Elhusseiny Abdelrahman M, Hassan Amr K, Azhari Jamal O, Elkheniny Fatmah D, Chauhan Muhammad Z, Chang Ta C, VanderVeen Deborah K, Oke Isdin, Mansour Munthir, Pakravan Mohammad, Shaarawy Tarek, Sallam Ahmed B
Department of Ophthalmology, Harvey and Bernice Jones Eye Institute.
Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Glaucoma. 2023 Aug 1;32(8):686-694. doi: 10.1097/IJG.0000000000002235. Epub 2023 May 9.
The effectiveness of Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI) was comparable in the management of childhood glaucoma over the long term despite initial better success rate with BGI. There were higher tube block and retraction rates in the BGI group and higher tube exposure rates in the AGV group.
To evaluate the outcomes and safety of AGV and BGI in childhood glaucoma.
We performed a systematic literature review of publications from 1990 to 2022 in PubMed, EMBASE, ClinicalTrials.gov, Ovid MEDLINE, Cochrane CENTRAL, and google scholar for studies evaluating AGV and BGI in childhood glaucoma. Primary outcome measures were intraocular pressure (IOP) reduction and glaucoma medication reduction. The secondary outcome measures were the success rates and incidence of postoperative complications. We conducted a meta-analysis using a random effects model.
Thirty-two studies met the inclusion criteria. A total of 1480 eyes were included. The mean IOP reduction was 15.08 mm Hg ( P < 0.00001) for AGV and 14.62 ( P < 0.00001) for the BGI group. The mean difference between pre and postoperative glaucoma medications was 1 ( P < 0.00001) fewer medications in the AGV group and 0.95 ( P < 0.0001) fewer medications in the BGI group. There was a lower success rate in the AGV versus BGI groups at 2 years [63% vs 83%, respectively ( P < 0.0001) and 3 years (43% vs 79%, respectively ( P < 0.0001)]; however, the success was higher for AGV at 5 years (63% vs 56% in the BGI group, P < 0.001). The incidence of postoperative complications was comparable in the AGV and BGI groups, with rates of 28% and 27%, respectively.
The IOP and glaucoma medication reduction, success rates, and incidence of postoperative complications were comparable in Ahmed and Baerveldt groups. Most literature comes from retrospective low-quality studies on refractory childhood glaucoma. Further larger cohort studies are needed.
尽管最初贝尔维尔德特青光眼植入物（BGI）的成功率更高，但长期来看，艾哈迈德青光眼引流阀（AGV）和BGI在儿童青光眼治疗中的效果相当。BGI组的引流管堵塞和退缩率较高，而AGV组的引流管暴露率较高。
评估AGV和BGI治疗儿童青光眼的疗效和安全性。
我们对1990年至2022年发表在PubMed、EMBASE、ClinicalTrials.gov、Ovid MEDLINE、Cochrane CENTRAL和谷歌学术上的评估AGV和BGI治疗儿童青光眼的研究进行了系统的文献综述。主要结局指标为眼压（IOP）降低和青光眼药物使用减少。次要结局指标为成功率和术后并发症发生率。我们使用随机效应模型进行了荟萃分析。
32项研究符合纳入标准。共纳入1480只眼。AGV组的平均眼压降低为15.08 mmHg（P < 0.00001），BGI组为14.62 mmHg（P < 0.00001）。AGV组术前和术后青光眼药物使用的平均差异为减少1种药物（P < 0.00001），BGI组为减少0.95种药物（P < 0.0001）。AGV组与BGI组在2年时的成功率较低[分别为63%和83%（P < 0.0001）]，在3年时也较低[分别为43%和79%（P < 0.0001）]；然而，AGV组在5年时的成功率较高（63%对BGI组的56%，P < 0.001）。AGV组和BGI组术后并发症的发生率相当，分别为28%和27%。
艾哈迈德组和贝尔维尔德特组在眼压降低、青光眼药物使用减少、成功率和术后并发症发生率方面相当。大多数文献来自关于难治性儿童青光眼的回顾性低质量研究。需要进一步开展更大规模的队列研究。
