Tsai James C, Johnson Cameron C, Kammer Jeffrey A, Dietrich Mary S
Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Ophthalmology. 2006 Jun;113(6):913-7. doi: 10.1016/j.ophtha.2006.02.029.
To analyze the longer-term surgical outcomes of Ahmed and Baerveldt shunt implants in the treatment of refractory glaucoma.
Retrospective, nonrandomized, comparative trial.
Consecutive patients who underwent glaucoma shunt implantation (70 Baerveldt, 48 Ahmed) by a single surgeon.
Follow-up retrospective analysis of 118 consecutive cases of refractory glaucoma that required placement of either Ahmed or Baerveldt shunt implants for intraocular pressure (IOP) control. The longer term clinical course (survival curve analysis up to 48 months) was reviewed.
The primary outcome measure was surgical success (6 mmHg < or = IOP < or = 21 mmHg without additional glaucoma surgery or devastating complication). 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 (up to 48 months). In unsuccessful cases, the median time to failure was determined.
No significant differences in success rates were noted at 1, 2, 3, or 4 years after surgery, with 4-year success rates of 62% for the Ahmed group and 64% for the Baerveldt group (P = 0.843). Mean IOPs were comparable from 1 to 48 months (P>0.05). However, patients in the Ahmed group required more glaucoma medications at 18, 24, 30, and 36 months (P<0.05). The median times to failure were 3.2 months in the Baerveldt group, compared with 15.0 months in the Ahmed group (P = 0.009).
No differences were observed in longer term survival rates and IOP profiles between Ahmed and Baerveldt shunt implants up to 48 months following surgery. Patients in the Baerveldt group were more likely to develop early postoperative hypotony-related complications and failure, whereas patients undergoing Ahmed implants were more likely to be on additional glaucoma medications (starting at 18 months postsurgery) and develop later onset failure.
分析Ahmed分流管和Baerveldt分流管植入术治疗难治性青光眼的长期手术效果。
回顾性、非随机、对照试验。
由同一外科医生连续进行青光眼分流管植入术的患者（70例植入Baerveldt分流管，48例植入Ahmed分流管）。
对118例连续的难治性青光眼患者进行随访回顾分析，这些患者均需要植入Ahmed或Baerveldt分流管以控制眼压。回顾长期临床病程（生存曲线分析长达48个月）。
主要观察指标为手术成功（眼压6 mmHg≤眼压≤21 mmHg，无需额外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个月及此后每6个月（直至48个月）随访时的平均眼压和使用的药物数量。对于手术失败的病例，确定失败的中位时间。
术后1年、2年、3年和4年的成功率无显著差异，Ahmed组4年成功率为62%，Baerveldt组为64%（P = 0.843）。1至48个月的平均眼压相当（P>0.05）。然而，Ahmed组患者在术后18、24、30和36个月需要更多的青光眼药物（P<0.05）。Baerveldt组失败的中位时间为3.2个月，而Ahmed组为15.0个月（P = 0.009）。
术后长达48个月，Ahmed分流管和Baerveldt分流管植入术的长期生存率和眼压情况无差异。Baerveldt组患者术后早期更易发生与低眼压相关的并发症和手术失败，而植入Ahmed分流管的患者更易在术后18个月开始使用额外的青光眼药物，并出现较晚发生的手术失败。
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