Davidov Bar, Kurtz Shimon, Mohilevtseva Ilona, Waisbourd Michael, Rachmiel Rony
Glaucoma Center, Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
Int J Ophthalmol. 2022 Jun 18;15(6):947-953. doi: 10.18240/ijo.2022.06.12. eCollection 2022.
To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy (ERC) after Ahmed glaucoma valve (AGV) failure.
Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval. The number of anti-glaucoma medications (AGMs), intraocular pressure (IOP) and best corrected visual acuity (BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d. Intra- and postoperative complications were also recorded. Positive outcome was defined as IOP≤21 mm Hg with or without AGMs.
Fourteen eyes [14 patients, median age 69.5y, interquartile range (IQR) 61.3-80] were included. Pseudoexfoliative glaucoma (=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo (IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0 (IQR 3.0-4.0) to 2.0 (IQR 1.5-3), the median IOP decreased from 26 mm Hg (IQR 22-29) to 16.5 mm Hg (IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1, 3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes (36%), which were resolved spontaneously during the first week following ERC.
ERC has a high success rate for short-term management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.
报告在艾哈迈德青光眼引流阀（AGV）植入失败后，采用丝裂霉素C辅助的带囊切除术的切除性滤过泡修复术（ERC）的短期效果。
回顾性评估2017年1月至2019年12月期间接受ERC手术且随访至少6个月的患者，分析AGV植入指征及AGV植入至ERC的间隔时间。记录基线、术后1、7、30、90和180天时的抗青光眼药物（AGM）数量、眼压（IOP）和最佳矫正视力（BCVA）。同时记录术中及术后并发症。阳性结果定义为眼压≤21 mmHg（无论是否使用AGM）。
纳入14只眼（14例患者，中位年龄69.5岁，四分位间距[IQR]为61.3 - 80岁）。剥脱性青光眼（n = 5，36%）是最常见的青光眼类型。AGV植入至ERC的中位间隔时间为8.8个月（IQR 3.91 - 43.67）。术后6个月时，AGM的中位数量从3.0（IQR 3.0 - 4.0）降至2.0（IQR 1.5 - 3），中位眼压从26 mmHg（IQR 22 - 29）降至16.5 mmHg（IQR 13.75 - 20），BCVA无显著变化。术后6个月成功率为92.9%。Kaplan - Meier生存累积概率在术后1周、1、3和6个月时分别为93%、79%、64%和64%。未发现术中并发症。5只眼（36%）出现术后并发症，均在ERC术后第一周内自行缓解。
ERC对AGV植入失败的短期治疗成功率较高。需要更长时间的随访研究来确定长期累积失败率。
