Smith Michael, Buys Yvonne M, Trope Graham E
Department of Ophthalmology and Visual Sciences, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
J Glaucoma. 2009 Aug;18(6):484-7. doi: 10.1097/IJG.0b013e31818fa73b.
To examine the results of removal and simultaneous replacement of Ahmed aqueous drainage devices (ADDs), which require removal due to complications.
Noncomparative retrospective case series of 6 patients.
For the period from January 1999 to December 2007, 325 Ahmed ADD insertions were performed in 272 patients. From this, we identified 6 patients (1.8%) who underwent removal of an ADD for device-associated complications. All had replacement of the Ahmed ADD in a different quadrant at the same surgery. The mean time interval from the original valve insertion was 31.2 months (median, 32.5; range, 3 to 67 mo). The indication for tube removal was chronic uveitis in 3 patients, plate exposure in 2 patients, and tube exposure in 1 patient. We examined the results at 12 months postsimultaneous removal and replacement of the ADD and at final follow-up (median, 25 mo; range, 13 to 52 mo). The preoperative complications resolved in all cases, with the inflammation settling postoperatively in the patients with preoperative uveitis and no patients developing tube or plate exposure at last follow-up. The mean preoperative intraocular pressure (IOP) was 16.0 mm Hg (median, 15.0; range, 9 to 29 mm Hg). At 12 months and final review, the mean IOP was 10.8 mm Hg (median, 10.0; range, 1 to 24 mm Hg) and 11.0 mm Hg (median, 10.0; range, 3 to 24 mm Hg), respectively. The mean number of glaucoma medications preoperatively was 2.8 (median, 3.5; range, 0 to 5). This was reduced to 1.7 (median, 1.5; range, 0 to 4) at 12 months and 2.2 (median, 1.5; range, 0 to 5) at final follow-up. Of the 6 cases in this series, 4 (66.6%) were considered to have adequate IOP control postoperatively. One patient developed postoperative hypotony, with an IOP of 4 mm Hg and reduced vision due to hypotony maculopathy. This patient declined further surgical intervention. One patient had a preoperative IOP of 29 mm Hg on 4 drops and acetazolamide 250 mg b.i.d. At 14 months postsurgery, IOP was 24 mm Hg on 4 drops and the patient underwent insertion of a second ADD. At last follow-up 14 months later, IOP was 10 mm Hg on 4 drops. There were no other significant intraoperative or postoperative complications in this series.
In patients who require removal of Ahmed ADDs due to complications, removal of the offending ADD and replacement in another quadrant is effective in both resolving the complications and maintaining IOP control.
探讨因并发症而需要取出并同时更换艾哈迈德房水引流装置（ADD）的结果。
6例患者的非对照回顾性病例系列。
在1999年1月至2007年12月期间，272例患者进行了325次艾哈迈德ADD植入术。从中，我们确定了6例（1.8%）因装置相关并发症而接受ADD取出术的患者。所有患者均在同一次手术中于不同象限更换了艾哈迈德ADD。从最初植入瓣膜到此次手术的平均时间间隔为31.2个月（中位数为32.5个月；范围为3至67个月）。取出引流管的指征为：3例患者为慢性葡萄膜炎，2例患者为引流盘暴露，1例患者为引流管暴露。我们在同时取出并更换ADD后12个月以及末次随访时（中位数为25个月；范围为13至52个月）检查了结果。所有病例术前并发症均得到解决，术前患有葡萄膜炎的患者术后炎症消退，末次随访时无患者出现引流管或引流盘暴露。术前平均眼压（IOP）为16.0 mmHg（中位数为15.0 mmHg；范围为9至29 mmHg）。在12个月及末次复查时，平均IOP分别为10.8 mmHg（中位数为10.0 mmHg；范围为1至24 mmHg）和11.0 mmHg（中位数为10.0 mmHg；范围为3至24 mmHg）。术前青光眼药物的平均使用数量为2.8种（中位数为3.5种；范围为0至5种）。在12个月时减少至1.7种（中位数为1.5种；范围为0至4种），在末次随访时减少至2.2种（中位数为1.5种；范围为0至5种）。本系列6例病例中，4例（66.6%）被认为术后眼压控制良好。1例患者术后出现低眼压，眼压为4 mmHg，因低眼压性黄斑病变视力下降。该患者拒绝进一步手术干预。1例患者术前使用4种滴眼液和每日2次、每次250 mg乙酰唑胺时眼压为29 mmHg。术后14个月，使用4种滴眼液时眼压为24 mmHg，该患者接受了第二次ADD植入术。在14个月后的末次随访时，使用4种滴眼液时眼压为10 mmHg。本系列中无其他显著的术中或术后并发症。
对于因并发症而需要取出艾哈迈德ADD的患者，取出有问题的ADD并在另一象限进行更换，在解决并发症和维持眼压控制方面均有效。
