Kolipaka Gowri Pratinya, Sastry Ramyashri, Nukala Naveen, Shanbhag Swapna S, Senthil Sirisha
VST Centre for Glaucoma Care, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
Anant Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India ; and.
Cornea. 2025 Jan 29;44(8):938-945. doi: 10.1097/ICO.0000000000003819.
To evaluate intermediate-term outcomes and complications associated with Ahmed glaucoma valve (AGV) implantation in eyes with type 1 keratoprosthesis (KPro).
We retrospectively reviewed records of 43 eyes of 43 Indian patients with type 1 KPro and AGV from 2009 to 2021 with a minimum of 6-months of follow-up. Five eyes that had AGV before KPro were excluded, leaving 38 eyes for analysis. Primary outcome measure was postoperative complications. Secondary outcome measure was stability of glaucoma, assessed by Humphrey visual fields, intraocular pressure, and best-corrected visual acuity (BCVA). Sight-threatening complications, implant removal, or repeat glaucoma surgery was considered failure.
Median age (interquartile range) at AGV implantation was 36.5 (23-49) years, with median post-AGV follow-up of 30.5 (6.5-53) months. Preoperative logarithm of minimal angle of resolution median BCVA was 0.6 (0.4-1). Post-AGV, median intraocular pressure as measured by scleral Schiotz reduced significantly from 30.4 (20.6-30.4) to 13.5(12.2-14.8) mm Hg ( P < 0.0001), and the mean number of antiglaucoma medications significantly decreased from 3.4 to 1.7 ( P < 0.0001). Mean BCVA ( P = 0.24) remained stable. Humphrey visual fields mean deviation progressed from -13.5 dB (-25, -9) to -26 dB (-30, -13) at final follow-up ( P = 0.05) and progression occurred in 10 eyes. Seven eyes (18.4%) had postoperative complications needing surgical intervention, including tube block [5 eyes (13.1%)] and tube exposure [2 eyes (5%)]. One failed AGV needed additional glaucoma surgery after 8 years. None had implant extrusion/explanation or endophthalmitis.
Ahmed glaucoma valve implantation offered promising results in managing glaucoma in eyes with type 1 KPro, particularly in relatively young Indian population. However, close monitoring for tube-related complications and glaucoma progression is warranted.
评估1型角膜移植术（KPro）患者植入艾哈迈德青光眼引流阀（AGV）的中期疗效及并发症。
我们回顾性分析了2009年至2021年间43例印度患者43只接受1型KPro和AGV植入术且随访至少6个月的眼睛的记录。排除5例在KPro植入术前已植入AGV的眼睛，剩余38只眼睛用于分析。主要观察指标为术后并发症。次要观察指标为青光眼的稳定性，通过汉弗莱视野、眼压和最佳矫正视力（BCVA）进行评估。威胁视力的并发症、植入物取出或再次青光眼手术被视为治疗失败。
AGV植入时的中位年龄（四分位间距）为36.5（23 - 49）岁，AGV植入后的中位随访时间为30.5（6.5 - 53）个月。术前最小分辨角对数的中位BCVA为0.6（0.4 - 1）。AGV植入后，经巩膜施-氏眼压计测量的中位眼压从30.4（20.6 - 30.4）显著降至13.5（12.2 - 14.8）mmHg（P < 0.0001），抗青光眼药物的平均使用数量从3.4显著降至1.7（P < 0.0001）。平均BCVA（P = 0.24）保持稳定。最终随访时，汉弗莱视野平均缺损从-13.5 dB（-25，-9）进展至-26 dB（-30，-13）（P = 0.05），10只眼睛出现进展。7只眼睛（18.4%）发生了需要手术干预的术后并发症，包括引流管堵塞[5只眼睛（13.1%）]和引流管暴露[2只眼睛（5%）]。1只AGV植入失败的眼睛在8年后需要再次进行青光眼手术。无植入物挤出/脱出或眼内炎发生。
艾哈迈德青光眼引流阀植入术在治疗1型KPro患者的青光眼方面取得了有前景的结果，尤其在相对年轻的印度人群中。然而，需要密切监测与引流管相关的并发症及青光眼进展情况。
