在难治性青光眼患者中，艾哈迈德青光眼引流阀失败后行晶状体囊切除术联合分流管修复术与重复植入分流管的比较

Capsulectomy Shunt Revision versus Repeat Shunt Implantation Following Ahmed Glaucoma Valve Failure in Refractory Glaucoma.

作者信息

Yazdani Shahin, Doozandeh Azadeh, Sharifipour Farideh, Hassanpour Kiana, Pakravan Mohammad, Hajizadeh Maryam, Esfandiari Hamed, Mohammadi Parisa

机构信息

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

Ophthalmol Glaucoma. 2023 Jul-Aug;6(4):325-331. doi: 10.1016/j.ogla.2022.10.003. Epub 2022 Oct 15.

DOI:10.1016/j.ogla.2022.10.003

PMID:36257587

Abstract

PURPOSE

To investigate the efficacy of capsulectomy shunt revision (CSR) compared with the implantation of a second Ahmed glaucoma valve (re-AGV) in glaucoma patients with failed shunts.

DESIGN

Quasi-experimental study.

SUBJECTS

Forty-six eyes with failed Ahmed glaucoma valves (AGVs) were included in the study; 25 underwent CSR, whereas 21 underwent re-AGV.

METHODS

Patients were scheduled for CSR or re-AGV based on the appearance and accessibility of the existing AGV versus the feasibility for re-AGV in other quadrants. The CSR involved incision and dissection down to the thick fibrous capsule around the AGV plate, which was excised extensively. For re-AGV, the second shunt was implanted in the supranasal or infranasal quadrants.

MAIN OUTCOME MEASURES

Surgical success, defined as intraocular pressure (IOP) > 5 mmHg, ≤ 21 mmHg, IOP reduction ≥ 20% from baseline, and no reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and complications during a 12-month follow-up period.

RESULTS

Mean IOP was significantly lower than preoperative values at all time points in both study groups (P < 0.001). Intraocular pressure decreased significantly from 28.3 ± 5.04 mmHg at baseline to 16.4 ± 2.4 mmHg at final follow-up in the capsulectomy group (P = 0.002). Corresponding IOP values for re-AGV were 30.99 ± 6.2 and 13.6 ± 3.8 mmHg, respectively (P = 0.001). Intraocular pressure in the CSR group was higher than re-AGV during the study (P = 0.003). The cumulative probability of success at 12 months was significantly higher in the re-AGV group (87.5% vs 53.3%, P = 0.002). There was no significant difference in the number of glaucoma medications and overall complications rate between the study groups. Wound leakage was the only complication more common in the CSR group (P = 0.012).

CONCLUSION

In the eyes with a failed AGV, re-AGV and CSR are both effective. Implantation of a second shunt seems more effective than the surgical revision of an existing device; however, the latter procedure may be a viable option in selected cases.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

摘要

目的

研究在分流失败的青光眼患者中，与植入第二个艾哈迈德青光眼引流阀（再次植入艾哈迈德青光眼引流阀，re-AGV）相比，囊切除术分流修复术（CSR）的疗效。

设计

准实验研究。

对象

本研究纳入了46只艾哈迈德青光眼引流阀（AGV）失败的眼睛；25只接受了CSR，而21只接受了再次植入AGV。

方法

根据现有AGV的外观和可及性以及在其他象限再次植入AGV的可行性，为患者安排CSR或再次植入AGV。CSR包括切开并分离至AGV板周围的厚纤维囊，并广泛切除该囊。对于再次植入AGV，将第二个分流装置植入鼻上象限或鼻下象限。

主要观察指标

手术成功定义为眼压（IOP）>5 mmHg、≤21 mmHg，眼压较基线降低≥20%，且无需因青光眼再次手术。次要观察指标为眼压、青光眼药物使用数量以及12个月随访期内的并发症。

结果

在两个研究组中，所有时间点的平均眼压均显著低于术前值（P<0.001）。在囊切除术组中，眼压从基线时的28.3±5.04 mmHg显著降至最终随访时的16.4±2.4 mmHg（P = 0.002）。再次植入AGV组相应的眼压值分别为30.99±6.2和13.6±3.8 mmHg（P = 0.001）。在研究期间，CSR组的眼压高于再次植入AGV组（P = 0.003）。再次植入AGV组12个月时的累积成功概率显著更高（87.5%对53.3%，P = 0.002）。研究组之间青光眼药物使用数量和总体并发症发生率无显著差异。伤口渗漏是CSR组中唯一更常见的并发症（P = 0.012）。