不同部位植入Ahmed青光眼阀对难治性青光眼患者最佳矫正视力及眼压的影响

Effect of Ahmed glaucoma valve implantation at different sites on best corrected visual acuity and intraocular pressure in patients with refractory glaucoma

目的探讨不同部位植入Ahmed青光眼阀(AGV)对难治性青光眼患者最佳矫正视力及眼压的影响。方法回顾性分析2019年1月至2020年2月在我院行AGV植入术的81例难治性青光眼患者的临床资料,将其中行鼻上方AGV植入术的32例纳入A组,行颞上方AGV植入术的34例纳入B组,行颞下方AGV植入术的15例纳入C组。比较三组患者术后角膜内皮细胞计数、最佳矫正视力(BCVA)、眼压及术后并发症情况。结果在术后3个月时,三组患者角膜内皮细胞计数、眼压较术前降低,BCVA较术前升高,差异有统计学意义(ta组=4.023、76.191、15.902,tb组=4.421、73.672、16.001,tc组=2.692、51.241、9.045;P<0.05);治疗后,三组角膜内皮细胞计数、眼压及BCVA组间比较,差异无统计学意义(F=0.009、0.019、0.188;P=0.991、0.982、0.829)。术后3个月内,C组并发症总发生率(46.67%)最高,其次为A组(12.50%),B组最低(8.82%),三组间比较,差异有统计学意义(P<0.05)。结论不同部位植入AGV均可改善难治性青光眼患者的BCVA及眼压,且对术后角膜内皮细胞的影响并无明显差异,但颞下方植入术后并发症相对较高,因此对于切除玻璃体后依赖硅油者、合并白内障者、滤过术后结膜瘢痕化者,可选择颞下方植入,其余患者应首选颞上方植入。

Objetive corrected visual acuity(BCVA)and intraocular pressure(IOP)in patients with refractory glaucoma.Methods The clinical data of 81 patients with refractory glaucoma who underwent AGV implantation in our hospital from January 2019 to February 2020 were retrospectively analyzed.32 patients underwent Supranasal AGV implantation were included in group A,34 patients underwent supratemporal AGV implantation were included in group B,and 15 patients underwent subtemporal AGV implantation were included in group C.Corneal endothelial cell count,best corrected visual acuity(BCVA),intraocular pressure and postoperative complications were compared among the three groups.Results At 3 months after operation,the corneal endothelial cell count and intraocular pressure of the three groups were lower than those before operation,while BCVA was higher than that before operation(TA group=4.023,76.191,15.902,TB group=4.421,73.672,16.001,TC group=2.692,51.241,9.045;P<0.05);after treatment,there was no significant difference in corneal endothelial cell count,intraocular pressure and BCVA among the three groups 0.982、0.829.Within 3 months after operation,the total incidence of complications in group C(46.67%)was the highest,followed by group A(12.50%),and group B was the lowest(8.82%).The difference between the three groups was statistically significant(P<0.05)Conclusion Implantation of AGV at different sites can improve BCVA and intraocular pressure in patients with refractory glaucoma,and there was no significant difference in the effect on corneal endothelial cells after surgery,but the complications after subtemporal implantation were relatively high.Therefore,for patients who rely on silicone oil after vitrectomy,those with cataract and conjunctival scarring after filtering surgery,inferior temporal implantation can be selected,and other patients should be the first choice for supratemporal implantation.