第二次植入艾哈迈德青光眼引流阀术后的成功率评估。
Evaluation of success after second Ahmed glaucoma valve implantation.
作者信息
Nilforushan Naveed, Yadgari Maryam, Jazayeri Anis Alsadat, Karimi Nasser
机构信息
Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
出版信息
Indian J Ophthalmol. 2016 Mar;64(3):206-10. doi: 10.4103/0301-4738.181740.
PURPOSE
To evaluate the outcome of the second Ahmed glaucoma valve (AGV) surgery in eyes with failed previous AGV surgery.
DESIGN
Retrospective case series.
PATIENTS AND METHODS
Following chart review, 36 eyes of 34 patients with second AGV implantation were enrolled in this study. The primary outcome measure was surgical success defined in terms of intraocular pressure (IOP) control using two criteria: Success was defined as IOP ≤21 mmHg (criterion 1) and IOP ≤16 mmHg (criterion 2), with at least 20% reduction in IOP, either with no medication (complete success) or with no more than two medications (qualified success). Kaplan-Meier survival analysis was used to determine the probability of surgical success.
RESULTS
The average age of the patients was 32.7 years (range 4-65), and the mean duration of follow-up was 21.4 months (range 6-96). Preoperatively, the mean IOP was 26.94 mmHg (standard deviation [SD] 7.03), and the patients were using 2.8 glaucoma medications on average (SD 0.9). The mean IOP decreased significantly to 13.28 mmHg (SD 3.59) at the last postoperative visit (P = 0.00) while the patients needed even fewer glaucoma medications on average (1.4 ± 1.1, P = 0.00). Surgical success of second glaucoma drainage devices (Kaplan-Meier analysis), according to criterion 1, at 6, 12, 18, and 42 months was 94%, 85%, 80%, and 53% respectively, and according to criterion 2, was 94%, 85%, 75%, and 45%, respectively.
CONCLUSION
Repeated AGV implantation seems to be a safe modality of treatment with acceptable success rate in cases with failed previous AGV surgery.
目的
评估既往 Ahmed 青光眼引流阀（AGV）手术失败的患眼行二次 AGV 手术的效果。
设计
回顾性病例系列研究。
患者与方法
经病历回顾，34 例患者的 36 只患眼接受了二次 AGV 植入术并纳入本研究。主要观察指标为手术成功率，眼压（IOP）控制情况依据以下两条标准定义：成功定义为眼压≤21 mmHg（标准 1）且眼压≤16 mmHg（标准 2），眼压降低至少 20%，无需用药（完全成功）或使用不超过两种药物（合格成功）。采用 Kaplan-Meier 生存分析确定手术成功的概率。
结果
患者平均年龄为 32.7 岁（范围 4 - 65 岁），平均随访时间为 21.4 个月（范围 6 - 96 个月）。术前，平均眼压为 26.94 mmHg（标准差[SD] 7.03），患者平均使用 2.8 种青光眼药物（SD 0.9）。末次术后随访时，平均眼压显著降至 13.28 mmHg（SD 3.59）（P = 0.00），同时患者平均所需青光眼药物更少（1.4 ± 1.1，P = 0.00）。根据标准 1，二次青光眼引流装置手术成功（Kaplan-Meier 分析）在 6、12、18 和 42 个月时分别为 94%、85%、80%和 53%，根据标准 2 分别为 94%、85%、75%和 45%。
结论
对于既往 AGV 手术失败的病例，重复 AGV 植入术似乎是一种安全的治疗方式，成功率可接受。
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