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Ahmed引流阀植入治疗多次小梁切除术失败后的难治性青光眼

时间:2016-07-22 10:41来源:未知 作者:国际眼科网编辑 点击:
Ahmed引流阀植入治疗多次小梁切除术失败后的难治性青光眼 Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy 投稿时间: 2016-03-31 最后修改时间: 2016-06-12 推荐文章 收藏文章 打印页面 DOI: 10.3980
Ahmed引流阀植入治疗多次小梁切除术失败后的难治性青光眼
Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy
投稿时间: 2016-03-31  最后修改时间: 2016-06-12
推荐文章  收藏文章  打印页面
DOI:10.3980/j.issn.1672-5123.2016.7.40
关键词:  青光眼引流植入物  难治性青光眼  眼压  术后并发症
Key Words:  glaucoma drainage implant  refractory glaucoma  intraocular pressure  postoperative complication
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作者 单位
伍志琴 中国湖北省荆州市中心医院眼科
聂尚武 中国湖北省荆州市中心医院眼科
王金华 中国湖北省荆州市中心医院眼科
王晓琴 中国湖北省荆州市中心医院眼科
苏凡凡 中国湖北省荆州市中心医院眼科
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摘要:
      目的:观察Ahmed青光眼引流阀植入治疗经多次(≥2次)小梁切除术失败后的难治性青光眼的疗效及安全性。

 

     方法:对36例36眼经多次小梁切除术后眼压仍失控的患者行Ahmed青光眼引流阀植入术,观察手术前后眼压、最佳矫正视力以及术后并发症。所有患者至少随访12mo。

 

     结果:术前平均眼压为35.20±7.28mmHg,术后1、2wk,1、3、6、12mo平均眼压分别降至10.15±3.34、11.23±3.56、15.63±5.72、17.17±5.47、17.73±6.23、19.76±5.43mmHg,与术前眼压相比差异均有统计学意义(t=12.643、11.837、10.324、8.839、8.462、8.046,均P<0.05)。术后1a的视力与术前比较无统计学差异(Z=-0.420,P>0.05)。术后1a时完全成功率为78%,条件成功率为92%。术后早期并发症主要为浅前房、低眼压以及前房积血,经过治疗均自行恢复,晚期并发症为引流管暴露和滤过泡包裹,1例患者出现严重的角膜内皮失代偿。

 

     结论:Ahmed青光眼引流阀植入治疗多次小梁切除术后失败的难治性青光眼是一种有效的方法,但应充分认识并预防各种术后并发症的发生。

Abstract:
      AIM: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for refractory glaucoma after sequential failed trabeculectomy.

 

     METHODS: Thirty-six patients(36 eyes)with prior failed sequential trabeculectomy who underwent Ahmed glaucoma valve implantation were included. The intraocular pressure(IOP), best corrected visual acuity(BCVA)and complications were ovserved and all the patients were followed up at least for 12mo.

 

     RESULTS: Mean preoperative IOP was 35.20±7.28mmHg and reduced to 10.15±3.34, 11.23±3.56, 15.63±5.72, 17.17±5.47, 17.73±6.23,19.76±5.43mmHg at 1, 2wk, 1, 3, 6 and 12mo after surgery, which was significant different from the preoperative level(t=12.643, 11.837, 10.324, 8.839, 8.462, 8.046, all P<0.05). Visual acuity was not significantly different between pre-operation and 12mo post-operation(Z=-0.420, P>0.05). At 12mo after operation, the complete success rate reached 78% and the conditional success rate reached 92%. There were 5 eyes complicated with shallow anterior chamber, 3 eye complicated with anterior chamber hemorrhage, which all recovered after additional treatments. Late complications included valve exposure and encapsulated cystic blebs around the plate. Severe corneal endothelium loss occurred in 1 patient.

 

     CONCLUSION: Ahmed glaucoma valve implantation is effective in reducing IOP at 1-year follow-up in refractory glaucoma patients with prior sequential failed trabeculectomy, but we should fully understand and attach great importance to all kinds of complications that may occur.

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