Department of Ophthalmology, University of California San Francisco, San Francisco, California; The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology and Chongqing Eye Institute, Chongqing, China.
Department of Ophthalmology, University of California San Francisco, San Francisco, California.
Ophthalmology. 2021 Feb;128(2):218-226. doi: 10.1016/j.ophtha.2020.06.050. Epub 2020 Jun 27.
To compare the effects of the Ahmed glaucoma valve (AGV; New World Medical, Rancho Cucamonga, CA) with sulcus versus anterior chamber (AC) tube placement on the corneal endothelial density and morphology over time.
Nonrandomized, interventional study.
This study included 106 eyes from 101 pseudophakic patients who had the AGV tube placed in the AC (acAGV) and 105 eyes from 94 pseudophakic patients who had the AGV tube placed in the ciliary sulcus (sAGV).
All patients underwent preoperative specular microscopy, which was repeated postoperatively in 2019. The patients' demographic information, glaucoma diagnoses, and basic ocular information were obtained on chart review. Anterior segment OCT was conducted for patients who underwent sAGV to evaluate the sulcus tube position. Gonioscopy was performed to document peripheral anterior synechiae (PAS). Linear mixed-effects models were used to compare the different ocular and endothelial measurements between the 2 groups and to identify risk factors for endothelial cell density (ECD) loss over time.
Monthly change in corneal endothelial measurements, including ECD and coefficient of variation (CV), calculated as the difference between preoperative and postoperative measurements divided by the number of months from the time of surgery to postoperative specular microscopy.
The acAGV and sAGV groups were comparable in all baseline characteristics except that the acAGV group had longer follow-up (37.6 vs. 20.1 months, respectively, P < 0.001). Mean monthly loss in central ECD was significantly more in the acAGV group (mean ± standard deviation: 29.3±29.7 cells/mm) than in the sAGV group (15.3±20.7 cells/mm, P < 0.0001). Mean monthly change in CV was similar between the 2 groups (P = 0.28). Multivariate analyses revealed that younger age and tube location in the AC were associated with faster central ECD loss (P = 0.02, P < 0.0001, respectively). For patients with sAGV, while PAS was associated with faster central ECD loss (P = 0.002), a more forward tube position tenting the iris was not (P > 0.05).
Compared with anterior segment placement, ciliary sulcus tube implantation may be a preferred surgery approach to reduce endothelial cell loss in pseudophakic patients.
比较 Ahmed 青光眼引流阀（AGV；新视野医疗，Rancho Cucamonga，CA）在巩膜下与前房（AC）管植入对角膜内皮密度和形态的影响。
非随机、干预性研究。
这项研究包括 101 例无晶状体眼患者的 106 只眼，这些患者在 AC 中植入了 AGV 管（acAGV），94 例无晶状体眼患者的 105 只眼在睫状体沟中植入了 AGV 管（sAGV）。
所有患者均接受术前共焦显微镜检查，并于 2019 年进行术后重复检查。通过图表回顾获取患者的人口统计学信息、青光眼诊断和基本眼部信息。对接受 sAGV 的患者进行眼前段 OCT 检查，以评估沟管位置。进行房角镜检查以记录周边前粘连（PAS）。线性混合效应模型用于比较两组之间不同的眼部和内皮测量值，并确定内皮细胞密度（ECD）随时间损失的危险因素。
角膜内皮测量值的每月变化，包括 ECD 和变异系数（CV），计算为术前和术后测量值之间的差异除以从手术到术后共焦显微镜检查的月数。
acAGV 和 sAGV 两组在所有基线特征方面均无差异，仅 acAGV 组的随访时间更长（分别为 37.6 和 20.1 个月，P < 0.001）。acAGV 组中央 ECD 的平均每月损失明显高于 sAGV 组（平均±标准差：29.3±29.7 个细胞/mm）（P < 0.0001）。两组间 CV 的平均每月变化相似（P = 0.28）。多变量分析显示，年龄较小和 AC 中的管位置与中央 ECD 损失较快相关（P = 0.02，P < 0.0001）。对于接受 sAGV 的患者，虽然 PAS 与中央 ECD 损失较快相关（P = 0.002），但虹膜前房管位置的前突并没有关系（P > 0.05）。
与前节放置相比，睫状体沟管植入可能是减少无晶状体眼患者内皮细胞损失的首选手术方法。
