Singer Reut, Kapelushnik Noa, Rotenstreich Ygal, Leshno Ari, Barkana Yaniv, Skaat Alon
The Sam Rothberg Glaucoma Center, Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Eur J Ophthalmol. 2021 Apr 28:11206721211012869. doi: 10.1177/11206721211012869.
To summarize the surgical outcomes of Ahmed glaucoma valve (AGV) implantation with plate fixation with vicryl absorbable sutures or no plate suturing.
This study was a retrospective case series that included all glaucoma patients who underwent AGV implantation surgery with vicryl absorbable sutures for plate fixation or without plate fixation by a single surgeon between 2014 and 2019. We reviewed their medical records and retrieved clinical data on intra- and postoperative complications, best-corrected visual acuity, intraocular pressure (IOP), and number of IOP-lowering medications.
Twenty out of 29 eyes (29 patients, mean age 61.04 ± 27.1 years, 17 men) underwent AGV implantation without plate fixation and nine had AGV implantation with fixation with vicryl sutures. Complications were observed in 15 cases (51.7%). Nine of these were defined as failure due to the need for removal or repositioning of the AGV or for further surgery for uncontrolled IOP, of which five were no-fixation cases (5/20, 25%) and four were vicryl-fixation cases (4/9, 44.4%). Six of all surgical failures were related to AGV migration (6/9, 66.6%). There were three cases of extrusion and one case of plate migration in the no-fixation group, and two cases of plate migration and one case of extrusion in the vicryl-fixation group.
AGV implantation without suture plate fixation or with vicryl suture fixation had a high complication and failure rate, often necessitating reoperation and AGV removal. The high rate of tube-related complications observed after both techniques does not favor either of them. The use of non-absorbable sutures for suturing of the AGV plate is recommended.
总结使用可吸收的维可牢缝线进行板固定或不进行板缝合的艾哈迈德青光眼阀（AGV）植入术的手术结果。
本研究为回顾性病例系列，纳入了2014年至2019年间由同一位外科医生进行的、使用可吸收的维可牢缝线进行板固定或不进行板固定的AGV植入手术的所有青光眼患者。我们查阅了他们的病历，并获取了关于术中及术后并发症、最佳矫正视力、眼压（IOP）以及降低眼压药物使用数量的临床数据。
29只眼中的20只（29例患者，平均年龄61.04±27.1岁，17名男性）接受了无板固定的AGV植入术，9只眼接受了使用维可牢缝线固定的AGV植入术。观察到15例并发症（51.7%）。其中9例因需要移除或重新定位AGV或因眼压控制不佳需要进一步手术而被定义为失败，其中5例为无固定病例（5/20，25%），4例为维可牢固定病例（4/9，44.4%）。所有手术失败中有6例与AGV移位有关（6/9，66.6%）。无固定组有3例引流管挤出和1例板移位，维可牢固定组有2例板移位和1例引流管挤出。
不进行缝线板固定或使用维可牢缝线固定的AGV植入术并发症和失败率较高，常常需要再次手术和移除AGV。两种技术后观察到的与引流管相关的并发症发生率较高，两种技术都不占优势。建议使用不可吸收缝线缝合AGV板。
