Jiménez-Román Jesús, Gil-Carrasco Félix, Costa Vital Paulino, Schimiti Rui Barroso, Lerner Fabián, Santana Priscila Rezende, Vascocellos Jose Paulo Cabral, Castillejos-Chévez Armando, Turati Mauricio, Fabre-Miranda Karina
Glaucoma Department, Asociación Para Evitar la Ceguera en México, Mexico City, Mexico.
Glaucoma Department, UNICAMP, Sao Paulo, Brazil.
Int Ophthalmol. 2016 Jun;36(3):347-53. doi: 10.1007/s10792-015-0125-z. Epub 2015 Sep 3.
The objective of this study is to evaluate the efficacy and safety of a second Ahmed glaucoma valve (AGV) in eyes with refractory glaucoma that had undergone prior Ahmed device implantation. This multicenter, retrospective study evaluated 58 eyes (58 patients) that underwent a second AGV (model S2-n = 50, model FP7-n = 8) due to uncontrolled IOP under maximal medical therapy. Outcome measures included IOP, visual acuity, number of glaucoma medications, and postoperative complications. Success was defined as IOP <21 mmHg (criterion 1) or 30 % reduction of IOP (criterion 2) with or without hypotensive medications. Persistent hypotony (IOP <5 mmHg after 3 months of follow-up), loss of light perception, and reintervention for IOP control were defined as failure. Mean preoperative IOP and mean IOPs at 12 and 30 months were 27.55 ± 1.16 mmHg (n = 58), 14.45 ± 0.83 mmHg (n = 42), and 14.81 ± 0.87 mmHg (n = 16), respectively. The mean numbers of glaucoma medications preoperatively at 12 and 30 months were 3.17 ± 0.16 (n = 58), 1.81 ± 0.2 (n = 42), and 1.83 ± 0.35 (n = 18), respectively. The reductions in mean IOP and number of medications were statistically significant at all time intervals (P < 0.001). According to criterion 1, Kaplan-Meier survival curves disclosed success rates of 62.9 % at 12 months and 56.6 % at 30 months. According to criterion 2, Kaplan-Meier survival curves disclosed success rates of 43.9 % at 12 months and 32.9 % at 30 months. The most frequent early complication was hypertensive phase (10.3 %) and the most frequent late complication was corneal edema (17.2 %). Second AGV implantation may effectively reduce IOP in eyes with uncontrolled glaucoma, and is associated with relatively few complications.
本研究的目的是评估第二代艾哈迈德青光眼引流阀（AGV）在先前已植入艾哈迈德装置的难治性青光眼患者眼中的疗效和安全性。这项多中心回顾性研究评估了58例患者的58只眼睛，这些患者因在最大药物治疗下眼压仍无法控制而接受了第二代AGV植入（S2型n = 50，FP7型n = 8）。观察指标包括眼压、视力、青光眼药物使用数量和术后并发症。成功定义为眼压<21 mmHg（标准1）或眼压降低30%（标准2），无论是否使用降压药物。持续性低眼压（随访3个月后眼压<5 mmHg）、光感丧失以及为控制眼压而再次干预定义为失败。术前平均眼压以及术后12个月和30个月的平均眼压分别为27.55±1.1,6 mmHg（n = 58）、14.45±0.83 mmHg（n = 42）和14.81±0.87 mmHg（n = 16）。术前、术后12个月和30个月青光眼药物的平均使用数量分别为3.17±0.16（n = 58）、1.81±0.2（n = 42）和1.·83±0.35（n = 18）。在所有时间间隔内，平均眼压和药物使用数量的降低均具有统计学意义（P < 0.001）。根据标准1，Kaplan-Meier生存曲线显示12个月时成功率为62.9%，30个月时为56.6%。根据标准2，Kaplan-Meier生存曲线显示12个月时成功率为43.9%，30个月时为32.9%。最常见的早期并发症是高血压期（10.3%），最常见的晚期并发症是角膜水肿（17.2%）。第二代AGV植入可有效降低眼压控制不佳的青光眼患者的眼压，且并发症相对较少。
