Lee Seung Yeop, Kim Yong Hyun, Kim Ko Eun, Ahn Jaehong
Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, Korea.
Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
J Clin Med. 2022 Mar 2;11(5):1368. doi: 10.3390/jcm11051368.
We compared 1-year outcomes of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation with MMC as a first surgical procedure in patients with uveitic glaucoma. A total 38 eyes of 38 patients undergoing trabeculectomy ( =16) or Ahmed valve implantation ( = 22) were included. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg, IOP reduction ≥20% from baseline, no secondary glaucoma surgery, and no loss of light perception. The main outcome measurements including success rate, IOP, and the number of antiglaucoma medications and complications were compared. The overall success rates were comparable between the Ahmed and trabeculectomy groups (81.3 vs. 81.8%, = 0.987). The mean IOPs were similar as well ( = 0.084), though the number of antiglaucoma medications was significantly lower in the trabeculectomy group than in the Ahmed group (1.0 ± 1.2 vs. 2.2 ± 1.1; = 0.005). A statistically significant reduction in corneal endothelial cell density was noted in the Ahmed group ( = 0.004). Both treatments offered reasonable IOP control and safety for eyes with uveitic glaucoma. However, significantly fewer antiglaucoma medications were used in the trabeculectomy group. Furthermore, our results suggest that cautious postoperative monitoring with regard to corneal endothelial cell density should be additionally performed after Ahmed valve implantation.
我们比较了葡萄膜炎性青光眼患者首次手术采用丝裂霉素C(MMC)小梁切除术和MMC植入Ahmed人工房水引流阀的1年预后。纳入了38例患者的38只眼,其中16例行小梁切除术,22例行Ahmed人工房水引流阀植入术。手术成功定义为眼压(IOP)≤21 mmHg,眼压较基线降低≥20%,未行二次青光眼手术,且无光感丧失。比较了主要结局指标,包括成功率、眼压、抗青光眼药物使用数量及并发症。Ahmed人工房水引流阀组和小梁切除术组的总体成功率相当(81.3%对81.8%,P = 0.987)。平均眼压也相似(P = 0.084),不过小梁切除术组抗青光眼药物的使用数量显著低于Ahmed人工房水引流阀组(1.0±1.2对2.2±1.1;P = 0.005)。Ahmed人工房水引流阀组角膜内皮细胞密度有统计学意义的降低(P = 0.004)。两种治疗方法对葡萄膜炎性青光眼患眼均能提供合理的眼压控制和安全性。然而,小梁切除术组使用的抗青光眼药物明显较少。此外,我们的结果表明,Ahmed人工房水引流阀植入术后应额外谨慎监测角膜内皮细胞密度。