Posarelli Chiara, Toro Mario Damiano, Rejdak Robert, Żarnowski Tomasz, Pożarowska Dorota, Longo Antonio, Miccoli Mario, Nardi Marco, Figus Michele
Department of Surgical, Medical and Molecular Pathology and of the Critical Area, University of Pisa, 56126 Pisa, Italy.
Department of General Ophthalmology and Pediatric Ophthalmology Service, Medical University of Lublin, 20079 Lublin, Poland.
J Clin Med. 2020 Jun 29;9(7):2039. doi: 10.3390/jcm9072039.
Refractory glaucoma still represents a challenge for ophthalmologists to manage intraocular pressure. The present study aimed to evaluate long term efficacy and safety of a second Ahmed valve implantation after the failure of a first implant in patients with refractory glaucoma and elevated intraocular pressure (IOP).
Retrospective, multicenter non-comparative case series. Twenty-eight patients were retrospectively recruited between January 2011 and December 2017. Demographic data, glaucoma type, visual acuity, intraocular pressure, medical therapy, and complications were registered. Three criteria of success were established: Type 1 surgical success: IOP ≤ 15 mmHg and a reduction of IOP ≥ 40% from baseline; Type 2 surgical success: IOP ≤ 18 mmHg and a reduction of IOP ≥ 30% from baseline; and Type 3 surgical success: IOP ≤ 21 mmHg and a reduction of IOP ≥ 20% from baseline. Surgical failure has been established as IOP less than 5 mmHg or over 21 mmHg and less than a 20% reduction of IOP from baseline despite medications in two consecutive visits, light perception loss referable to glaucoma, and the necessity for further glaucoma surgery. Failure was observed in six (21%) patients. (3) Results: Mean IOP and mean glaucoma medication number significantly reduced from baseline after the second implantation, and the surgical success rate at 72 months ranged from 10% to 78% based on the different criteria of success. Failure was observed in six (21%) patients.
This study confirmed the safety and efficacy of a second Ahmed valve implantation in patients with refractory glaucoma and elevated IOP at baseline.
难治性青光眼仍是眼科医生控制眼压面临的一项挑战。本研究旨在评估难治性青光眼且眼压升高患者首次植入Ahmed阀失败后再次植入该阀的长期疗效和安全性。
回顾性、多中心非对照病例系列研究。2011年1月至2017年12月期间，对28例患者进行了回顾性招募。记录了人口统计学数据、青光眼类型、视力、眼压、药物治疗情况及并发症。确立了三项成功标准：1型手术成功：眼压≤ 15 mmHg且眼压较基线降低≥ 40%；2型手术成功：眼压≤ 18 mmHg且眼压较基线降低≥ 30%；3型手术成功：眼压≤ 21 mmHg且眼压较基线降低≥ 20%。手术失败定义为连续两次就诊时眼压低于5 mmHg或高于21 mmHg，尽管使用了药物但眼压较基线降低不足20%，因青光眼导致光感丧失，以及需要进一步进行青光眼手术。6例（21%）患者出现失败情况。结果：再次植入后，平均眼压和平均青光眼用药数量较基线均显著降低，根据不同的成功标准，72个月时的手术成功率为10%至78%。6例（21%）患者出现失败情况。
本研究证实了难治性青光眼且基线眼压升高患者再次植入Ahmed阀的安全性和有效性。
