Promelle Veronique, Lyons Christopher J
Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
J Glaucoma. 2021 Jul 1;30(7):596-605. doi: 10.1097/IJG.0000000000001881.
Mitomycin was used with Ahmed valve implantation in 81 eyes of 63 children. After 5 years, probability of intraocular pressure (IOP) control without glaucoma medication was 35±6%; 57% achieved IOP control with topical medications after 10 years.
The purpose of this study was to determine the long-term outcomes of Ahmed glaucoma valve (AGV) implantation with intraoperative application of mitomycin-C (MMC) for the treatment of childhood glaucoma.
Retrospective review of children undergoing AGV implantation with subtenon application of MMC between 2000 and 2019. We defined surgical success as a final IOP of 5 to 21 mm Hg with no glaucoma medication, no subsequent glaucoma surgery, and no severe complication. Qualified success was defined if the above criteria were met with topical antiglaucoma medication.
Eighty-one eyes of 63 patients were included. The probability of complete success was 72±5% (63% to 83%) at 1 year, 58±6% (48% to 70%) at 2 years, and 35±6% (25% to 48%) at 5 years. The probability of qualified success was 92±3% (87% to 98%) at 1 year, 79±5% (70% to 89%) at 5 years, 57±7% (44% to 73%) at 10 years, and 39±9% (24% to 62%) at 14 years. The IOP was reduced by an average of 10.7±9 mm Hg from preoperative visit to the last follow-up, and the number of medications decreased from 3.0±1.4 to 1.5±1.4 after implantation.
A significant proportion of patients achieved long-term IOP control without glaucoma medication. The majority achieved IOP control with additional topical antiglaucoma medications. When compared with existing AGV implantation in childhood literature, the use of MMC appears to lengthen the drop-free (complete success) duration, as well as the long-term IOP control with topical medications.
63名儿童的81只眼睛在植入艾哈迈德引流阀时使用了丝裂霉素。5年后，无需使用青光眼药物而眼压得到控制的概率为35±6%；10年后，57%的患者使用局部药物实现了眼压控制。
本研究的目的是确定术中应用丝裂霉素C（MMC）植入艾哈迈德青光眼引流阀（AGV）治疗儿童青光眼的长期效果。
回顾性分析2000年至2019年间接受AGV植入并在球结膜下应用MMC的儿童患者。我们将手术成功定义为最终眼压在5至21 mmHg之间，无需使用青光眼药物，无需后续青光眼手术，且无严重并发症。如果满足上述标准且使用局部抗青光眼药物，则定义为合格成功。
纳入63例患者的81只眼睛。1年时完全成功的概率为72±5%（63%至83%），2年时为58±6%（48%至70%），5年时为35±6%（25%至48%）。1年时合格成功的概率为92±3%（87%至98%），5年时为79±5%（70%至89%），10年时为57±7%（44%至73%），14年时为39±9%（24%至62%）。从术前检查到最后一次随访，眼压平均降低了10.7±9 mmHg，植入后药物数量从3.0±1.4减少到1.5±1.4。
相当一部分患者在无需使用青光眼药物的情况下实现了长期眼压控制。大多数患者通过额外使用局部抗青光眼药物实现了眼压控制。与儿童青光眼现有文献中AGV植入的情况相比，使用MMC似乎延长了无降压（完全成功）持续时间以及使用局部药物的长期眼压控制时间。
