Tsai James C, Johnson Cameron C, Dietrich Mary S
Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Ophthalmology. 2003 Sep;110(9):1814-21. doi: 10.1016/S0161-6420(03)00574-8.
To compare the surgical outcome of Baerveldt and Ahmed shunt implants in the treatment of refractory glaucoma.
Retrospective, nonrandomized, comparative trial.
Medical records of 118 consecutive patients who underwent glaucoma shunt implantation (70 Baerveldt, 48 Ahmed) by a single surgeon were reviewed.
The primary outcome measure was surgical success (6 mmHg <or= intraocular pressure [IOP] <or= 21 mmHg without additional glaucoma surgery or devastating complication) at 12 months after surgery. Secondary outcome measures included mean IOP and number of medications used at the following postoperative visits: day 1, 1 week, 1 month, 3 months, 6 months, and every 6 months thereafter. Additional outcome measures evaluated include visual acuities, prevalence and timing of postoperative choroidal detachment, and clinical bleb encapsulation.
Survival curve analysis showed success rates of 82.9% of the Ahmed group and 72.9% of the Baerveldt group at 12 months after surgery (P = 0.257). Patients in the Ahmed group exhibited lower IOPs at 1 day (P < 0.001) and 1 week (P < 0.001) after surgery and were taking fewer glaucoma medications at 1 week (P < 0.001) and 1 month (P < 0.001) after surgery. A higher proportion of Ahmed patients experienced clinical bleb encapsulation than did the Baerveldt patients (60.4% vs. 27.1%; P < 0.001). Moreover, the first observation of postoperative bleb encapsulation was sooner after surgery for the Ahmed patients (50.0 +/- 43.8 days) than for the Baerveldt patients (69.8 +/- 22.6 days; P = 0.001).
The Ahmed shunt implant exhibited better control of IOP in the early postoperative period (1 day and 1 week) with patients requiring fewer glaucoma medications at 1 week and 1 month after surgery. There was both a higher prevalence and earlier onset of bleb encapsulation observed with the Ahmed shunt implant.
比较贝尔维德（Baerveldt）分流植入物和艾哈迈德（Ahmed）分流植入物治疗难治性青光眼的手术效果。
回顾性、非随机、对照试验。
回顾了由一名外科医生连续进行青光眼分流植入手术的118例患者的病历（70例使用贝尔维德分流植入物，48例使用艾哈迈德分流植入物）。
主要观察指标为术后12个月时的手术成功率（眼压[IOP]≤6 mmHg或≤21 mmHg，无需额外的青光眼手术或严重并发症）。次要观察指标包括术后第1天、1周、1个月、3个月、6个月及之后每6个月随访时的平均眼压和使用的药物数量。评估的其他观察指标包括视力、术后脉络膜脱离的发生率和时间，以及临床滤过泡包裹情况。
生存曲线分析显示，术后12个月时，艾哈迈德组的成功率为82.9%，贝尔维德组为72.9%（P = 0.257）。艾哈迈德组患者在术后1天（P < 0.001）和1周（P < 0.001）时眼压较低，在术后1周（P < 0.001）和1个月（P < 0.001）时使用的青光眼药物较少。与贝尔维德组患者相比，艾哈迈德组患者发生临床滤过泡包裹的比例更高（60.4%对27.1%；P < 0.001）。此外，艾哈迈德组患者术后首次观察到滤过泡包裹的时间（50.0±43.8天）比贝尔维德组患者（69.8±22.6天；P = 0.001）更早。
艾哈迈德分流植入物在术后早期（1天和1周）对眼压的控制更好，术后1周和1个月时患者使用的青光眼药物较少。使用艾哈迈德分流植入物观察到滤过泡包裹的发生率更高且发生时间更早。
