改良AGV植入术对难治性青光眼疗效的临床观察

The effective observation and study of improved Ahmed glaucoma valve implantation for refractory glaucoma

目的:观察自体巩膜瓣联合瓣后制作巩膜隧道的方式植入Ahmed青光眼阀(Ahmed glaucoma valve,AGV)治疗难治性青光眼的临床疗效和并发症。方法:采用回顾性研究,观察2017年1月至2019年1月的102例难治性青光眼的患者,行自体巩膜瓣联合应用23 g针头制作瓣后巩膜隧道的方式植入青光眼阀,观察患者术后眼压、视力、引流管的位置等情况,结果:观察术后不同时间段的眼压、视力、及其它眼部情况,术前平均眼压(49.21±9.8)mmHg,术后1周、1月、3月、6月、12月的眼压分别是(11.3±5.4)mmHg、(15.3±7.9)mmHg、(13.1±8.1)mmHg、(12.9±7.9)mmHg、(13.5±6.9)mmHg,术后视力提高23眼,视力无改变68眼,视力下降11眼。术后并发症包括浅前房11例,前房出血15例,脉络膜脱离2例,引流管包裹10例,无引流管暴露。结论:自体巩膜瓣联合应用23 g针头制作瓣后巩膜隧道的方式植入青光眼阀的手术操作,在降低眼压的同时有效的防止了术后引流管的暴露,且巩膜面无需缝线固定引流管,简化了手术操作,为切实可行的手术方法。

Objective:To observe the clinical efficacy and complication of the treatment of refractory glaucoma by the scleral petal combined with scleral tunnel implanted into the Ahmed glaucoma valve(AGV).Methods:A retrospective study was conducted to observe 102 cases of refractory patients from January 2017 to January 2019.The glaucoma valve was implanted with scleral petal combined with 23 g needle to make posterior scleral tunnel,and the postoperative intraocular pressure,visual acuity and position of drainage tube were observed.Results:The mean IOP and visual acuity were observed at different time after operation,the preoperative IOP was(49.21±9.8)mmHg,1 month,3 months,6 months and 12 months after operation,respectively.(11.3±5.4)mmHg,(15.3±7.9)mmHg,(13.1±8.1)mmHg,(12.9±7.9)mmHg,(13.5±6.9)mmHg,The postoperative visual acuities were improved in 23 eyes and decreased in 11 eyes,No improvement in visual acuities in 68 eyes.The postoperative complications included 11 cases of shallow anterior chamber,15 cases of anterior hemorrhage,2 cases of choroidal detachment,and 10 cases of drainage tube wraping,and no drainage tube exposure.Conclusion:AGV implantation by scleral petal combined with scleral tunnel is feasible and easy.It simplify the operation technique by avoiding stitching,and prevent the exposure of around tube,meanwhile,this procedure decrease the IOP.