Ahmed青光眼引流阀植入术治疗玻璃体切割术后继发性青光眼的临床观察
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摘要
目的观察Ahmed青光眼引流阀(AGV)植入术治疗玻璃体切割术后继发性青光眼的临床疗效。方法回顾性分析2012年2月—2016年11月行AGV FP7植入术的玻璃体切割术后继发性青光眼患者38例(38眼)的临床资料,观察术前,术后1 d、1、3、6、12、24月时的视力、眼压、手术成功率及术后并发症情况。结果患者术前与术后24月视力比较,差异无统计学意义(Z=-1.492,P=0.136)。术前、术后1 d、1、3、6、12、24月眼压整体比较差异有统计学意义(F=284.520,P <0.001);与术前相比,术后1 d、1、3、6、12、24月时眼压均明显下降,差异均有统计学意义(P <0.001)。治疗后各时间点两两比较差异均无统计学意义(P>0.05)。术后1、3、6、12、24月时手术累积总成功率分别为97.37%、94.74%、86.84%、78.95%、76.32%。术后早期共有14眼出现并发症,包括前房积血11眼、浅前房1眼和引流管阻塞2眼。晚期共有8眼出现并发症,包括滤过泡纤维包裹6眼,引流阀暴露1眼,角膜内皮失代偿1眼。结论 Ahmed青光眼引流阀植入术治疗玻璃体切割术后继发性青光眼效果良好,安全性高。
Objective To observe the clinical efficacy of Ahmed glaucoma valve(AGV) implantation on secondary glaucoma after vitrectomy surgeries.Methods A retrospective analysis was made of 38 cases(38 eyes)of secondary glaucoma after vitrectomy surgeries from February 2012 to November 2016 for AGV FP7 implantation.The follow-up ranged from 1 day to 24 months to observe visual acuity,intraocular pressure(IOP),cumulative success rate and postoperative complications.Results There was no significant difference in visual acuity between preoperative and 24 months after operations(Z =-1.492,P = 0.136).The IOP before operation1 day,1 month,3 months,6 months,12 months and 24 months following surgeries was significantly different betweem various time points(F = 284.520,P < 0.001).Compared with the preoperative situation,IOP decreased significantly at 1 day,1 month,3 months,6 months,12 months,and 24 months after surgeries,the difference was statistically significant(P < 0.001).But those after treatment had no difference from each other(P > 0.05).The total cumulative success rate at 1 month,3 months,6 months,12 months and 24 months was97.37%,94.74%,86.84%,78.95% and 76.32%,respectively.There were 14 eyes with complications in the early postoperative period,including hyphema,shallow anterior chamber and drainage tube obstruction,all of which were relieved by drug or surgery.There were 8 eyes with complications in the late stage,including encapsulated cyst formation and valve exposure,all of which were relieved after surgeries.Corneal endothelial decompensation occurred in one patient who refused to undergo keratoplasty.Conclusion Ahmed glaucoma valve implantation is effective and safe in the treatment of secondary glaucoma after vitrectomy surgeries.
Objective To observe the clinical efficacy of Ahmed glaucoma valve(AGV) implantation on secondary glaucoma after vitrectomy surgeries.Methods A retrospective analysis was made of 38 cases(38 eyes)of secondary glaucoma after vitrectomy surgeries from February 2012 to November 2016 for AGV FP7 implantation.The follow-up ranged from 1 day to 24 months to observe visual acuity,intraocular pressure(IOP),cumulative success rate and postoperative complications.Results There was no significant difference in visual acuity between preoperative and 24 months after operations(Z =-1.492,P = 0.136).The IOP before operation1 day,1 month,3 months,6 months,12 months and 24 months following surgeries was significantly different betweem various time points(F = 284.520,P < 0.001).Compared with the preoperative situation,IOP decreased significantly at 1 day,1 month,3 months,6 months,12 months,and 24 months after surgeries,the difference was statistically significant(P < 0.001).But those after treatment had no difference from each other(P > 0.05).The total cumulative success rate at 1 month,3 months,6 months,12 months and 24 months was97.37%,94.74%,86.84%,78.95% and 76.32%,respectively.There were 14 eyes with complications in the early postoperative period,including hyphema,shallow anterior chamber and drainage tube obstruction,all of which were relieved by drug or surgery.There were 8 eyes with complications in the late stage,including encapsulated cyst formation and valve exposure,all of which were relieved after surgeries.Corneal endothelial decompensation occurred in one patient who refused to undergo keratoplasty.Conclusion Ahmed glaucoma valve implantation is effective and safe in the treatment of secondary glaucoma after vitrectomy surgeries.
引文
[1] Liu Zhen, Fu Gang, Liu Ai-hua. The relationship between inflammatory mediator expression in the aqueous humor and secondary glaucoma incidence after silicone oil tamponade[J]. Experimental and Therapeutic Medicine, 2017,14(6):5833—5836
[2] Gedde SJ. Management of glaucoma after retinal detachment surgery[J]. Current Opinion in Ophthalmology, 2002,13(2):103—109
[3] Zhou Xiao-ping, Kuang Guo-ping, Ou Yu-lun, et al. Efficacy of two different treatments for secondary glaucoma after traumatic vitrectomy[J]. International Eye Science,2017, 17(5):925—927
[4] He Ye, Tian Ying, Song Wei-tao, et al. Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors:a strobecompliant article[J]. Medicine, 2017, 96(42):e8350
[5] Wu L, Berrocal MH, Rodriguez FJ, et al. Intraocular pressure elevation after uncomplicated pars plana vitrectomy:results of the pan American collaborative retina study group[J]. Retina, 2014, 34(10):1985—1989
[6] Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vitrectomy and silicone oil injection[J]. Ophthalmologica, 2018, 240(3):129—134
[7] Stefansson E. Physiology of vitreous surgery[J]. Graefes Archive Clinical and Experimental Ophthalmology, 2009,247(2):147—163
[8] Holekamp NM, Shui YB, Beebe DC. Vitrectomy surgery increases oxygen exposure to the lens:a possible mechanism for nuclear cataract formation[J]. American Journal of Ophthalmology, 2005, 139(2):302—310
[9] Chang S. LXII Edward Jackson lecture:open angle glaucoma after vitrectomy[J]. American Journal of Ophthalmology, 2006, 141(6):1033—1043
[10] Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy(TVT)study after five years of follow-up[J]. American Journal of Ophthalmology, 2012, 153(5):789—803
[11] Sarkisian SR. Tube shunt complications and their prevention[J]. Current Opinion in Ophthalmology, 2009,20(2):126—130
[12] Hille K, Moustafa B, Hille A, et al. Drainage devices in glaucoma surgery[J]. Klinika Oczna, 2004, 106(4/5):670—681
[13] Elhefney E, Mokbel T, Abou SW, et al. Long-term results of Ahmed glaucoma valve implantation in Egyptian population[J]. International Journal of Ophthalmology,2018, 11(3):416—421
[14] Ishida K, Ahmed IP. Ahmed glaucoma valve surgical outcomes in eyes with and without silicone oil endotamponade[J]. Journal of Glaucoma, 2009, 18(4):325—330
[15] Lee CK, Ma KT, Hong YJ, et al. Long-term clinical outcomes of Ahmed valve implantation in patients with refractory glaucoma[J]. PLoS One, 2017, 12(11):e0187533
[2] Gedde SJ. Management of glaucoma after retinal detachment surgery[J]. Current Opinion in Ophthalmology, 2002,13(2):103—109
[3] Zhou Xiao-ping, Kuang Guo-ping, Ou Yu-lun, et al. Efficacy of two different treatments for secondary glaucoma after traumatic vitrectomy[J]. International Eye Science,2017, 17(5):925—927
[4] He Ye, Tian Ying, Song Wei-tao, et al. Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors:a strobecompliant article[J]. Medicine, 2017, 96(42):e8350
[5] Wu L, Berrocal MH, Rodriguez FJ, et al. Intraocular pressure elevation after uncomplicated pars plana vitrectomy:results of the pan American collaborative retina study group[J]. Retina, 2014, 34(10):1985—1989
[6] Jabbour E, Azar G, Antoun J, et al. Incidence and risk factors of ocular hypertension following pars plana vitrectomy and silicone oil injection[J]. Ophthalmologica, 2018, 240(3):129—134
[7] Stefansson E. Physiology of vitreous surgery[J]. Graefes Archive Clinical and Experimental Ophthalmology, 2009,247(2):147—163
[8] Holekamp NM, Shui YB, Beebe DC. Vitrectomy surgery increases oxygen exposure to the lens:a possible mechanism for nuclear cataract formation[J]. American Journal of Ophthalmology, 2005, 139(2):302—310
[9] Chang S. LXII Edward Jackson lecture:open angle glaucoma after vitrectomy[J]. American Journal of Ophthalmology, 2006, 141(6):1033—1043
[10] Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy(TVT)study after five years of follow-up[J]. American Journal of Ophthalmology, 2012, 153(5):789—803
[11] Sarkisian SR. Tube shunt complications and their prevention[J]. Current Opinion in Ophthalmology, 2009,20(2):126—130
[12] Hille K, Moustafa B, Hille A, et al. Drainage devices in glaucoma surgery[J]. Klinika Oczna, 2004, 106(4/5):670—681
[13] Elhefney E, Mokbel T, Abou SW, et al. Long-term results of Ahmed glaucoma valve implantation in Egyptian population[J]. International Journal of Ophthalmology,2018, 11(3):416—421
[14] Ishida K, Ahmed IP. Ahmed glaucoma valve surgical outcomes in eyes with and without silicone oil endotamponade[J]. Journal of Glaucoma, 2009, 18(4):325—330
[15] Lee CK, Ma KT, Hong YJ, et al. Long-term clinical outcomes of Ahmed valve implantation in patients with refractory glaucoma[J]. PLoS One, 2017, 12(11):e0187533
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