抑制Ahmed青光眼引流阀植入术后滤过区瘢痕化相关研究进展

Research progress on inhibition of filtration area scarring after implantation of Ahmed glaucoma valve

Ahmed青光眼引流阀(AGV)植入术是治疗难治性青光眼的主要手段之一,其相对于常规滤过性手术具有更高的手术成功率。但AGV作为异物常会引起滤过区瘢痕组织增生,包裹引流盘,从而抑制房水外流,引起眼压重新升高,导致手术失败。尽管AGV植入术中和术后多次注射抗代谢药物可抑制术后滤过区瘢痕化,但术后多次结膜下注射不仅会引起患者的不适,而且会引起相应并发症,因此需要对AGV进行改进,避免反复注射药物,使药物在局部缓慢释放,同时减轻AGV的异物反应。最近,Ologen胶原蛋白、聚2-羟基甲基丙烯酸乙酯凝胶、聚乳酸-羟基乙酸共聚物和天然蛋白页岩等新型材料及技术的应用为抑制AGV植入术后滤过区瘢痕化提供了新的治疗方法选择。本文从AGV引流盘材料的发展、AGV联合新型材料药物缓释系统的构建、AGV引流盘结构的改进等方面对抑制滤过区瘢痕化的方法和研究进展进行综述。

Ahmed glaucoma drainage valve(AGV)implantation is one of the main methods for the treatment of refractory glaucoma with a higher success rate than conventional filtration surgery.However,as a foreign body,the AGV often causes hyperplasia of scar tissue in the filtration area,wrapping around the drainage plate,thereby inhibiting aqueous fluid outflow and causing the intraocular pressure to rise again,leading to surgical failure.Although multiple injections of anti-metabolic drugs during and after AGV implantation can inhibit postoperative scarring,multiple postoperative subconjunctival injections will not only cause discomfort to patients,but also lead to complications.Therefore,it is necessary to improve the AGV to avoid repeated injection of the drug,achieve slow local release of the drug,and reduce the foreign body reaction of AGV at the same time.Recently,the development of new materials,such as Ologen collagen,poly(2-hydroxyethyl methacrylate),poly lactic-co-glycolic acid and opal shale and new techniques provides new methods to inhibit the scarring of filtration area after AGV implantation.This article reviews the methods and progress of inhibition of scar formation in filtration area from the aspects of development of AGV drainage plate materials,construction of drug delivery system of AGV combined with new materials,and improvement of AGV drainage plate structure.