巩膜长隧道法Ahmed阀植入术治疗新生血管性青光眼的一年效果观察
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摘要
目的研究经巩膜长隧道法植入Ahmed青光眼引流阀治疗新生血管性青光眼的疗效。设计回顾性比较性病例系列。研究对象福建医科大学第一医院新生血管性青光眼患者20例(20眼)。方法常规巩膜瓣下植入组10例10眼,巩膜长隧道法植入组10例10眼。巩膜长隧道法系用27G针头在颞上方距角巩膜缘4mm处巩膜穿刺入前房形成巩膜隧道用以插入引流管。术后平均随访(11.6±5.77)个月。主要指标眼压、手术成功率及术后并发症。结果末次随访时,常规巩膜瓣下植入组平均眼压(17.0±8.97)mmHg,巩膜长隧道组平均眼压(18.5±7.78) mmHg。组内各随访时间点的眼压同术前相比,差异具统计学意义。组间各随访时间点的眼压之间相比较,差异无统计学意义。完全成功率常规巩膜辦组60%,巩膜长隧道组80%(P=0.035);部分成功率常规巩膜辦组30%,巩膜长隧道组20%(P=0.487)。常规巩膜辦组、巩膜长隧道组低眼压性浅前房发生率(4例、0例)比较,差异有统计学意义(P=0.0433)。结论引流管经巩膜长隧道植入Ahmed阀治疗新生血管性青光眼对巩膜组织损伤更轻、操作更简便,且术后早期浅前房并发症更少,1年的降眼压效果不亚于常规巩膜瓣下植入法。
Objective To evaluate the efficacy of Ahmed glaucoma valve(AGV) implantation via two different pathways on intraocular pressure(IOP) and complications in patients with neovascular glaucoma(NVG). Design Retrospective comparative case series.Participants Twenty cases(20 eyes) with NVG were undergone AGV implantations in First Hospital of Fujian Medical University.Methods Ten cases(10 eyes) were treated with scleral flaps implantation(SF group), the other 10 cases(10 eyes) were treated with scleral tunnels implantation(ST group). In the scleral tunnel group, a 27 G needle was inserted into the anterior chamber parallel to the iris at 4 mm from temporal-superior comer limbus to form a tunnel for inserting a drainage tube of Ahmed glaucoma valve. A follow-up ranged from 1 to 29 months(mean 11.6±5.77 months). Main Outcome Measures IOP, surgical success rate and complications with slit-lamp. Results Compared with pre-operation, IOP was significantly reduced to 17.0±8.97 mmHg in the SF group, while significantly decreased to 18.5±7.78 mmHg in the ST group at the end of follow-up. The difference of IOP at each time point in each group was statistically significant compared with that before surgery. However, there was no significant difference in IOP between two groups at each time point of follow-up. The complete success rate of SF group was 60% and the partial success rate of 30%. The complete success rate of ST group was 80% and the partial success rate of 20%. The complete success rate between two groups was statistically significant(P=0.035), while the partial success rate was not statistically significant(P=0.487). The incidence of shallow anterior chamber with low tension of the ST group(0 case) was significantly lower than that of the SF group(4 cases)(P=0.0433). Conclusion The efficacy is similar between the two different pathways of AGV implantations in patients with NVG. Our results indicate that the procedure via scleral tunnels is simpler and convenient with a lower incidence of shallow anterior chamber with low tension within one year.
Objective To evaluate the efficacy of Ahmed glaucoma valve(AGV) implantation via two different pathways on intraocular pressure(IOP) and complications in patients with neovascular glaucoma(NVG). Design Retrospective comparative case series.Participants Twenty cases(20 eyes) with NVG were undergone AGV implantations in First Hospital of Fujian Medical University.Methods Ten cases(10 eyes) were treated with scleral flaps implantation(SF group), the other 10 cases(10 eyes) were treated with scleral tunnels implantation(ST group). In the scleral tunnel group, a 27 G needle was inserted into the anterior chamber parallel to the iris at 4 mm from temporal-superior comer limbus to form a tunnel for inserting a drainage tube of Ahmed glaucoma valve. A follow-up ranged from 1 to 29 months(mean 11.6±5.77 months). Main Outcome Measures IOP, surgical success rate and complications with slit-lamp. Results Compared with pre-operation, IOP was significantly reduced to 17.0±8.97 mmHg in the SF group, while significantly decreased to 18.5±7.78 mmHg in the ST group at the end of follow-up. The difference of IOP at each time point in each group was statistically significant compared with that before surgery. However, there was no significant difference in IOP between two groups at each time point of follow-up. The complete success rate of SF group was 60% and the partial success rate of 30%. The complete success rate of ST group was 80% and the partial success rate of 20%. The complete success rate between two groups was statistically significant(P=0.035), while the partial success rate was not statistically significant(P=0.487). The incidence of shallow anterior chamber with low tension of the ST group(0 case) was significantly lower than that of the SF group(4 cases)(P=0.0433). Conclusion The efficacy is similar between the two different pathways of AGV implantations in patients with NVG. Our results indicate that the procedure via scleral tunnels is simpler and convenient with a lower incidence of shallow anterior chamber with low tension within one year.
引文
[1] Bai YJ, Li YQ, Chai F, et al. Comparison of FP-7 and S-2 Ahmed glaucoma valve implantation in refractory glaucoma patients for short-term follow-up. Chin Med J(Engl), 2011, 124(8):1128-1133.
[2]李美玉.青光眼学.北京:人民卫生出版社,2004:68-70.
[3] Mokbel TH, Khalaf MA, El-Khouly SE, et al. Flexible Ahmed valve for selected cases of refractory glaucoma. Eur J Ophthalmol, 2012,22(1):83-89.
[4]赵琪,李静敏,王慧珠.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.大连医科大学学报,2011,33(1):64-66.
[5]中华医学会眼科学分会青光眼学组.我国青光眼引流阀植入手术操作规范专家共识(2016年).中华眼科杂志,2016, 52(6):407-409.
[6] Gedde SJ, Schiffman JC, Feuer WJ, et al.Treatment outcomes in the tube versus trabeculectomy(TVT)study after five years offollow-up. Am J Ophthalmol, 2012,143(1):9-22.
[7]周民稳,王伟,王世明,等.不同材料的引流管覆盖物在房水引流阀植人术中的应用研究.中华眼科杂志,2013,49(2):102-108.
[8]林明楷,葛坚,卓业鸿,等.异体巩膜瓣联合引流管植人治疗难治性青光眼.中华显微外科杂志,2006, 29(6):463-465.
[9] Mukhtaramovich BM, Ildarovich KI. The results of the use of Ahmed valve in refractory glaucoma surgery. J Curr Glaucoma Pract,2015, 9(3):86-91.
[10] Ozdamar A, Aras C, Ustundag C, et al. Scleral tunnel for the implantation of glaucoma seton devices. Ophthalmic Surg Lasers,2001, 32(5):432-435.
[11] Ozdamar A, Aras C, Karacorlu M. Suprachoroidal seton implantation in refractory glaucoma:a novel surgical technique. J Glaucoma, 2003, 12(4):354-359.
[12]王云,谢驰,于燕,等.Ahmed引流阀植人术治疗新生血管性青光眼临床观察.临床眼科杂志,2013, 21(5):422-424.
[13] Rj G, Phan AD, Cantor LB, et al. Efficacy of the Ahmed S2glaucoma valve compared with the Baerveldt 250-mm2 glaucoma implant. Ophthalmology, 2008, 115(7):1141-1147.
[2]李美玉.青光眼学.北京:人民卫生出版社,2004:68-70.
[3] Mokbel TH, Khalaf MA, El-Khouly SE, et al. Flexible Ahmed valve for selected cases of refractory glaucoma. Eur J Ophthalmol, 2012,22(1):83-89.
[4]赵琪,李静敏,王慧珠.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.大连医科大学学报,2011,33(1):64-66.
[5]中华医学会眼科学分会青光眼学组.我国青光眼引流阀植入手术操作规范专家共识(2016年).中华眼科杂志,2016, 52(6):407-409.
[6] Gedde SJ, Schiffman JC, Feuer WJ, et al.Treatment outcomes in the tube versus trabeculectomy(TVT)study after five years offollow-up. Am J Ophthalmol, 2012,143(1):9-22.
[7]周民稳,王伟,王世明,等.不同材料的引流管覆盖物在房水引流阀植人术中的应用研究.中华眼科杂志,2013,49(2):102-108.
[8]林明楷,葛坚,卓业鸿,等.异体巩膜瓣联合引流管植人治疗难治性青光眼.中华显微外科杂志,2006, 29(6):463-465.
[9] Mukhtaramovich BM, Ildarovich KI. The results of the use of Ahmed valve in refractory glaucoma surgery. J Curr Glaucoma Pract,2015, 9(3):86-91.
[10] Ozdamar A, Aras C, Ustundag C, et al. Scleral tunnel for the implantation of glaucoma seton devices. Ophthalmic Surg Lasers,2001, 32(5):432-435.
[11] Ozdamar A, Aras C, Karacorlu M. Suprachoroidal seton implantation in refractory glaucoma:a novel surgical technique. J Glaucoma, 2003, 12(4):354-359.
[12]王云,谢驰,于燕,等.Ahmed引流阀植人术治疗新生血管性青光眼临床观察.临床眼科杂志,2013, 21(5):422-424.
[13] Rj G, Phan AD, Cantor LB, et al. Efficacy of the Ahmed S2glaucoma valve compared with the Baerveldt 250-mm2 glaucoma implant. Ophthalmology, 2008, 115(7):1141-1147.