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.

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.

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.

Uveitis glaucoma hyphema syndrome as a result of glaucoma implant: A case report

BACKGROUND Glaucoma is caused by increased intraocular pressure(IOP)that damages the optic nerve,leading to blindness.The Ahmed glaucoma valve(AGV)is a glau-coma drainage implant device that is used in glaucoma patients with uncontrolled IOP.A possible complication after any ocular surgery however is hyphema,which can itself progress to uveitis glaucoma hyphema(UGH)syndrome on rare occasions.UGH syndrome has not yet been reported as a complication of AGV implantation.CASE SUMMARY Here,we have reported a case of a 55-year-old female who developed both hyphema and pigmentation as a result of AGV implantation.We confirmed UGH syndrome secondary to AGV implantation after the patient underwent another surgery to shorten and reposition the AGV tube.After the second surgery,the patient’s IOP was reduced,and she had a clear cornea and no signs of hyphema.CONCLUSION This first report of UGH syndrome as a complication of AGV implantation reminds clinicians that frequent follow-up is paramount.

Efficacy of selective laser trabeculoplasty following incisional glaucoma surgery

AIM： To evaluate the efficacy of selective laser trabeculoplasty（SLT） in glaucomatous eyes with previous incisional glaucoma surgery. METHODS： A retrospective cohort of eyes that underwent SLT at a single institution from 2013-2015 were followed for 1 y. Reduction in intraocular pressure（IOP） following SLT was evaluated in eyes with prior trabeculectomy with Ex Press mini shunt（Alcon, Ft Worth, TX, USA）, Ahmed valve（New World Medical, Cucamonga, CA, USA）, or combined phacoemulsification-trabeculectomy. A control group was included with eyes without prior surgery that underwent SLT. Success was defined as 〉20% drop in IOP from pre-SLT baseline. RESULTS： One-hundred and six eyes were included with 53 in both the prior glaucoma surgery（PGS） and no prior glaucoma surgery（NPGS） groups. Mean pre-SLT IOP was 19.2±4.3 and 20.6±6.0 mm Hg for PGS and NPGS groups, respectively（P=0.17）. Both groups produced statistically significant IOP reductions at 1 and 6 mo（P〈0.04）. At 6 mo, mean IOP reduction reached 7.3% and 10.8% for the PGS and NPGS groups, respectively（P=0.42）. Overall, 27.9% and 31.7% of eyes in PGS and NPGS groups met success criteria at 1 y（P=0.70）. In the PGS group, eyes with baseline IOP ≥21 mm Hg had IOP reductions of 18.1%（P〈0.001）, 16.7%（P〈0.01）, and 8.4%（P=0.31） compared to eyes with baseline IOP 〈21 mm Hg who had IOP reductions of 2.3%（P=0.39）, 3.4%（P=0.19）, and 1.1%（P=0.72） at 1, 6 mo, and 1 y, respectively. CONCLUSION： SLT is efficacious in eyes with prior incisional glaucoma surgery and results in similar IOP reductions compared to eyes without PGS. A larger IOP reduction is observed following SLT in eyes with higher pre-SLT IOP.

Efficacy and safety of XEN 45 gel stent alone or in combination with phacoemulsification in advanced open angle glaucoma patients: 1-year retrospective study

AIM:To assess the effectiveness of the XEN 45 gel stent,either alone or combined with cataract surgery,in advanced stage open angle glaucoma(OAG)patients.METHODS:Retrospective and single-center study conducted on consecutive OAG patients who underwent a XEN 45 gel stent implantation surgery,between July 2017 and September 2018.The primary efficacy end-point was the mean intraocular pressure(IOP)reduction at the end of the follow-up period.Success was defined as an IOP reduction of at least 20%and an IOP value≤18 mm Hg without(complete)or with(qualified)hypotensive medication.RESULTS:Seventy-four patients(80 eyes)were included in the study.In the overall study sample,XEN implant significantly reduced IOP from 21.0(19.8 to 22.1)mm Hg at baseline to 9.3(8.2 to 10.4),10.7(9.6 to 11.9),13.4(12.2 to 14.7),14.5(13.6 to 15.4),14.7(13.8 to 15.6),and 14.7(13.9 to 15.4)mm Hg at 1 d,1 wk,1,3,6,and 12 mo of follow-up,respectively(P<0.0001 each).In the overall study population,at the end of the study the mean IOP reduction was 27.4%(23.3%to 31.5%).Adjusted IOP reduction was similar in XEN and XEN+phacoemulsification groups[30.0(23.4 to 36.4)mm Hg vs 24.8(18.4 to 31.2)mm Hg,respectively,P=0.2939].At the last follow-up visit,52(65.0%)eyes were considered success,29(36.3%)eyes as complete success and 23(28.7%)as qualified success.Mean number of hypotensive medications was significantly reduced from 2.8(2.7 to 3.0)at baseline to 1.1(0.8 to 1.3),P<0.0001.Kaplan-Meier survival analysis did not find any difference in the success rate between XEN and XEN+PHACO,mean hazard ratio 0.56,95%CI 0.26 to 1.23;P=0.1469.Needling was performed in 7(8.8%)eyes at months 1(n=3);3(n=2);4(n=1)and 11(n=1).Eleven(13.8%)eyes presented adverse events.CONCLUSION:XEN implant,either alone or in combination with phacoemulsification,significantly reduced the IOP and the number of hypotensive medications in patients with OAG in advanced stage.

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。

Modern Monitoring Intraocular Pressure Sensing Devices Based on Application Specific Integrated Circuits

Glaucoma is a neurodegenerative condition that is the leading cause of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is the main risk factor for the development and progression of the disease. Methods to lower IOP remain the first line treatments for the condition. Current methods of IOP measurement do not permit temporary noninvasive monitoring 24-hour IOP on a periodic basis. Ongoing research will in time provide a means of developing a device that will enable continuous or temporary monitoring of IOP. At present a device suitable for clinical use is not yet available.This review contains a description of different devices currently in development for measuring IOP: soft contact lens, LC resonant circuits and on-chip sensing devices. All of them use application-specific integrated circuits (ASICS) to process the measured signals and send them to recording devices. Soft contact lens devices are based on an embedded strain gauge, LC circuits vary their resonance frequency depending on the intraocular pressure (IOP) and, finally, on-chip sensing devices include an integrated microelectromechanical sensor (MEMS). MEMS are capacitors whose capacity varies with IOP. These devices allow for an accurate IOP measurement (up to +/– 0.2 mm Hg) with high sampling rates (up to 1 sample/min) and storing 1 week of raw data. All of them operate in an autonomous way and even some of them are energetically independent.

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。

Adjunctive with versus without intravitreal bevacizumab injection before Ahmed glaucoma valve implantation in the treatment of neovascular glaucoma

Background Neovascular glaucoma （NVG） is a refractory disease which is difficult to manage. This study aimed at evaluating the efficacy and safety of adjunctive intravitreal bevacizumab （IVB） injection in conjunction with Ahmed glaucoma valve implantation （AGVI） in the management of NVG. Methods This was a retrospective study of patients with NVG in whom AGVI was performed between October 2008 and May 2012. The sample was divided into two groups according to the pretreatment： with adjunctive IVB injection （the IVB group, n=25 eyes） and without adjunctive IVB injection （the control group, n=28 eyes）. The surgical success rate, number of antiglaucoma medications used, best-corrected visual acuity （BCVA）, postoperative complications, regression, and recurrence of iris neovascularization （NVI） were analyzed between the groups. Results The surgical outcomes of the two groups were compared. The complete success rates in the IVB and control groups were 84.0% and 64.3% at 12 months and 80.0% and 53.6% at 18 months, respectively. There was a significant difference between the two groups （P=0.041）. Mean postoperative intraocular pressures, mean number of postoperative antiglaucoma medications, and BCVA were not significant between the two groups. The NVI in 22 （88.0%） eyes had completely regressed within 2-8 days after IVB. However, NVI recurred in 10 eyes （40.0%） 2-9 months later after IVB. The IVB group had only 1 case （4.0%） of hyphema out of 25 eyes, while there were 8 （28.6%） cases of hyphema out of 28 eyes in the control group （P=0.026）.Conclusions This study showed that preoperative IVB injection reduced NVI remarkably, decreased hyphema, and led to higher surgical success rates. Pre-operative IVB injection may be an effective adjunct to AGVI in the management of NVG.

A prospective comparative study on neovascular glaucoma and non- neovascular refractory glaucoma following Ahmed glaucoma valve implantation

Background Neovascular glaucoma is a refractory disease, and difficult to manage. The aim of this study was to evaluate the clinical outcomes of Ahmed glaucoma valve implantation （AGVI） in neovascular glaucoma （NVG） and non- NVG patients. Methods This prospective, non-randomized study included 55 eyes of 55 patients with refractory glaucoma; 27 had NVG （NVG group） and 28 had non-NVG （non-NVG group）. All of the patients underwent AGVI. The NVG group was adjunctively injected with intravitreal ranibizumab/bevacizumab （IVR/IVB） before AGVI. Intraocular pressure （lOP） was the primary outcome measure in this study. Surgical success rate, number of antiglaucoma medications used, best corrected visual acuity （BCVA）, and postoperative complications were analyzed between the groups. Results All of the patients completed the study （follow-up of 12 months）. Kaplan-Meier survival curve analysis indicated that the qualified success rates in the NVG and non-NVG groups at 12 months were 70.5% and 92.9%, respectively; this difference was significant （P=-0.036）. The complete success rates in the NVG and non-NVG groups at 12 months were 66.7% and 89.3%, respectively （P=0.049）. Compared with preoperative examinations, the postoperative mean lOP and use of medications were significantly lower at all follow-up time points in both groups （all P 〈0.05）. There were significant differences in BCVA between the two groups at the 12-month follow-up （X2=9.86, P=0.020）. Cox proportional hazards regression showed NVG as a risk factor for surgical failure （RR=15.08, P=0.033）. Postoperative complications were similar between the two groups. Conclusions AGVI is a safe and effective procedure in refractory glaucoma, but the success rate of surgery was related to the type of refractory glaucoma. The complete and qualified success rates of NVG patient adjunctive anti-vascular endothelial growth factor treatment are still lower than those of non-NVG patients.

Disorder of blood-aqueous barrier following Ahmed Glaucoma Valve implantation

Background Ahmed Glaucoma Valve implantation （AGVI） is blood-aqueous barrier （BAB） has been noted after some surgica BAB disruption afterAGVl. used to treat refractory glaucoma. Breakdown of the techniques. The current study was designed to assess Methods Anterior chamber protein content was measured by the laser flare cell photometry in 22 eyes of 22 patients with refractory glaucoma before AGVI and at each postoperative visit up to 1 month. Results Before AGVI the mean aqueous flare values in all eyes were （15.17＋9.84） photon counts/ms. After AGVI, the values significantly increased at day 1, day 3, and week I compared to those before AGVI （all P 〈0.05） with a peak at day 3. They returned to pre-operative levels at week 2, and were lower than preoperative level at month 1. Eyes with previous intraocular surgery history had greater aqueous flare values than those without previous intraocular surgery history, but there were no significant differences at all time points postoperatively （all P 〉0.05）. Furthermore, eyes with shallow anterior chambers had greater aqueous flare values at day 3 and week 1 （all P 〈0.05）. When comparing eyes with other refractory glaucoma conditions, neovascular glaucoma combined with intravitreal bevacizumab injection resulted in lower aqueous flare values after AGVI, but no significant differences were observed at all time points, postoperatively （all P 〉0.05）. Conclusions The BAB was impaired and inflammation was present in the anterior chamber in refractory glaucomatous eyes following AGVI. However, such conditions were resolved within 1 month postoperatively. Intravitreal bevacizumab treatment in neovascular glaucoma eyes before AGVI may prevent BAB breakdown.

FP-7/FP-8 Ahmed青光眼引流阀植入治疗儿童难治性青光眼的临床评价

背景 临床研究已证实FP-7/FP-8 Ahmed青光眼引流阀治疗成人难治性青光眼有效且安全,但由于儿童青光眼的病理机制复杂及其临床表现的多样性,采用FP-7/FP-8 Ahmed青光眼引流阀治疗儿童难治性青光眼的疗效和安全性评价较少. 目的 评价FP-7/FP-8 Ahmed青光眼引流阀治疗儿童难治性青光眼的临床效果.方法 采用回顾性系列病例观察研究设计,纳入2008年10月至2011年4月于沧州市中心医院行FP-7/FP-8 Ahmed青光眼引流阀植入术的儿童青光眼患者26例30眼,患者年龄为4个月～16.5岁,包括先天性青光眼小梁/房角切开术后高眼压、晚期先天性青光眼、无晶状体眼或人工晶状体植入术后青光眼、外伤性青光眼和Sturge-Weber综合征.分别于术后1周及1、6、12、24个月复查,观察术眼术后眼压、手术并发症及手术成功率. 结果 患者术前平均眼压为（36.93±177;10.56） mmHg（1 mmHg=0.133 kPa）,术后1周及1、6、12、24个月眼压分别为（13.13±177;3.34）、（14.13±177;3.15）、（15.93±177;4.76）、（17.96±177;5.37）、（19.74±177;5.43） mmHg,不同时间点的眼压整体比较差异有统计学意义（F=58.929,P＜0.05）;与术前眼压值比较,术后1周及1、6、12、24个月术眼眼压均明显下降,差异均有统计学意义（t=11.641、11.458、10.688、7.988、8.018,P＜0.05）.本组术眼术后1周及1、6、12、24个月的累积总成功率分别为100％、96.67％、93.21％、85.76％和71.46％.术后共有8眼出现轻度并发症,包括浅前房4眼、引流管阻塞1眼、前房积血2眼和引流管暴露1眼,经药物或手术治疗后痊愈,未发现术后严重并发症.结论 FP-7/FP-8 Ahmed青光眼引流阀植入术治疗儿童难治性青光眼有效且安全,可作为儿童难治性青光眼的首选手术方式之一.

葡萄膜炎继发性青光眼与其他难治性青光眼Ahmed青光眼引流阀植入后前房反应的非随机对照研究

背景 葡萄膜炎继发性青光眼患者由于葡萄膜的炎症而导致血-房水屏障的破坏,局部手术的创伤刺激可加重炎症反应,对术眼前房炎症反应进行定量检测可监测眼部反应程度. 目的 探讨葡萄膜炎继发性青光眼患者行Ahmed青光眼引流阀植入术后前房内炎症反应是否重于其他类型的难治性青光眼.方法 采用前瞻性非随机对照的病例对照研究方法,于2011年10月至2012年7月纳入在中山大学中山眼科中心确诊的难治性青光眼29例29眼,分为葡萄膜炎继发性青光眼组（10眼）及其他类型的难治性青光眼组（19眼）,2个组间术眼术前性别、年龄、眼压及房水闪辉值等基线特征匹配.所有患者均接受Ahmed房水引流阀植入术并随访3个月,记录术前、术后1d、3d、1周、2周、1个月和3个月术眼的眼压,同时采用FC-2000激光蛋白细胞检测仪定量测定术眼的房水闪辉值,以光粒子数/ms表示.比较2个组间房水引流阀植入术后房水闪辉值的不同,对术眼手术前后眼压值变化与房水闪辉值变化的关系进行分析. 结果 葡萄膜炎继发性青光眼组术后1d、3d和1周房水闪辉值分别为[21.10 （10.50,38.58）]、[88.00（23.55,168.63）]和[29.90（8.90,65.18）]光粒子数/ms,均明显高于术前的[13.53（7.60,24.00）]光粒子数/ms,差异均有统计学意义（均P＜0.01）,术后1个月和3个月房水闪辉值分别为[6.45 （4.70,13.50）]光粒子数/ms和[8.95 （6.23,18.20）]光粒子数/ms,均低于术前值,差异均有统计学意义（均P＜0.01）;其他类型青光眼组遵循同样的趋势.术后3个月葡萄膜炎继发性青光眼组术眼房水闪辉值明显高于其他类型青光眼组,差异有统计学意义（q=-3.445,P＜0.01）.术后2个组间眼压的比较差异无统计学意义（P＞0.05）.所有患者术眼术后眼压值均逐渐下降,术前及术后1d、3d、1周、2周、1个月和3个月术眼眼压与前房闪辉值间均无明显相关性（rs =0.136,P=0.481;rs=0.019,P=0.922;rs =-0.035,P=0.858;r,=0.317,P=0.094;rs=0.034,P=0.861;rs=-0.094,P=0.628;rs=0.065,P=0.738）. 结论 FC-2000激光蛋白细胞检测仪检测证实Ahmed房水引流阀植入术可导致术眼术后早期的前房炎症反应,葡萄膜炎继发性青光眼患者术后炎症反应的恢复较缓慢,术后3个月时房水闪辉值仍高于其他类型的难治性青光眼.

Ahmed青光眼阀治疗难治性青光眼的作用和现状

青光眼是致盲性疾病,难治性青光眼的治疗更为棘手。青光眼房水引流物的出现,是治疗难治性青光眼的突破性进展,提高了中短期治疗成功率,同时也存在较多并发症。本文就常用的引流植入物—Ahmed青光眼阀在治疗难治性青光眼中的作用和研究现状作一综述。

改良的Ahmed青光眼引流阀植入术治疗难治性青光眼的疗效

目的:观察改良的Ahmed引流阀植入术治疗难治性青光眼的临床疗效。方法:回顾性分析2014-01/2018-09在我院行Ahmed引流阀植入手术的难治性青光眼患者30例32眼,按手术方式分为试验组(14例16眼)及对照组(16例16眼)。试验组采用改良Ahmed引流阀植入术,对照组采用传统Ahmed引流阀植入术。观察Ahmed引流阀植入术后1d,1wk,1、3、6mo视力、眼压和并发症等情况。结果:术前,术后1d,1wk,1、3、6mo两组患者眼压无差异(均P>0.05)。术后6mo,两组患者BCVA较术前无差异(均P>0.05)。术后6mo,试验组手术总成功率为87%,对照组为75%(P=0.654),试验组平均住院时间(4.50±1.37d)低于对照组(7.63±3.69d)(P=0.003)。试验组术后6mo内未发生浅前房,对照组术后浅前房发生率为31%。结论:改良Ahmed引流阀植入术治疗难治性青光眼,操作简便,平均住院日短,术后浅前房发生率低,是治疗难治性青光眼的有效方法。

Ahmed青光眼引流阀植入术治疗难治性青光眼的临床疗效观察

[目的]评价Ahm ed青光眼引流阀植入术治疗难治性青光眼的疗效并探讨其并发症的防治。[方法]回顾性分析对23例难治性青光眼行Ahm ed青光眼阀植入术的疗效,主要观察指标为手术前后视力、眼压、并发症及手术成功率等,术后随访6~18月。[结果]术后最佳矫正视力不变8眼,提高12眼,下降3眼。术后眼压控制的有效率达到86.96%,术后并发症主要是早期的短暂性浅前房和高眼压,前房积血,以及晚期的滤过道瘢痕纤维化。[结论]Ahm ed引流阀植入术是治疗难治性青光眼比较有效的方法。