Tekcan Hatice, Imamoglu Serhat, Ozturk Yucel
Department of Ophthalmology, Health Sciences University, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye.
Private Practice, Istanbul, Türkiye.
Beyoglu Eye J. 2024 Jun 1;9(2):76-85. doi: 10.14744/bej.2024.64497. eCollection 2024.
The aim of this study was to compare the outcomes of Ahmed glaucoma valve implantation (AGVI) in neovascular glaucoma (NVG) due to proliferative diabetic retinopathy (PDR) with or without a pars plana vitrectomy (PPV) history and to analyze the factors affecting surgical failure.
Patients with NVG secondary to PDR undergoing AGVI at a single center were reviewed retrospectively. The surgical failure rates and post-operative complications were compared between eyes with (PPV-AGVI group) and without previous PPV (AGVI group). Failure was defined as loss of light perception or intraocular pressure (IOP) >17 mmHg despite maximum medication, or need of additional intervention for IOP control or for the management of complications. Survival analysis was investigated by Kaplan-Meier test. The possible factors for failure were analyzed with logistic regression analysis.
The failure rates were 21.9% during the mean follow-up of 27.56±15.38 months and 14.3% during 23.63±12.38 months, in PPV-AGVI group (n=32) and in AGVI group (n=49), respectively (p=0.37). The frequency of complications and surgical intervention need for management of post-operative complications was similar between groups (p>0.05). There was no significant difference in survival analysis (p=0.13). The history of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection before AGVI was significantly associated with failure (odds ratio = 26.941, p=0.02).
The results of AGVI performed with long scleral tunnel technique were comparable in terms of failure rates, between NVG patients with and without previous diabetic vitrectomy. The only significant factor for failure was intravitreal anti-VEGF pre-treatment. This may be related to the necessity of anti-VEGF therapy in aggressive PDR, and also, anti-VEGF agents may increase fibrosis in the anterior chamber angle.
本研究旨在比较有或无玻璃体切割术（PPV）病史的增殖性糖尿病视网膜病变（PDR）所致新生血管性青光眼（NVG）患者行艾哈迈德青光眼引流阀植入术（AGVI）的效果，并分析影响手术失败的因素。
回顾性分析在单一中心接受AGVI治疗的继发于PDR的NVG患者。比较有PPV史的眼（PPV - AGVI组）和无PPV史的眼（AGVI组）的手术失败率和术后并发症。失败定义为无光感或尽管使用最大剂量药物眼压（IOP）>17 mmHg，或需要额外干预以控制眼压或处理并发症。采用Kaplan - Meier检验进行生存分析。用逻辑回归分析失败的可能因素。
PPV - AGVI组（n = 32）平均随访27.56±15.38个月时失败率为21.9%，AGVI组（n = 49）平均随访23.63±12.38个月时失败率为14.3%（p = 0.37）。两组间并发症发生率及处理术后并发症所需手术干预频率相似（p>0.05）。生存分析无显著差异（p = 0.13）。AGVI术前玻璃体内抗血管内皮生长因子（抗VEGF）注射史与失败显著相关（比值比 = 26.941，p = 0.02）。
对于有或无既往糖尿病玻璃体切割术的NVG患者，采用长巩膜隧道技术进行AGVI的失败率相当。失败的唯一显著因素是玻璃体内抗VEGF预处理。这可能与侵袭性PDR中抗VEGF治疗的必要性有关，此外，抗VEGF药物可能增加前房角纤维化。
