimetabolites injection in the early bleb encapsulation after Ahmed glaucoma valve implantation.Design Retrospective case series.Participarts Seventy nine(84 eyes)patients with glaucoma who underwent Ahmed glaucoma valve implantation in The Eye Hospital of WMU at Zhijiang from April 2018 to September 2019 were included.Methods Injection was performed under the slitlamp.A needle was inserted into to the bleb through the incision 2 mm behind the middle point of the two fixative sutures between the plate and sclera.The viscoelastic agent with 0.4 ml volume was injected into the bleb and was pushed backwards.Thereafter,antimetabolite agent of 5-fluorouracil or MMC was subconjunctivally injected around the drainage plate.If intraocular pressure<21mmHg,complete success was defined as not using glaucoma drugs.Main Outcome Measures The time of intraocular pressure≥21 mmHg,intraocular pressure at the time of encapsulation,Intraocular pressure at the followed up point after injection,anterior chamber depth after injection,injection times,types of glaucoma drugs used.Results Eighty four eyes underwent AGV implantation,48(57.14%)eyes occurred intraocular pressures elevation after surgery.The mean duration of elevation was 24.6±14.5 days.Viscoelastic agents alone or combined with antimetabolites(5-FU or MMC)were injected in 48 eyes.Three months after injection,14 eyes(38.9%)were complete success and 36 eyes(75%)were modified success respectively.There were 15 eyes(31.25%)with transient shallow anterior chamber and 5 eyes(10.41%)with anterior chamber disappearing.Multiple factor analysis showed that the intraocular pressure at the time of early encapsulation after glaucoma valve surgery was a factor influencing the effectiveness of soft separation(P=0.026).Conclusion Soft separation by viscoelastic agents in combination with antimetabolites is safe and effective to separate early encapsulated bleb after Ahmed valve implantation.(Ophthalmol CHN,2021,30:25-29)