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, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran.
BMC Ophthalmol. 2024 Aug 23;24(1):367. doi: 10.1186/s12886-024-03610-7.
To investigate the outcomes of trabeculectomy (TRAB) versus repeat Ahmed glaucoma valve (re-AGV) implantation in eyes with Ahmed glaucoma valve (AGV) failure.
This quasi-experimental study includes patients with failed AGV implants requiring additional surgical intervention between 2018 and 2022. Patients in the TRAB group underwent a fornix-based procedure with mitomycin C 0.01% injection (0.1 mL). Eyes in the re-AGV group underwent repeat shunt surgery. The choice of the procedure was based on conjunctival condition. The primary outcome measure was surgical success rate based on various intraocular pressure (IOP) targets and percentages of IOP reduction from baseline: IOP ≤ 21 mmHg and 20% reduction (conventional criteria), IOP ≤ 18 and > 20% reduction (criterion A), IOP ≤ 15 and > 25% reduction (criterion B), and IOP ≤ 12 and > 30% reduction (criterion C).
Forty-eight eyes of 48 patients were operated and reported herein, consisting of 22 eyes of 22 patients undergoing TRAB and 26 eyes of 26 subjects undergoing re-AGV. No significant difference was observed between the study groups in terms of initial diagnoses, baseline IOP or the number of prior surgeries. The cumulative probability of survival at one year was significantly higher in the trabeculectomy group using the three stricter success definitions. In both study groups, IOP was significantly reduced from baseline at all postoperative visits, and was significantly lower in the TRAB group at all time points beyond one month. At 12 months, 5% of TRAB versus 48% of re-AGV eyes required glaucoma medications (P < 0.001). The rate of complications was comparable between the study groups (P = 0.76) but there was a trend toward a greater need for repeat surgery in the re-AGV group (4 eyes versus nil, P = 0.07).
Trabeculectomy can be considered a safe and effective surgical option in eyes with failed AGV leading to significantly lower IOP levels and more favorable success rates than re-AGV in selected patients.
本研究旨在比较小梁切除术（TRAB）与 Ahmed 青光眼阀（AGV）再植入术治疗 Ahmed 青光眼阀植入失败患者的疗效。
本准实验研究纳入了 2018 年至 2022 年间因 AGV 植入失败而需要额外手术干预的患者。TRAB 组患者行穹窿为基底的小梁切除术，术中应用丝裂霉素 C 0.01%（0.1mL）。再植入组患者行重复引流手术。手术方式的选择基于结膜情况。主要观察指标为不同眼压（IOP）目标值和 IOP 自基线降低百分比的手术成功率：IOP≤21mmHg 且降低 20%（传统标准），IOP≤18mmHg 且降低>20%（标准 A），IOP≤15mmHg 且降低>25%（标准 B），IOP≤12mmHg 且降低>30%（标准 C）。
共纳入 48 例 48 只眼，其中 22 只眼（22 例）行 TRAB，26 只眼（26 例）行再植入术。两组患者的初始诊断、基线 IOP 或术前手术次数均无显著差异。在采用更严格的三种成功标准时，小梁切除术组的 1 年累积生存率显著更高。在两组患者中，IOP 均自术后各随访时间点较基线显著降低，且 TRAB 组在术后 1 个月后的所有时间点均显著低于再植入组。术后 12 个月，TRAB 组 5%的患者需要使用降眼压药物，而再植入组为 48%（P<0.001）。两组患者的并发症发生率相当（P=0.76），但再植入组有更多患者需要再次手术（4 只眼比无，P=0.07）。
在因 AGV 植入失败而导致眼压升高的患者中，小梁切除术可作为一种安全有效的手术选择，与再植入术相比，可显著降低眼压水平，并在选择的患者中获得更高的成功率。
