Navigating postoperative complications:Uveitis-glaucoma-hyphema syndrome after Ahmed glaucoma valve implantation

Altwijri and Alsirhy reported a case of uveitis-glaucoma-hyphema syndrome after an Ahmed glaucoma valve implantation surgery in an advanced primary open-angle glaucoma patient,being the first ever recorded of its kind.The author describes the position of the tube as the origin of the anterior chamber inflam-mation and hyphema,which resolved shortly after shortening and relocating it.This publication emphasizes the importance of precise implant positioning and close-up patient follow-up after glaucoma filtration surgery as an important standard for healthcare providers.

Long-term success of ahmed glaucoma valve in refractory glaucoma

AIM:To evaluate the long-term results and complications of ahmed glaucoma valve (AGV) implantation in refractory glaucoma.· METHODS:A retrospective review of 13 patients (13 eyes) with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 18 months was performed.All patients underwent a complete ophthalmologic examination and intraocular pressure (IOP) measurement before surgery and at 1 month,3 months,6 months,1 year after surgery and yearly afterwards.Complications and the number of antiglaucoma medications needed were recorded.· RESULTS:Mean age was 27.3±16.0 years.All eyes (100%) had at least one prior incisional surgery.Mean follow-up was 61.3±30.8 months.IOP was reduced from a mean of 35.0±7.0mmHg to 18.2±7.9mmHg at 12 months and to 17.0±4.1mmHg at 96 months (P <0.05) with a lower number of medications from baseline,76.9% patients required additional procedures to achieve the success criteria set by previously published series.The most common complications were encapculated cyst formation in eight eyes (61.5%) and tube exposure in four eyes (30.8%).· CONCLUSION:Encapsulated cyst formation was the most common complication which hindered succesful IOP control after AGV implant insertion for refractory glaucoma.Despite cyst excision with anti-fibrotic agents,successful IOP reduction was not achieved in 76.9% of the patients without antiglaucoma medication.

Intravitreal bevacizumab and Ahmed glaucoma valve implantation in patients with neovascular glaucoma

AIM:To explore the efficacy of preoperative intravitreal bevacizumab(IVB) injection combined with Ahmed glaucoma valve(AGV) implantation in the treatment of neovascular glaucoma(NVG).METHODS:This retrospective study included 35 eyes from 35 patients who underwent preoperative IVB and AGV implantation for treatment of NVG. Findings such as intraocular pressure(IOP) number of anti-glaucoma medications, visual acuity(VA), surgical success rates,and complications were recorded.RESULTS:AfterAGVimplantation,IOPwas18.2±4.0mmHg,15.5±3.3 mm Hg and 9.8±2.6 mm Hg at 6, 12 and 36 mo,significantly decreased compared with pre-IOP(P 【0.01).The number of anti-glaucoma medications was 0.9 ±0.5,0.8 ±0.9 and 0.8 ±0.6 at 6, 12 and 36 mo, significantly decreased compared to pre-treatment(P 【0.01). At last visit, there were 19 eyes with stable VA, 4 with VA improvement, 12 with diminished VA and 3 with complete loss light perception. There were 7 cases that failed during 3-year fellow up period. Cumulative probabilities of valve survival by Kaplan-Meier analysis were 82.9%,74.1% and 71.0% at 12, 24 and 36 mo, respectively. Cox stepwise regression analysis found that the survival time was significant associated with the pre-visual acuity 【2/400(P 【0.05). Post-operative complications occurred in 8eyes, of which hyphema presented in 2 eyes, choroidal effusion in 2 eyes.CONCLUSION:The procedure of preoperative IVB andAGV implantation should be one of treatments for NVG because of its safety and effectiveness.

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

·AIM: To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23 -gauge vitrectomy for proliferative diabetic retinopathy (PDR). ·METHODS: Twelve medically uncontrolled NVG with earlier 23 -gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best -corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up. ·RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5 ± 1.6mmHg. The control of IOP was achieved at the final follow -up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow -up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention. ·CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.·

Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP） 〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.

Long-term results of Ahmed glaucoma valve implantation in Egyptian population

AIM： To evaluate the long-term results and complications of Ahmed glaucoma valve （AGV） implantation in a cohort of Egyptian patients. METHODS： A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure （lOP） measurement before surgery and at ld, weekly for the 1st month, 3, 6mo, and ly after surgery and yearly afterward for 5y. lOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as lOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS： Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery, lOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes （41.1%）, complicated cataract in 9 eyes （7.25%）, recessed tube in 8 eyes （6.45%）, tube exposure in 6 eyes （4.8%） and corneal touch in 6 eyes （4.8%）. Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes （1.6%）. ~ CONCLUSION： Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful lOP control after AGV implantation. However, effective complications management can improve the rate of success.

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM：To evaluate the efficacy and safety of intravitreal ranibizumab（IVR）with panretinal photocoagulation（PRP）followed by trabeculectomy compared with Ahmed glaucoma valve（AGV）implantation in neovascular glaucoma（NVG）.METHODS：This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included：diabetic retinopathy（25 eyes）,and retinal vein occlusion（20 eyes）.All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities（BCVA）were converted to the logarithms of the minimum angle of resolution（log MAR）for the statisitical analyses.Intraocular pressure（IOP）,the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS：A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery（F=545.468,P〈0.05）,and the mean postoperative log MAR BCVA was also significantly improved（F=10.964,P〈0.05）with no significant difference between two groups.CONCLUSION：It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR＋AGV implantation＋PRP and IVR＋trabeculectomy＋PRP in eyes with NVG.

Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

AIM: To evaluate the outcomes of Ahmed glaucoma valve(AGV) implantation surgery for refractory glaucoma.METHODS: This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure(IOP) greater than21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation,data were collected on IOP, the best corrected visual acuity(BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56 wk postoperatively. Logarithm values of IOP were calculated and compared. RESULTS: The study group was comprised of 30patients(30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3 ±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg,19.6 ±12.8 mm Hg and 13.9 ±14.2 mm Hg at 12, 24 and56 wk respectively. BCVA was ≥6/60 in 11 eyes preoperatively, and five eyes had BCVA ≥6/60 at 56 wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At12 wk postoperatively, no medications were required to control IOP in 20 eyes. At 56 wk postoperatively, at least one medication was required to control IOP in 10 eyes.Over the entire follow up period, four eyes were treated with yttrium aluminium garnet(YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.

Clinical efficacy of Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma with proliferative diabetic retinopathy

AIM:To describe the clinical results of combined Ahmed valve implantation and 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR).METHODS:The medical records of medically uncontrolled NVG patients with PDR who underwent Ahmed valve implantation and 23-gauge vitrectomy between March 2016 and December 2018 were reviewed.Enrolled patients had at least 6-month follow-up.Panretinal photocoagulation(PRP),anti-vascular endothelial growth factor,surgery and medication history were documented.RESULTS:Eleven eyes of 11 patients were included in our study.The visual acuity improved in 8 eyes and remained unchanged in 3 eyes.The preoperative intraocular pressure(IOP)was significantly decreased at the last follow-up(48.8±4.3 to 17.0±1.5 mm Hg,P<0.001).All eyes needed three topical anti-glaucomatous medications before surgery,but the number was significantly reduced to 0.72±0.19 at the last visit(P<0.001).Four eyes had choroidal detachment and 3 eyes had minor hyphemia,all of which gradually resolved without treatments in one week.CONCLUSION:Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy might be a safe and alternative treatment for NVG with PDR.

Simultaneous pars plana vitrectomy,panretinal photocoagulation,cryotherapy,and Ahmed valve implantation for neovascular glaucoma

AIM:To describe and evaluate the efficacy of Ahmed glaucoma valve implantation(AGV)combined with pars plana vitrectomy(PPV)in a single surgical act for the treatment of advanced neovascular glaucoma(NVG).METHODS:Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV,AGV,and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period(2005-2018).Preoperative,intraoperative and postoperative data at day 1 and months 1,3,6,21,and 24 were systematically collected.Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment.RESULTS:Main indications for surgery were NVG secondary to proliferative diabetic retinopathy(39.2%)and central retinal vein occlusion(37.3%).Mean(±SD)preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12 mo and 15.8±9.1 mm Hg at 24 mo of follow up.Cumulative incidence of success of IOP control was 76.0%at first postoperative month,reaching 88.3%at 6 mo.Prevalence of successful IOP control at long term was 74.4%at 12 mo and 71.4%at 24 mo.Eye evisceration for unsuccessful NVG management was required in 1 case(2.0%).CONCLUSION:Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.

Managing high risk glaucoma with the Ahmed valve implant:20 years of experience

AIM： To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery.METHODS： In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure（IOP） control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS： Follow-up ranged from 18 to 120m o with a mean follow-up of 63.2m o. IOP before the operation decreased from 31.6±10.4 mmHg to 18.3±5.4 mm Hg（no systemic treatment） at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference（P〈0.001）. The success rate was 85.2% during the first semester, 76.8% at 12 mo and 50.3% at the end of follow up period（18 to 120 mo after implantation）. Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were： serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6%（phakic eyes）, shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%.CONCLUSION： Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.

Intraluminal stenting versus external ligation of Ahmed glaucoma valve in prevention of postoperative hypotony

AIM:To compare intraluminal stenting and external ligation of Ahmed glaucoma valves(AGV)for refractory glaucoma management and postoperative hypotony prevention.METHODS:This randomized prospective blind study included 30 eyes of 25 patients(age range:44-56y)with refractory glaucoma.This study was conducted from September 2018 to January 2020.The study included two groups,AGV with intraluminal stenting group(n=15 eyes)and AGV with external ligation group(n=15 eyes).Follow-up period was one year postoperatively.The primary outcome was intraocular pressure(IOP)and its association with the number of postoperative glaucoma medications.IOP≤21 mm Hg without medications indicated complete success while IOP≤21 mm Hg with medications indicated qualified success;and IOP<6 mm Hg was defined as hypotony.RESULTS:After a year of follow-up,IOP was significantly reduced in the intraluminal stenting group than in the external ligation group(11.67±0.89 vs 14.2±4.0 mm Hg,respectively,P=0.024).Postoperative hypotony was more common in the external ligation group(2 cases,13.33%)than in the intraluminal stenting group(1 case,6.67%).CONCLUSION:Application of intraluminal stenting or external ligation during AGV surgery usually prevents postoperative hypotony(transient and persistent)that occurs in conventional AGV surgery.

Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM： To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve（AGV） implantation in a series of Chinese patients. METHODS： The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure（IOP） levels between 6 and 21 mm Hg with or without additional antiglaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60 mo after surgery, surgical complications, final best-corrected vision acuity（BCVA）, visual field（VF） and retinal nerve fiber layer（RNFL）.RESULTS： The mean follow-up was 53.3±8.5（range 48 to 60）mo. The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60 mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60 mo, respectively（P〈0.01）. The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period（P〈0.05）. There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery.CONCLUSION： AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.

Ahmed青光眼阀植入术联合雷珠单抗治疗NVG患者的效果

目的:探讨Ahmed青光眼阀(AGV)植入术联合雷珠单抗治疗新生血管性青光眼(NVG)患者的效果。方法:选择2016年9月—2022年9月河池市第三人民医院收治的66例NVG患者作为研究对象,按照计算机分组法分为两组,各33例。对照组给予AGV植入术治疗,观察组在对照组基础上加用雷珠单抗治疗。比较两组临床疗效、眼压及视力的变化情况、眼动脉血流动力学及并发症发生率。结果:观察组总有效率为93.94%,高于对照组的75.76%,差异有统计学意义(P<0.05)。治疗1周、1个月、3个月后,观察组眼压水平低于对照组,术眼最佳矫正视力(BCVA)高于对照组,差异有统计学意义(P<0.05)。治疗3个月后,观察组舒张末期流速(EDV)、收缩期峰值流速(PSV)高于对照组,血流阻力指数(RI)低于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论:AGV植入术联合雷珠单抗具有良好的临床疗效,可有效改善NVG患者眼动脉血流动力学指标,促进眼部血液循环,以降低眼压,提高视力,且不增加并发症发生率。

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma

·AIM: To compare the clinical efficacy and safety of ultrasonic cycloplasty(UCP) vs Ahmed glaucoma drainage valve implantation(ADV) in addition to intravitreal antivascular endothelial growth factor(VEGF) for treatment of fundus disease-related neovascular glaucoma(NVG).·METHODS: A total of 43 patients(45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients(15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients(30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure(IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded.·RESULTS: The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively(P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0%(27/30) in the ADV group and 86.7%(13/15) in the UCP group at the last follow-up of 6mo(P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups(both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation(P<0.05).·CONCLUSION: UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

抗VEGF联合Ahmed引流阀植入治疗新生血管性青光眼的临床疗效

目的:观察玻璃体腔抗血管内皮生长因子(VEGF)注射联合Ahmed青光眼引流阀(AGV)植入对新生血管性青光眼(NVG)的疗效与安全性。方法:回顾性分析NVG病人47例(47眼)临床资料,其中25例(25眼)实施AGV植入术(AGV组),22例(22眼)行小梁切除术(小梁组)。2组病人术前均予以玻璃体腔内抗VEGF药物注射,术后完成全视网膜光凝,1年内定期随访。比较2组术后最佳矫正视力改善情况和手术前后眼内压(IOP)、抗青光眼药物使用情况及术后并发症、手术成功率。结果:抗VEGF治疗后,2组病人均获得不同程度的虹膜面新生血管消退,且IOP均较术前降低(P<0.05);术后各时点,2组IOP均较术前和抗VEGF治疗后降低(P<0.05)。2组病人间比较,各时间点IOP差异均无统计学意义(P>0.05)。2组术后最佳矫正视力改变情况差异无统计学意义(P>0.05)。2组术后应用抗青光眼药物种类均较术前明显减少(P<0.01)。2组术后并发症发生率差异无统计学意义(P>0.05)。AGV组手术成功率高于小梁组(P<0.05)。结论:抗VEGF药物玻璃体腔内注射联合AGV植入术治疗NVG安全有效。

抗VEGF药物联合Ahmed引流阀植入术治疗新生血管性青光眼患者的效果及其对眼动脉血流动力学、血清VEGF及PDGF水平的影响

目的 探讨Ahmed青光眼阀植入术联合抗血管内皮生长因子(VEGF)药物治疗新生血管性青光眼的效果。方法 掷币法我科62例(95眼)新生血管性青光眼患者分2组,对照组31例(47眼)行Ahmed青光眼阀植入术,观察组31例(48眼),术前1w在眼内注射0.5mg雷珠单抗,随访6个月,对比两组新生血管消退情况、眼动脉血流动力学、血清血小板衍生生长因子(PDGF)及VEGF、成功率和并发症。结果 3个月末,观察组新生血管消退率95.83%、6个月末手术总成功率95.83%高于对照组的76.60%和78.72%(χ^(2)=7.441,6.299,P<0.05),舒张末期流速(EDV)(10.92±0.51) cm/s、收缩期峰值流速(PSV)(35.07±3.66) cm/s高于对照组的(7.41±0.45) cm/s、(29.34±3.07) cm/s(t=35.542,8.259,P<0.05),3个月末眼动脉血流阻力系数(RI)(0.70±0.08)、眼压(14.24±3.36) mmHg、PDGF (83.25±18.44) ng/L及VEGF (328.31±41.62) ng/L低于对照组(0.76±0.07)、(21.12±4.67) mmHg、(147.41±26.55) ng/L及(531.83±58.46) ng/L (t=3.887,8.228,13.654,19.511,P<0.05),两组并发症无统计学差异(P>0.05)。结论 新生血管性青光眼患者Ahmed青光眼阀植入术前1w联合雷珠单抗治疗,可有效改善患者眼动脉血流动力学和VEGF、PDGF水平,促进新生血管消退,提高手术成功率且较安全。

Ahmed青光眼引流阀睫状沟植入治疗人工晶状体眼青光眼

目的:评价Ahmed青光眼引流阀睫状沟植入术治疗人工晶状体眼青光眼的疗效。方法:采用回顾性病例系列研究。收集2020-02/2022-02柳州市红十字会医院收治的人工晶状体眼青光眼患者18例18眼的临床资料,所有患者均行Ahmed青光眼引流阀睫状沟植入术。观察术前,术后1、3、6、12mo的视力、眼压、角膜内皮细胞密度、角膜内皮细胞丢失率及并发症发生情况。结果:术前平均眼压为43.41±5.33mmHg,术后1、3、6、12mo的平均眼压分别为12.11±3.26、13.82±4.12、13.54±3.83、15.80±4.35mmHg,术后各随访点平均眼压较术前明显下降(F=203.40,P<0.01)。术后各时间点角膜内皮细胞密度较术前降低(F=6.18,P<0.01),但术后1、3、6、12mo各时间点角膜内皮细胞密度及丢失率均无差异(P>0.05),总手术成功率为83%。结论:青光眼引流阀睫状沟植入术治疗人工晶状体眼青光眼安全有效,对角膜内皮细胞损伤小,术后角膜内皮细胞不随时间的变化减少。

对比分析Ahmed青光眼阀植入术与复合式小梁切除术分别联合阿柏西普对新生血管性青光眼患者疗效及视力的影响

目的对比分析Ahmed青光眼阀植入术与复合式小梁切除术分别联合阿柏西普对新生血管性青光眼患者疗效及视力的影响。方法前瞻性选择自2019年1月至2022年12月咸阳市第一人民医院接诊的80例(80眼)新生血管性青光眼患者作为研究对象,按照随机数字表法分为A组和B组,各40例(40眼)。其中A组予以Ahmed青光眼阀植入术治疗,B组予以复合式小梁切除术治疗,两组均联合阿柏西普治疗。记录两组患者不同时间点(手术前、手术后7 d、14 d、1个月、3个月)的眼压、最佳矫正视力,比较两组视力改善效果、并发症发生情况、手术成功率。结果手术后7 d、14 d、1个月、3个月,两组眼压均较手术前明显降低,其中A组手术后1、3个月的眼压分别为(1.92±0.37)、(1.93±0.35)kPa,均明显低于B组[(2.33±0.51)、(2.27±0.42)kPa],差异均有统计学意义(P<0.05)。手术后7 d、14 d、1个月、3个月,两组最佳矫正视力均较手术前提高,差异均有统计学意义(P<0.05);但组间各时间点的最佳矫正视力比较,差异均无统计学意义(P>0.05)。两组手术后3个月的视力改善效果比较,差异无统计学意义(P>0.05)。两组并发症发生率、手术成功率比较,差异均无统计学意义(P>0.05)。结论Ahmed青光眼阀植入术与复合式小梁切除术分别联合阿柏西普治疗新生血管性青光眼的效果显著,安全性均较好,而前者在降低和维持眼压上具有明显优势。

Ahmed青光眼引流阀植入术后处理引流盘纤维包裹的研究进展

Ahmed青光眼引流阀植入术作为难治性青光眼的主要治疗方案,能很大程度控制眼压,且疗效和预后均优于常规滤过性手术。但是远期引流盘周围被纤维包裹后会阻塞房水流出,引起术后高眼压,导致手术失败。因此,解决引流盘纤维包裹能很大程度地提高青光眼阀植入术后远期成功率,这也是目前的研究热点。目前临床上主要采用术前预防及术后二次操作对纤维包裹进行干预,但长期效果欠佳。本文就青光眼引流阀纤维包裹发生的组织病理学及分子机制、临床目前解决方案、前沿研究进展以及对Ahmed青光眼阀门的材料改造的探索进行综述。