Tanito Masaki, Tsutsui Aika, Manabe Kaoru, Matsuoka Yotaro
Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo.
Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Shimane Prefecture, Japan.
J Glaucoma. 2021 Jul 1;30(7):e327-e333. doi: 10.1097/IJG.0000000000001884.
Ahmed glaucoma valve (AGV) implantation in eyes with damaged iris-lens diaphragms ("1-chamber" eyes) resulted in mean intraocular pressure (IOP) and antiglaucoma medications decreases of 66% and 59% (P<0.0001 for both), respectively, at the mean 23-month follow-up.
The purpose of this study was to report the results of AGV implantation with pars plana tube insertion to control IOP in glaucomatous eyes with damaged iris-lens diaphragms ("1-chamber" eyes).
The medical records of 52 consecutive glaucomatous 1-chamber eyes (48 Japanese patients, mean age±SD, 76.0±11.2 y) were retrospectively reviewed. Other than aphakic eyes, eyes were defined as having 1 chamber if intraocular lenses (IOLs) were sclerally or intrasclerally fixated, IOLs were fixed on-the-bag due to posterior capsular defects, vitreous collapse into the anterior chamber resulted from Zinn zonular dialysis, and phacodonesis or IOL-donesis required lens/IOL explantation during AGV implantation. The data collected were preoperative/postoperative IOPs, numbers of antiglaucoma medications, visual acuity, anterior chamber flare, visual field mean deviation, corneal endothelial cell density, and surgical complications/interventions.
The preoperative IOP (28.5±9.4 mm Hg) and a number of antiglaucoma medications (3.2±1.2) decreased significantly (P<0.0001 for both) to 9.8±3.3 mm Hg and 1.3±1.3, respectively, at the final visit (mean follow-up, 23 mo). The success rates of IOP control (6 to 21 mm Hg and >20% reduction irrespective of medication use) were 82.5% and 79.0%, respectively, at postoperative years 1 and 2. The most common postoperative complications were macular edema (n=9, 17%), choroidal detachment (n=8, 15%), vitreous hemorrhage (n=7, 13%), and hyphema (n=7, 13%). The most common postoperative intervention was tubal repositioning/reopening (n=6, 12%). Compared with preoperative values, the visual acuity, anterior chamber flare, mean deviation, corneal endothelial cell density remained unchanged postoperatively.
Choice of pars plana AGV tube insertion with simultaneous vitrectomy is reasonable to achieve IOP reduction and minimize vision-threatening complication in glaucomatous eyes with a damaged iris-lens diaphragm.
在虹膜晶状体膈受损的眼睛（“单房”眼）中植入艾哈迈德青光眼引流阀（AGV），在平均23个月的随访中，平均眼压（IOP）和抗青光眼药物用量分别降低了66%和59%（两者P均<0.0001）。
本研究旨在报告经睫状体平坦部植入引流管的AGV植入术，用于控制虹膜晶状体膈受损的青光眼性“单房”眼眼压的结果。
回顾性分析52例连续的青光眼性单房眼（48例日本患者，平均年龄±标准差，76.0±11.2岁）的病历。除无晶状体眼外，如果人工晶状体（IOL）巩膜固定或巩膜内固定、因后囊膜缺损IOL囊袋内固定、因Zinn小带透析玻璃体塌陷至前房、晶状体震颤或人工晶状体震颤需要在AGV植入期间取出晶状体/IOL，则眼睛定义为单房眼。收集的数据包括术前/术后眼压、抗青光眼药物数量、视力、前房炎症、视野平均偏差、角膜内皮细胞密度以及手术并发症/干预措施。
末次随访（平均随访23个月）时，术前眼压（28.5±9.4 mmHg）和抗青光眼药物数量（3.2±1.2）显著降低（两者P均<0.0001），分别降至9.8±3.3 mmHg和1.3±1.3。术后第1年和第2年眼压控制成功率（眼压6至21 mmHg且无论是否使用药物降低幅度>20%）分别为82.5%和79.0%。最常见的术后并发症为黄斑水肿（n = 9，17%）、脉络膜脱离（n = 8，15%）、玻璃体出血（n = 7，13%）和前房积血（n = 7，13%）。最常见的术后干预措施为引流管重新定位/重新开放（n = 6，12%）。与术前值相比，术后视力、前房炎症、平均偏差、角膜内皮细胞密度保持不变。
对于虹膜晶状体膈受损的青光眼性眼，选择经睫状体平坦部植入AGV引流管并同时行玻璃体切除术，对于降低眼压和将威胁视力的并发症降至最低是合理的。
