Netland Peter A
Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, USA.
Trans Am Ophthalmol Soc. 2009 Dec;107:325-42.
To evaluate the results of Ahmed glaucoma valve surgery in neovascular glaucoma and control patients.
In this retrospective comparative study, we reviewed 76 eyes of 76 patients, comparing the surgical outcomes in control patients (N=38) to matched neovascular glaucoma patients (N=38). Success was defined as intraocular pressure (IOP) > or =6 mm Hg and < or =21 mm Hg, without further glaucoma surgery, and without loss of light perception.
Average follow-up for control and neovascular glaucoma patients was 18.4 and 17.4 months, respectively (P = .550). At last follow-up, mean IOP was 16.2 +/- 5.2 mm Hg and 15.5 +/- 12.5 mm Hg (P = .115) in control and neovascular glaucoma patients, respectively. Life-table analysis showed a significantly lower success for neovascular glaucoma patients compared with controls (P = .0096), with success at 1 year of 89.2% and 73.1%, at 2 years of 81.8% and 61.9%, and at 5 years of 81.8% and 20.6% for control and neovascular glaucoma eyes, respectively. Cox proportional hazards regression analysis showed neovascular glaucoma as a risk factor for surgical failure (odds ratio, 5.384, 95% CI, 1.22-23.84, P = .027). Although IOP control and complications were comparable between the two groups, visual outcomes were worse in neovascular glaucoma patients, with 9 eyes (23.7%) with neovascular glaucoma compared with no controls losing light perception vision (P = .002). The majority with loss of vision (5 of 9) had successful control of IOP during the postoperative period.
Neovascular glaucoma patients have greater risk of surgical failure after Ahmed glaucoma valve surgery compared with controls. Despite improved mean IOP with drainage implants, visual outcomes may be poor, possibly due to progression of underlying disease.
评估艾哈迈德青光眼引流阀手术治疗新生血管性青光眼及对照患者的效果。
在这项回顾性对照研究中，我们对76例患者的76只眼进行了回顾，比较了对照患者（N = 38）与配对的新生血管性青光眼患者（N = 38）的手术结果。成功定义为眼压（IOP）≥6 mmHg且≤21 mmHg，无需进一步行青光眼手术，且无光感丧失。
对照患者和新生血管性青光眼患者的平均随访时间分别为18.4个月和17.4个月（P = 0.550）。在最后一次随访时，对照患者和新生血管性青光眼患者的平均眼压分别为16.2±5.2 mmHg和15.5±12.5 mmHg（P = 0.115）。寿命表分析显示，新生血管性青光眼患者的成功率显著低于对照组（P = 0.0096），对照眼和新生血管性青光眼眼在1年时的成功率分别为89.2%和73.1%，2年时分别为81.8%和61.9%，5年时分别为81.8%和20.6%。Cox比例风险回归分析显示新生血管性青光眼是手术失败的危险因素（比值比，5.384，95%可信区间，1.22 - 23.84，P = 0.027）。虽然两组之间的眼压控制和并发症相当，但新生血管性青光眼患者的视力预后较差，9例（23.7%）新生血管性青光眼患者无光感，而对照组无此情况（P = 0.002）。大多数视力丧失患者（9例中的5例）在术后眼压得到了成功控制。
与对照组相比，新生血管性青光眼患者在接受艾哈迈德青光眼引流阀手术后手术失败的风险更高。尽管引流植入物使平均眼压有所改善，但视力预后可能较差，这可能是由于潜在疾病的进展所致。
