Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
PLoS One. 2012;7(5):e37867. doi: 10.1371/journal.pone.0037867. Epub 2012 May 21.
To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) surgery and the optimal interval between penetrating keratoplasty (PKP) and AGV implantation in a population of Asian patients with preexisting glaucoma who underwent PKP.
METHODOLOGY/PRINCIPAL FINDINGS: In total, 45 eyes of 45 patients were included in this retrospective chart review. The final intraocular pressures (IOPs), graft survival rate, and changes in visual acuity were assessed to evaluate the outcomes of AGV implantations in eyes in which AGV implantation occurred within 1 month of post-PKP IOP elevation (Group 1) and in eyes in which AGV implantation took place more than 1 month after the post-PKP IOP evaluation (Group 2). Factors that were associated with graft failure were analyzed, and the overall patterns of complications were reviewed. By their final follow-up visits, 58% of the patients had been successfully treated for glaucoma. After the operation, there were no statistically significant differences between the groups with respect to graft survival (p = 0.98), but significant differences for IOP control (p = 0.049) and the maintenance of visual acuity (VA) (p<0.05) were observed. One year after surgery, the success rates of IOP control in Group 1 and Group 2 were 80% and 46.7%, respectively, and these rates fell to 70% and 37.3%, respectively, by 2 years. Factors that were associated with a high risk of AGV failure were a diagnosis of preexisting angle-closure glaucoma, a history of previous PKP, and a preoperative IOP that was >21 mm Hg. The most common surgical complication, aside from graft failure, was hyphema.
CONCLUSIONS/SIGNIFICANCE: Early AGV implantation results in a higher probability of AGV survival and a better VA outcome without increasing the risk of corneal graft failure as a result of post-PKP glaucoma drainage tube implantation.
评估 Ahmed Glaucoma Valve (AGV) 手术在亚洲青光眼患者中的疗效，这些患者在穿透性角膜移植术（PKP）后眼压升高时行 AGV 植入的最佳时间间隔。
方法/主要发现：本回顾性图表研究共纳入 45 例 45 眼患者。评估最终眼压（IOP）、移植物存活率和视力变化，以评估 AGV 植入对 PKP 后眼压升高 1 个月内（AGV 植入组 1）和 PKP 后眼压评估后 1 个月以上（AGV 植入组 2）发生的眼的 AGV 植入的结果。分析与移植物失败相关的因素，并回顾并发症的总体模式。在最后一次随访时，58%的患者成功治疗青光眼。术后两组间移植物存活率无统计学差异（p=0.98），但眼压控制（p=0.049）和视力（VA）维持（p<0.05）有显著差异。术后 1 年，AGV 植入组 1 和组 2 的眼压控制成功率分别为 80%和 46.7%，术后 2 年分别降至 70%和 37.3%。AGV 失败风险高的相关因素为：既往闭角型青光眼诊断、既往 PKP 病史和术前 IOP>21mmHg。除移植物失败外，最常见的手术并发症是前房积血。
结论/意义：早期 AGV 植入可提高 AGV 存活率和 VA 结果的可能性，同时不会因 PKP 后引流管植入而增加角膜移植物失败的风险。
