Rao Aparna
Glaucoma, L V Prasad Eye Institute - Kallam Anji Reddy Campus, Hyderabad, IND.
Cureus. 2024 Aug 27;16(8):e67923. doi: 10.7759/cureus.67923. eCollection 2024 Aug.
To report the surgical outcomes of sterile dehydrated human umbilical cord allograft over the Ahmed glaucoma valve (AGV) plate for refractory glaucoma.
Thirty-four eyes of 34 patients with refractory glaucoma who underwent AGV with umbilical cord allograft (AmnioPlast THICK™; Life Cell International Private Limited, Mumbai, India) placed over the AGV plate between September 2021 and 2022 at a tertiary eye care centre were included (group1) and compared with 30 eyes of 30 patients undergoing AGV without amnioblasts (group 2). The intraocular pressure (IOP) at day one, one month, six months, and final IOP; the necessity for medications; or additional surgeries for IOP control were extracted from the hospital database. Success was defined as achieving an IOP below 22 mm Hg with or without glaucoma medications. IOP spikes after surgery were identified as a rise in pressure beyond 22 mm Hg at any point beyond six weeks post-surgery following an initial reduction of pressure exceeding 30% from the baseline pre-surgical IOP.
A notable reduction in intraocular pressure (37 ± 7.9 mm Hg preoperative versus 14 ± 3.7 mm Hg at the final follow-up and 28 ± 3.6 mm Hg versus 18 ± 6.7 mm Hg in group 1 and 2, respectively) was observed in all eyes, with successful outcomes observed in 23 out of 34 eyes (67%). Ten eyes experienced a pressure spike, occurring at a median time of 12 months (range: 6-18 months), predominantly beyond six months post-surgery in group 1, while group 2 had similar pressure spikes in 21 of 30 eyes at a median time of two months (range: 1-5 months). No eyes necessitated supplementary glaucoma procedures, concluding with a final IOP of 14 ± 3.7 mm Hg at 1.9 ± 0.8 years. Vision loss occurred in only one of the 11 eyes that failed owing to non-glaucoma-related causes in group 1.
The human umbilical cord allograft plate over the AGV plate may help in postponing the onset of intraocular pressure spikes beyond traditionally defined timelines. This helps in reducing and delaying the hypertensive phase occurring due to fibrosis.
报告在艾哈迈德青光眼引流阀（AGV）板上使用无菌脱水人脐带同种异体移植物治疗难治性青光眼的手术效果。
纳入2021年9月至2022年期间在一家三级眼科护理中心接受AGV并在AGV板上放置脐带同种异体移植物（AmnioPlast THICK™；印度孟买生命细胞国际私人有限公司）的34例难治性青光眼患者的34只眼（第1组），并与30例接受AGV但未使用成羊膜细胞的30只眼（第2组）进行比较。从医院数据库中提取术后第1天、1个月、6个月时的眼压（IOP）以及最终眼压；控制眼压所需的药物治疗情况或额外手术情况。成功定义为眼压降至22 mmHg以下，无论是否使用青光眼药物。术后眼压峰值定义为术后6周后眼压从术前基线眼压初始降低超过30%后，眼压在任何时间点升至22 mmHg以上。
所有眼均观察到眼压显著降低（第1组术前眼压为37±7.9 mmHg，最终随访时为14±3.7 mmHg；第2组术前为28±3.6 mmHg，最终随访时为18±6.7 mmHg），34只眼中有23只（67%）获得成功。10只眼出现眼压峰值，中位时间为12个月（范围：6 - 18个月），主要发生在第1组术后6个月后，而第2组30只眼中有21只在中位时间2个月（范围：1 - 5个月）出现类似的眼压峰值。无需进行补充性青光眼手术，在1.9±0.8年时最终眼压为14±3.7 mmHg。在第1组中，因非青光眼相关原因失败的11只眼中只有1只眼出现视力丧失。
在AGV板上使用人脐带同种异体移植物板可能有助于将眼压峰值的出现推迟到传统定义的时间线之后。这有助于减少和延迟因纤维化导致的高血压期。
