Fu Xiangjun, He Juan, Li Guoliang, Luo Hongyi, Peng Ruijue, Cheng Yilian, Peng Jie, Chen Shiyan, Qu Chao
School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Sci Prog. 2025 Jan-Mar;108(1):368504241301520. doi: 10.1177/00368504241301520.
The aim of this study was to evaluate the efficacy and safety of the Ahmed glaucoma valve in pediatric patients with refractory glaucoma.
A comprehensive literature search was conducted across multiple major databases, including PubMed, Embase, the Cochrane Library of Systematic Reviews, Science Direct, China's National Knowledge Infrastructure, and the Wanfang database. We retrieved studies published before December 2022 that met the inclusion criteria, including clinical controlled trials (randomized controlled trials) and clinical noncontrolled trials (non-randomized controlled trials) on the use of Ahmed glaucoma valve in pediatric patients with refractory glaucoma. We performed a meta-analysis and systematic review. The efficacy measures included intraocular pressure, number of anti-glaucoma medications, visual acuity, and success rate. The safety measures were complications. Statistical analysis was performed using RevMan 5.0 software.
We identified 46 eligible studies: Compared with geographic location and study type, the Ahmed glaucoma valve showed a decrease in postoperative intraocular pressure and number of anti-glaucoma medications compared to preoperative levels in children with refractory glaucoma ( < 0.001). Compared with etiological, the Ahmed glaucoma valve showed a decrease in intraocular pressure after surgery compared to preoperative levels in children with refractory glaucoma (SMD: 14.57, 95% CI: 14.05-15.08, < 0.00 1), and a decrease in postoperative number of anti-glaucoma medications compared to preoperative number of anti-glaucoma medications (SMD: 1.45, 95% CI: 1.37-1.54, < 0.001). Compared with trabeculectomy revision surgery, there was no significant difference in the complete success rate between the two groups (SMD: 0.86, 95% CI: 0.52-1.39; = 0.37).Overall, the postoperative intraocular pressure at the time of Ahmed glaucoma valve implantation was lower than that at the time of trabeculectomy revision surgery (SMD: 1.01, 95% CI: 0.71-1.31, = 99%, < 0.001). Subgroup analyses based on whether mitomycin C was use d or not. There was a statistically significant difference in intraocular pressure between Ahmed's glaucoma valve surgery and preoperative (SMD: 14.13, 95% CI: 13.47-14.80, = 0.007). Comparison of cumulative complete success rates of Ahmed S2, S3, and Ahmed FP7, FP8 in Ahmed glaucoma valve surgery (SMD: 0.74, 95% CI: 0.38-1.45, = 85%, = 0.38). There is no statistical difference between the two groups. Choroidal effusion and anterior chamber hemorrhage are the two most common adverse events after Ahmed's glaucoma valve surgery.
The Ahmed glaucoma valve implantation has some effectiveness in reducing intraocular pressure in children with refractory glaucoma, but there are still many complications. Valve model may not be the key factor affecting the postoperative effectiveness and adverse reactions of refractory glaucoma in children.
本研究旨在评估艾哈迈德青光眼阀在难治性青光眼患儿中的疗效和安全性。
在多个主要数据库中进行了全面的文献检索，包括PubMed、Embase、Cochrane系统评价图书馆、Science Direct、中国知网和万方数据库。我们检索了2022年12月之前发表的符合纳入标准的研究，包括关于艾哈迈德青光眼阀在难治性青光眼患儿中应用的临床对照试验（随机对照试验）和临床非对照试验（非随机对照试验）。我们进行了荟萃分析和系统评价。疗效指标包括眼压、抗青光眼药物数量、视力和成功率。安全指标为并发症。使用RevMan 5.0软件进行统计分析。
我们确定了46项符合条件的研究：与地理位置和研究类型相比，艾哈迈德青光眼阀在难治性青光眼患儿中术后眼压和抗青光眼药物数量较术前水平降低（<0.001）。与病因相比，艾哈迈德青光眼阀在难治性青光眼患儿中术后眼压较术前水平降低（标准化均数差：14.57，95%可信区间：14.05 - 15.08，<0.001），术后抗青光眼药物数量较术前抗青光眼药物数量减少（标准化均数差：1.45，95%可信区间：1.37 - 1.54，<0.001）。与小梁切除术翻修手术相比，两组的完全成功率无显著差异（标准化均数差：0.86，95%可信区间：0.52 - 1.39；P = 0.37）。总体而言，艾哈迈德青光眼阀植入时的术后眼压低于小梁切除术翻修手术时的眼压（标准化均数差：1.01，95%可信区间：0.71 - 1.31，P = 99%，<0.001）。基于是否使用丝裂霉素C进行亚组分析。艾哈迈德青光眼阀手术与术前眼压之间存在统计学显著差异（标准化均数差：14.13，95%可信区间：13.47 - 14.80，P = 0.007）。艾哈迈德青光眼阀手术中艾哈迈德S2、S3与艾哈迈德FP7、FP8累积完全成功率的比较（标准化均数差：0.74，95%可信区间：0.38 - 1.45，P = 85%，P = 0.38）。两组之间无统计学差异。脉络膜积液和前房出血是艾哈迈德青光眼阀手术后最常见的两种不良事件。
艾哈迈德青光眼阀植入术在降低难治性青光眼患儿眼压方面有一定效果，但仍有许多并发症。瓣膜型号可能不是影响儿童难治性青光眼术后疗效和不良反应的关键因素。
