Basir Eye Health Research Center, Tehran, Iran.
Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int Ophthalmol. 2021 Jan;41(1):99-105. doi: 10.1007/s10792-020-01556-5. Epub 2020 Aug 27.
To evaluate the efficacy and safety of primary needle revision after Ahmed Glaucoma Valve (AGV) implantation in comparison with glaucoma medication use.
In this interventional case series, 23 eyes of 23 patients who underwent AGV implantation were enrolled. Needle revision was performed when the intraocular pressure was higher than the target pressure before glaucoma medications. Using a 30-gauge needle, the Tenon's capsule over the plate was incised and the bleb was reformed. Patients were examined on a postoperative day one, weekly (for four weeks), and every 1-3 months. Two criteria were used to define cumulative success as a minimum 20% reduction in IOP and 5 < IOP ≤ 21 mmHg (Criteria A) or 5 < IOP ≤ 18 mmHg (Criteria B) without (Complete success) or with (Qualified success) glaucoma medication.
In this pilot study, we enrolled 23 patients with a mean age of 53.8 ± 12.4 years (25-78 years) who underwent AGV implantation and a one-year follow-up period. The mean number of primary needle revision was 2.2 ± 1.6 (1-6). One year postoperatively, the cumulative success rate was 91.4% and 86.9% based on Criteria A and B, respectively. The average of preoperative IOP was 28.26 ± 8.86 mmHg (range 15-46 mmHg), reaching 13.78 ± 3.54 mmHg (range 8-20) at the end of the one-year follow-up. (P < 0.001) The mean preoperative medication significantly decreased from a median of 4 (range 3-4) at baseline to 2 (range 1-4) after the one-year follow-up (P < 0.001). One patient experienced leakage over the plate, which was successfully treated via conservative management.
This pilot study showed that primary needle revision is a safe and effective method for controlling IOP after AGV implantation with a lower need for medication.
评估 Ahmed Glaucoma Valve（AGV）植入术后初次针头修正的疗效和安全性，并与青光眼药物治疗进行比较。
在这项干预性病例系列研究中，纳入了 23 例 23 只眼的患者，这些患者均接受了 AGV 植入术。当眼压高于青光眼药物治疗前的目标眼压时，进行针头修正。使用 30 号针头，在巩膜瓣上切开 Tenon 囊，重塑囊泡。患者在术后第 1 天、每周（4 周）和每 1-3 个月进行检查。使用两种标准定义累积成功率：眼压降低至少 20%（标准 A）或眼压 5<21mmHg（标准 B）（无（完全成功）或有（合格成功）青光眼药物）。
在这项初步研究中，我们纳入了 23 例平均年龄为 53.8±12.4 岁（25-78 岁）的患者，他们接受了 AGV 植入术和为期一年的随访。初次针头修正的平均次数为 2.2±1.6（1-6）次。术后 1 年，累积成功率分别为标准 A 为 91.4%，标准 B 为 86.9%。术前眼压平均为 28.26±8.86mmHg（范围 15-46mmHg），在 1 年随访结束时降至 13.78±3.54mmHg（范围 8-20mmHg）（P<0.001）。术前药物的平均中位数从基线时的 4 次（范围 3-4 次）降至 1 年后的 2 次（范围 1-4 次）（P<0.001）。1 例患者出现巩膜瓣漏液，经保守治疗成功治疗。
这项初步研究表明，初次针头修正术是一种安全有效的控制 AGV 植入术后眼压的方法，降低了对药物的需求。
