Wy Seoyoung, Kim Young Kook, Jeoung Jin Wook, Kim Mee Kum
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea.
Front Med (Lausanne). 2022 Mar 1;9:810848. doi: 10.3389/fmed.2022.810848. eCollection 2022.
To compare the clinical outcomes of maximum tolerated medical therapy (MTMT) in patients with penetrating keratoplasty (PKP) with those of Ahmed glaucoma valve (AGV) implantation.
The medical records were retrospectively reviewed in patients who had undergone PKP for bullous keratopathy and were treated with MTMT or AGV implantation for the management of glaucoma. A total of 18 bullous keratopathic patients were investigated between January 2010 and February 2017: 9 patients treated with MTMT and 9 patients treated with AGV implantation. Non-corrected visual acuity (NCVA), intraocular pressure (IOP), endothelial cell density (ECD), hexagonality, coefficient of variation (CV), central corneal thickness (CCT), median survival time of the graft, and the presence of epithelial keratopathy were compared between the groups at each time point or between baseline and after treatment of glaucoma in each group.
There were no significant differences in the visual acuity and corneal thickness between the two groups or within each group over time. Both groups showed a significant reduction in IOP compared with the baseline IOP, and IOP reductions were greater in the AGV group than in the MTMT group ( = 0.040). Significant ECD reductions were found in each group between the baseline and 6 months ( = 0.008 in the MTMT group, = 0.015 in the AGV group); however, no differences were found between the two groups until 12 months. The significant hexagonality reduction was found in the AGV group between the baseline and 12 months ( = 0.018). The median survival time showed no significant difference in the survival analysis.
Maximum tolerated medical therapy in penetrating keratoplasty for bullous keratopathy seems to similarly affect the endothelial cell density or graft survival when compared with at least 12 month-followed Ahmed glaucoma valve implantation.
比较穿透性角膜移植术（PKP）患者采用最大耐受药物治疗（MTMT）与植入艾哈迈德青光眼阀（AGV）的临床疗效。
回顾性分析因大泡性角膜病变接受PKP治疗且采用MTMT或AGV植入术治疗青光眼的患者病历。2010年1月至2017年2月期间共调查了18例大泡性角膜病变患者：9例接受MTMT治疗，9例接受AGV植入术治疗。比较两组在各时间点或每组青光眼治疗前后的裸眼视力（NCVA）、眼压（IOP）、内皮细胞密度（ECD）、六角形细胞比例、变异系数（CV）、中央角膜厚度（CCT）、移植片的中位生存时间以及上皮性角膜病变的情况。
两组之间以及每组随时间推移的视力和角膜厚度均无显著差异。与基线眼压相比，两组眼压均显著降低，且AGV组的眼压降低幅度大于MTMT组（P = 0.040）。每组在基线和6个月时ECD均显著降低（MTMT组P = 0.008，AGV组P = 0.015）；然而，直到12个月时两组之间才出现差异。AGV组在基线和12个月之间六角形细胞比例显著降低（P = 0.018）。生存分析显示中位生存时间无显著差异。
对于大泡性角膜病变的穿透性角膜移植术，与至少随访12个月的艾哈迈德青光眼阀植入术相比，最大耐受药物治疗似乎对内皮细胞密度或移植片存活有类似影响。
