Gdih Gdih, Jiang Kailun
Faculty of Medicine, University of Manitoba, Winnipeg, Man.
Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C.
Can J Ophthalmol. 2017 Feb;52(1):85-91. doi: 10.1016/j.jcjo.2016.06.007. Epub 2016 Aug 31.
To evaluate the safety, efficacy, and cost savings of Ahmed glaucoma valve (AGV) tube implantation through a 6-mm scleral tunnel (graft-free technique).
Retrospective cohort study.
The 95% confidence interval for fractional survival at any particular time was calculated using the Kaplan-Meier method. Failure was defined as (i) intraocular pressure (IOP) <6 mm Hg or >21 mm Hg or <20% IOP reduction on 2 consecutive visits after 12 months; (ii) additional surgical intervention to control IOP; or (iii) no light perception.
Eighty-four eyes were implanted with graft-free AGV with a success rate of 83% at 2 years. Fourteen eyes failed: 4 no light perception, 1 hypotony, 1 elevated IOP, 5 secondary glaucoma surgeries, 2 AGV extractions, and 1 corneal decompensation. The rate of transient hypotony peaked at 33% on postoperative day 1, reducing to 4% by 6 weeks. Transient flat anterior chamber developed in 8% of eyes. Eight percent of eyes experienced a hypertensive phase (mean IOP = 28 mm Hg). Preoperatively, eyes received 3.8 units of glaucoma medication on average. Postoperatively, 8 eyes required no medication for IOP control. Of the eyes requiring postoperative glaucoma medication, 33% restarted during week 4; an additional 25% of eyes were restarted 6 weeks postoperatively. By 6 months, eyes were on average using 2.2 units of glaucoma medication. Hyphema (18%) was the most common early postoperative complication. The rates of conjunctival and scleral erosion by 2 years were 2.4% and 0%, respectively. Within our institution, excluding valve cost, there was a 39%-45% ($192-$376) cost reduction with the graft-free technique.
The safety and efficacy of a 6-mm scleral tunnel is comparable to conventional scleral-graft method.
评估通过6毫米巩膜隧道植入艾哈迈德青光眼引流阀（AGV，无移植片技术）的安全性、有效性和成本节约情况。
回顾性队列研究。
采用Kaplan-Meier方法计算任何特定时间的部分生存率的95%置信区间。失败定义为：（i）眼压（IOP）<6毫米汞柱或>21毫米汞柱，或在12个月后连续两次就诊时眼压降低<20%；（ii）为控制眼压进行额外的手术干预；或（iii）无光感。
84只眼植入了无移植片的AGV，2年成功率为83%。14只眼失败：4只无光感，1只低眼压，1只眼压升高，5只进行了继发性青光眼手术，2只取出了AGV，1只角膜失代偿。短暂性低眼压发生率在术后第1天达到峰值，为33%，到6周时降至4%。8%的眼出现短暂性无前房。8%的眼经历了高血压期（平均眼压=28毫米汞柱）。术前，眼平均使用3.8单位青光眼药物。术后，8只眼无需使用药物控制眼压。在需要术后青光眼药物治疗的眼中，33%在第4周重新开始用药；另外25%的眼在术后6周重新开始用药。到6个月时，眼平均使用2.2单位青光眼药物。前房积血（18%）是最常见的早期术后并发症。2年时结膜和巩膜糜烂发生率分别为2.4%和0%。在我们机构内，排除引流阀成本，无移植片技术使成本降低了39%-45%（192-376美元）。
6毫米巩膜隧道的安全性和有效性与传统巩膜移植方法相当。
