Clinic of Ophthalmology, St. Johannes Hospital in Dortmund, Johannesstraße 9-13, 44137, Dortmund, Germany.
Clinic of Ophthalmology Pallas, Zurich, Switzerland.
Int Ophthalmol. 2021 Apr;41(4):1271-1282. doi: 10.1007/s10792-020-01682-0. Epub 2021 Jan 3.
To compare the efficacy of transscleral cyclophotocoagulation with MicroPulse laser (Iridex, Silicon Valley, California, USA) with 3000 mW to Ahmed valve implantation in eyes with advanced stage of primary open-angle glaucoma.
In a prospective observational clinical study, 30 patients (30 eyes) with advanced open-angle glaucoma were randomized for either micropulse transscleral cyclophotocoagulation with 3000 mW or Ahmed valve implantation. Fifteen eyes were treated with transscleral cyclophotocoagulation with MicroPulse laser with 3000 mW (group A) and 15 eyes with Ahmed valve implantation (group B). As inclusion criteria are included the diagnosis of advanced primary open-angle glaucoma, an intraocular pressure above 21 mmHg, cup-to-disk ratio 0.9-1.0, failure to meet the target IOP with either maximal tolerated local medical therapy (2-4 antiglaucoma agents) or systemic therapy (acetazolamide). The follow-up time of the study was 12 months. An absolute success was defined the achievement of IOP between 6 and 15 mmHg and at least 30% reduction of the IOP from baseline under reduced or the same number of antiglaucoma agents after the surgical procedure without following glaucoma surgeries and as qualified success the achievement of IOP between 6 and 18 mmHg and at least 20% reduction of the IOP from baseline regardless of the number of postoperative antiglaucoma agents. The efficacy was evaluated by estimating the absolute success rate and the qualified success rate using the Kaplan-Meier survival analysis.
A reduction of the intraocular pressure > 30% was achieved in 33.3% of group A and in 73.3% of group B during the follow-up period of 12 months. A statistically significant decrease in the number of eye drops was observed in both groups (p < 0.01). 53.3% of the eyes of group A underwent additional anti-glaucoma procedures to achieve target intraocular pressure. The number of the local medications that were administered 12 months after the ocular surgery was 2 (± 1.3) in group A and 0.57 (± 0.9) in group B, compared to 3.2 (± 0.78) in group A and 3.33 (± 0.7) in group B administered prior to the surgery (p: 0.016). 8 eyes (53.33%) in group A were referred for additional treatment due to an acute postoperative rise in IOP (5 eyes: mTS-CPC, 1 eye: canaloplasty, 2 eyes: AGV implantation). No further anti-glaucoma procedures were necessary in group B.
The Ahmed valve implantation achieves a more efficient decrease of the intraocular pressure as well as of the number of antiglaucoma agents than the transscleral cyclophotocoagulation with MicroPulse diode laser 3000 mW. Additionally, the Ahmed valve implantation showed better results in terms of absolute and qualified success rates in the treatment of advanced primary open-angle glaucoma.
比较 3000mW 微脉冲激光经巩膜睫状体光凝术（Iridex，加利福尼亚州硅谷，美国）与 Ahmed 阀植入术治疗晚期原发性开角型青光眼的疗效。
前瞻性观察性临床研究中，将 30 例（30 只眼）晚期开角型青光眼患者随机分为微脉冲经巩膜睫状体光凝术 3000mW 组（A 组）和 Ahmed 阀植入术组（B 组）。纳入标准为诊断为晚期原发性开角型青光眼，眼压高于 21mmHg，杯盘比 0.9-1.0，最大耐受局部药物治疗（2-4 种抗青光眼药物）或全身治疗（乙酰唑胺）后眼压仍未达标。研究随访时间为 12 个月。绝对成功率定义为手术治疗后眼压达到 6-15mmHg，眼压较基线降低至少 30%，且术后减少或维持相同数量的抗青光眼药物；合格成功率定义为手术治疗后眼压达到 6-18mmHg，眼压较基线降低至少 20%，术后无论使用多少种抗青光眼药物均可。采用 Kaplan-Meier 生存分析评估疗效，估计绝对成功率和合格成功率。
A 组在随访 12 个月期间，眼压降低>30%的比例为 33.3%，B 组为 73.3%。两组眼压均有统计学意义的显著下降（p<0.01）。A 组 53.3%的眼需要进一步行抗青光眼手术以达到目标眼压。术后 12 个月，A 组局部用药数量为 2（±1.3），B 组为 0.57（±0.9），而术前 A 组为 3.2（±0.78），B 组为 3.33（±0.7）（p：0.016）。A 组 8 只眼（53.33%）因术后急性眼压升高而需要进一步治疗（5 只眼：mTS-CPC，1 只眼：房水引流管成形术，2 只眼：AGV 植入术）。B 组无需进一步行抗青光眼手术。
与 3000mW 微脉冲二极管激光经巩膜睫状体光凝术相比，Ahmed 阀植入术能更有效地降低眼压和抗青光眼药物的使用数量。此外，在治疗晚期原发性开角型青光眼方面，Ahmed 阀植入术在绝对成功率和合格成功率方面的效果更好。
