简易硅管植入联合丝裂霉素C治疗顽固性青光眼

本文总结了对顽固性青光眼１７例２４眼采用简易硅管植入联合丝裂霉素Ｃ手术治疗的近期效果。术前眼压平均３９．９６±２．０６ｍｍＨｇ（５．３３±０．２７ｋＰａ），术后眼压平均１２．８８±１．７７ｍｍＨｇ（１．７２±０．２４ｋＰａ），Ｐ＜０．００１。总眼压有效控制率为７９％。随访时间平均３．７个月。并发症有浅前房、滤过泡渗漏、前房出血、硅管入口堵塞、持续性低眼压等。本手术方法对顽固性青光眼不失为一种实用有效的治疗方法。     

Molteno引流阈植入二期开放引流管治疗新生血管性青光眼

采用自闭巩膜隧道和１０￣１４天开放引流管的方法对１６例新生管性青光眼进行Ｍｏｌｔｅｎｏ房水引流阈植入术。术后前房段引流管开口若被堵塞时，则尽早用ＹＡＧ激光联合氩激光清除堵塞物。平均追踪９．３月，眼压自术前７．６６±１．８４ｋＰａ下降到２．８２±１．７１ｋＰａ。３例（３／６）成功行引流管开口堵塞物激光清除术。本方法简单、安全、有效、能避免术后早期低眼压及并发症。     

两阶段房水引流物植入术在新生血管性青光眼治疗中的应用

目的：探讨两阶段房水引流物植入手术在新生血管性青光眼治疗中的应用价值。方法：对１３例新生血管性青光眼患者行两阶段房水引流物植入手术,并根据不同的病因及眼压控制情况采取相应的改良技术和辅助治疗,病人追踪随访时间为６～１２个月。结果：所有病例术前眼压大于等于２３ｍｍＨｇ（３．０５ｋＰａ）,手术治疗后最后一次复查结果显示眼压控制在６～２１ｍｍＨｇ（０．７９８～２．７９３ｋＰａ）之间７例（约占５４％）,加用降眼压药后眼压控制在２１ｍｍＨｇ（２．７９３ｋＰａ）２例,总成功率近７０％。８例视力保持在术前水平或有所提高（占６２．３％）,５例由于原发病恶化及眼压控制不良,视力较术前下降（占３７．６％）。结论：两阶段房水引流物植入手术为新生血管性青光眼的治疗提供了新的选择     

非新生血管性顽固性青光眼的手术疗效观察

为探讨治疗非新生血管性顽固性青光眼的有效方法，对３７例（４６眼）非新生血管性顽固性青光眼，随机分为ＨＡＤ房水引流物置入术组（ＨＡＤ组，２４眼）与小梁切除术联合应用丝裂霉素Ｃ治疗组（ＭＭＣ组，２２只眼），平均随访１５．８月（３￣３４月）。术后一年眼压峰值（Ｘ↑－±ＳＤ）：ＨＡＤ组为１７．０±６．４ｍｍＨｇ，ＭＭＣ组为１８．７±７．５ｍｍＨｇ（Ｐ〈０．０５）；眼压下降率（Ｘ↑－±ＳＤ）：ＨＡＤ组为６３     

Ahmed青光眼阀植入术治疗难治性青光眼

目的评价Ａｈｍｅｄ青光眼阀植入术治疗难治性青光眼的近期和中期疗效，探讨术中、术后并发症及预防。方法对２０例难治性青光眼施行颞上象限前房到赤道部区域的Ａｈｍｅｄ青光眼阀植入术。其中新生血管性青光眼９例，无晶体或人工晶体植入术后青光眼７例，先天性青光眼３例，原发性慢性闭角型青光眼１例。结果术后１个月，眼压≤２．８ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）者１５例，总成功率为７５．０％；其中新生血管性青光眼成功率为５５．６％，其它类型青光眼成功率为９０．９％。８５．０％的患者视力提高或不变；随访６个月以上者１２例，总成功率为５８．３％；其中新生血管性青光眼成功率为４０．０％，而其它类型青光眼成功率为７１．４％。并发症包括短暂性前房出血，术后早期低眼压，引流管内、外口阻塞，引流管接触晶体或角膜，引流管外露，渗出性脉络膜脱离，植入盘脱出。结论尽管Ａｈｍｅｄ青光眼阀植入术存在一些不容忽视的并发症，但仍不失为治疗难治性青光眼的一种有效方法。     

青光眼眼压调节器植入睫状体冷凝治疗新生血管性青光眼

目的　探讨青光眼眼压调节器（ＯＧＰＲ）植入睫状体冷凝治疗新生血管性青光眼的方法和效果。方法　采取下方１８０°结膜面上睫状体冷凝８ 点，时间２０ｓ，温度－ ６５℃～－７５℃；ＯＧＰＲ引流头在巩膜瓣下斜形置入前房１．５ｍ ｍ ，引流部分固定于外直肌与上直肌间的赤道部巩膜面；另做切口作虹膜根部切除。结果　术后随访８～１８ｍ ｏ 见８例未使用任何药物，２例局部使用噻吗心安后眼压均控制在２．８０～１．３０ｋＰａ之间。结论　ＯＧＰＲ植入联合睫状体冷凝是治疗新生血管性青光眼的良好方法，两者间有协同作用     

Molteno引流装置植入治疗难治性青光眼的临床观察

目的 评价Ｍｏｌｔｅｎｏ引流装置植入治疗难治性青光眼的疗效。方法 应用Ｍｏｌｔｅｎｏ引流装置植入治疗难治性青光眼２４例（２４眼）。结果 术后１月,１８只眼眼压降至正常,成功率为７５％。术后随访５月以上者１６只眼,１１只眼眼压降至正常,成功率为６８．７５％。主要并发症为术后早期低眼压、浅前房,可通过期植入或Ⅰ期植入联合限制房水流出技术解决。结论 Ｍｏｌｔｅｎｏ引流装置植入是治疗难治性青光眼的有效方法。     

三种青光眼房水引流物治疗难治性青光眼

目的：三种青光眼房水引流物治疗难治性青光眼,评价三种不同类的青光眼房水引流物的临床治疗效果。方法：４９例难治性青光眼其中新生血管性青光眼１９例,２５例继发性青光眼,２例先天性青光眼,３例恶性青光眼,均施行颞上象限前房到赤道部区域的青光眼房水引流物的植入术,其中用ｍｏｌｔｅｎｏ植入６例,用Ｂａｅｒｖｅｌｄｔ植入８例,用Ａｈｍｅｄ植入３５例。结果：用ｍｏｌｔｅｎｏ植入术后一个月,４例眼压在１．３７ｋＰ     

青光眼阀植入物治疗难治性青光眼

目的观察Ahmed青光眼引流植入物治疗难治性青光眼的疗效.方法采用Ahmed青光眼引流植入物,共治疗28例(29只眼)难治性青光眼,其中新生血管性青光眼10例(10只眼),青少年型青光眼5例(6只眼),其它青光眼13例(13只眼).结果术后随访3～12个月,新生血管性青光眼的眼压由术前40.9±7.32 mmHg降至20.63±2.75 mmHg(1mmHg=0.133kPa);人工晶体联合玻璃体手术后青光眼的眼压由术前41±5.66mmHg降至术后18.00±2.12 mmHg;青少年型青光眼的眼压由术前33.65±5.28 mmHg降至术后16.45±1.48 mmHg;常规滤过性手术失败的青光眼的眼压由术前31.43±4.13 mmHg降至18.13±1.25 mmHg.术后常见并发症有浅前房、前房积血、前葡萄膜炎等.结论Ahmed青光眼引流植入物是治疗难治性青光眼的一种较为有效的降眼压方法.眼科学报2000;16259～261.     

三种抗青光眼手术后浅前房临床分析

目的讨论小梁切除术、巩膜咬切术和虹膜嵌顿术后浅前房的原因和发生情况。方法回顾性总结１９８６～１９９６年在我院眼科进行３种抗青光眼手术的３９０只各种青光眼病例。结果（１）术前眼压≤２１ｍｍＨｇ（１ｍｍＨｇ＝０．１３３ｋＰａ）者１０９只眼，小梁切除术６４只眼，术后浅前房９只眼，占１４．１％，巩膜咬切术３１只眼，术后浅前房７只眼，占２０．６％，虹膜嵌顿术１１只眼，术后无浅前房发生；（２）术前眼压２２～３５ｍｍＨｇ者１７５只眼，小梁切除术１０３只眼，术后浅前房２６只眼，占２５．２％，巩膜咬切术４６只眼，术后浅前房１５只眼，占３２．６％，虹膜嵌顿术２６只眼，术后浅前房５只眼，占１９．２％；（３）术前眼压＞３５ｍｍＨｇ者１０６只眼，小梁切除术４２只眼，术后浅前房１３只眼，占３１％，巩膜咬切术２３只眼，术后浅前房５只眼，占２１．７％，虹膜嵌顿术４１只眼，术后浅前房５只眼，占１２．２％．结论３种抗青光眼手术中，虹膜嵌顿术后浅前房发生率低；术前眼压控制正常后，术后浅前房发生率低。     

Ahmed青光眼阀植入治疗难治性青光眼

目的：探讨Ahmed青光眼阀植入治疗难治性青光眼的临床疗效。 方法：回顾性研究我院Ahmed青光眼阀植入术治疗21例21眼难治性青光眼的临床疗效并进行总结分析。 结果：术前平均眼压为44.6±7.2mmHg,术后6mo末次随访平均眼压15.4±5.3mmHg;视力提高4眼,无改变14眼,降低3眼;手术并发症主要包括术后前房形成迟缓2眼、持续高眼压1眼、引流管暴露1眼、角膜失代偿1眼、引流盘纤维包裹3眼;手术成功率为86％。 结论：Ahmed青光眼阀植入术是治疗难治性青光眼有效和安全的方法。     

The Ahmed Glaucoma Valve in refractory glaucoma: experiences in Indian eyes

PURPOSE: To evaluate the efficacy of the Ahmed Glaucoma Valve implant in refractory glaucomas in Indian eyes. MATERIALS AND METHODS: A retrospective review was conducted on the charts of 122 eyes of 122 patients with refractory glaucoma treated with Ahmed Glaucoma Valve implant placement at Guru Nanak Eye Centre, New Delhi between January 1996 and December 1999. The main outcome measure was success at the last follow-up. Success was defined as an intraocular pressure (IOP) of 22 mmHg or less and 5 mmHg or more and at least a 30% reduction in IOP without visually devastating complications or additional glaucoma surgery. RESULTS: The mean postoperative IOP (17.29+/-3.79 mmHg) was significantly (P<0.001) lower than the mean preoperative IOP (31.47+/-7.86 mmHg) at last follow up (mean 12.51+/-8.37 months; range 3-24 months). The cumulative probability of success by Kaplan-Meier analysis was 85.95% at 12 months and 82.83% at 24 months. The mean number of postoperative antiglaucoma medications (0.75+/-0.80) was also significantly lower (P<0.001) than the mean preoperative number of antiglaucoma medications (2.83+0.72). The most common complication was corneal-tube contact, which occurred in five (4.10%) eyes. Retinal detachment occurred postoperatively in one eye with the clinical diagnosis of neovascular glaucoma secondary to Eale's disease. Two patients had tube extrusion requiring repositioning and reinforcement with scleral patch graft. CONCLUSIONS: Ahmed Glaucoma Valve implantation is an effective and relatively safe therapy for the treatment of refractory glaucoma in Indians.     

Clinical evaluation and risk factors of time to failure of Ahmed Glaucoma Valve implant in pediatric patients

PURPOSE: To evaluate the clinical results and the risk factors related to time to failure of the Ahmed Glaucoma Valve implant (New World Medical, Inc., Rancho Cucamonga, CA), an aqueous shunting device with a unidirectional valve mechanism, in pediatric patients. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: We studied 35 Ahmed Glaucoma Valve implants in 35 eyes of 29 patients less than 15 years of age (median, 2.4 years; range, 0-14.8 years). METHODS: Thirty-five Ahmed Glaucoma Valve implants were placed in eyes of pediatric patients with refractory glaucoma between December 1994 and March 1999. MAIN OUTCOME MEASURES: Time after surgery without failure, intraocular pressure reduction, risk factors related to time to failure, and postoperative complications were evaluated. RESULTS: The cumulative probabilities of success according to Kaplan-Meier analysis 12 and 24 months after implantation were 70.1% +/- 8.5% and 63.7% +/- 9.9%, respectively. Intraocular pressure was reduced from a preoperative mean of 28.8 +/- 4.5 mmHg to 18.1 +/- 2.4 mmHg by postoperative month 18. Shallow anterior chambers of different grades developed in nine eyes (25.7%) on the first postoperative day; this was associated with choroidal detachment in four eyes. Nine eyes (25.7%) experienced malposition, causing failure in six eyes. In three other eyes (8.5%), the average intraocular pressure at the last two follow-up examinations was more than 22 mmHg. Congenital glaucoma and surgical experience were significantly associated with time to failure. CONCLUSIONS: The 12- and 24-month success rates of the Ahmed Glaucoma Valve implant in our study confirm its viability in the management of refractory infantile glaucoma. The complications related to overfiltration during the immediate postoperative period appear to be less severe than those associated with other drainage devices and resolve spontaneously. Diagnosis, number of previous glaucoma procedures, and the surgeon's experience seem to be related to the survival of the Ahmed Glaucoma Valve implant.     

Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life

PURPOSE: To compare the outcomes of children 24 months of age or younger treated with aqueous shunt devices or with mitomycin-C (MMC) trabeculectomy. DESIGN: Retrospective, age-matched, comparative case series. METHODS: Forty-six eyes of 32 patients with mean age of 7.0 +/- 5.1 month (range, 1 to 22 months) and uncontrolled glaucoma, which received an aqueous shunt device (Ahmed glaucoma valve or Baerveldt implant), compared with 24 eyes of 19 patients with mean age of 5.3 +/- 4.8 months (range, 0.5 to 24 months), which received an MMC trabeculectomy. Surgical success was defined as intraocular pressure < 23 mm Hg on maximal glaucoma medication, no further glaucoma surgery performed or recommended, no devastating complication, and stable ocular dimensions (axial length and corneal diameter). RESULTS: Cumulative probabilities of success were 87% +/- 5.0% for the aqueous shunt group compared with 36% +/- 8.0% success in the trabeculectomy group at 12 months and 53% +/- 12% in the aqueous shunt group compared with 19% +/- 7% in the trabeculectomy group at 72 months (chi(2) of 23.5, P <.0001). Aqueous shunt implantation was associated with significantly more postoperative complications requiring a return to the operating room (21 of 46 eyes, 45.7%) compared with trabeculectomy with MMC (3 of 24 eyes, 12.5%, P =.0074). The most common postoperative procedure in the aqueous shunt group was tube repositioning, performed in 16 of 46 eyes (34.8%). CONCLUSIONS: Aqueous shunt implantation offers a significantly greater chance of successful glaucoma control in the first 2 years of life, compared with trabeculectomy with MMC. However, the enhanced success with aqueous shunt devices is associated with a higher likelihood of postoperative complications requiring surgical revision, most commonly tube repositioning.     

Ahmed青光眼阀植入术的中远期疗效评价

目的评价Ahmed青光眼阀(AGV)植入术治疗难治性青光眼的中远期临床疗效。方法回顾性分析206例(221只眼)难治性青光眼患者应用AGV及其联合手术治疗的临床效果及其手术并发症。根据AGV植入术手术成功判断标准,采用寿命表法统计不同时间点的累积成功率,以Cox比例风险模型分析各种预测变量对不同时间点失败的影响。结果术后随访6～86个月,平均37个月。术后半年,1、2、3、4年的累积完全成功率分别为(88.5±2.2)%、(85.0±2.5)%、(76.4±3.1)%、(66.2±3.7)%、(55.5±4.7)%,累积总成功率分别为(91.2±1.9)%、(88.6±2.2)%、(88.6±2.2)%、(86.8±2.5)%、(86.8±2.5)%。术前平均眼压(44.59±13.04)mmHg(1mmHg=0.133kPa),术后平均眼压(16.52±4.61)mmHg,差异有统计学意义(P<0.01)。早期常见并发症为一过性低眼压43只眼(19.5%),浅前房32只眼(14.5%),引流管口堵塞25只眼(11.3%),眼内出血16只眼(7.2%)等。中晚期常见并发症为引流盘周纤维包裹24只眼(10.9%),引流管暴露11只眼(5.0%),引流管前移10只眼(4.5%),角膜失代偿5只眼(2.3%),引流盘脱出3只眼(1.4%)等。结论采用AGV植入术及其联合手术治疗难治性青光眼是比较有效和相对安全的治疗方法。及时并有效处理并发症可提高手术成功率。     

Fibrin glue for preventing immediate postoperative hypotony following glaucoma drainage implant surgery

PURPOSE: To prevent a leak of aqueous around the tube in the immediate postoperative period after glaucoma drainage implant (GDI) surgery. METHODS: A total of 42 eyes of 34 consecutive patients with refractory glaucoma requiring single-plate Molteno implantation were retrospectively reviewed. Peritubular filtration was checked intraoperatively in all filtered eyes. Fibrin glue was used over the scleral flap intraoperatively in every eye with peritubular leakage. All Molteno tubes were completely closed with an absorbable ligature. RESULTS: Peritubular filtration was detected in 11 eyes of 11 patients. All 11 eyes maintained intraocular pressure (IOP) >or= 16 mmHg in the immediate postoperative phase. The mean IOP on the first postoperative day was 30.5 +/- 10 mmHg. After an average follow-up of 6 months, the mean IOP in these 11 eyes was 19.1 +/- 6 mmHg. No complications or Seidel-positive aqueous leak were observed during the follow-up period. CONCLUSIONS: Results suggest that intraoperative use of fibrin glue is a viable option for reducing peritubular filtration and preventing immediate postoperative hypotony after GDI surgery.     

改良Ahmed青光眼阀治疗难治性青光眼

目的探讨改良Ahmed青光眼阀治疗难治性青光眼的有效性和安全性。方法20例（20眼）难治性青光眼行改良的引流装置（Ahmed青光眼阀）植入,术后观察眼压、滤过泡的形成,采用海德堡视网膜断层扫描仪Ⅱ（HRT-Ⅱ）随访比较视盘参数。结果术后随访8个月以上,术后末次随访平均眼压与术前平均眼压比较,差异有统计学意义（P〈0．01）。视盘沿面积（RA,m^2）、盘沿体积（RV,mm^2）、平均神经纤维层厚度（mRNFL,mm）与术前比较均有改善,差异有统计学意义（P〈0．05）。结论改良Ahmed青光眼阀植入,术后眼压控制效果明显,改善患眼视盘部分结构参数。     

小梁切除术联合硅胶片植入治疗难治性青光眼

目的:观察小梁切除术联合巩膜层间硅胶片填充治疗难治性青光眼的效果及并发症。方法:60眼难治性青光眼（包括新生血管性青光眼12眼,无晶体或人工晶体性青光眼14眼,先天性青光眼4眼,滤过性手术失败的青光眼18眼,外伤性青光眼12眼）作小梁切除术联合硅胶片填充于巩膜层间,术后观察其降眼压效果及并发症。结果:术后随访5～34个月（平均18.3个月）,最后一次随访时的眼压范围是17.30～37.19mmHg[平均（23.36±4.06）。Hg],其中38眼（63.3％）术后眼压降至21 mmHg以下,18眼（30％）眼压在21～30 mmHg之间,仅4眼（6.7％）术后眼压高于30 mmHg,术后随访时间内未发现与硅胶片填充有关的严重并发症及硅胶片排斤反应。结论:小梁切除术联合巩膜层间硅胶片植入是治疗难治性青光眼的有效方法,尤其是在我国广大基层医院可以代替昂贵进曰引流性植入物治疗难治性青光眼,因此,值得推广应用。     

Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma

OBJECTIVE: To evaluate the efficacy and safety of Baerveldt glaucoma drainage devices in the management of uveitic glaucoma. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-four eyes of 24 patients who underwent implantation of Baerveldt glaucoma drainage devices between 1996 and 2000 for the treatment of uveitic glaucoma refractory to medical therapy. INTERVENTION: Implantation of Baerveldt glaucoma drainage device. MAIN OUTCOME MEASURES: Control of intraocular pressure (IOP), number of glaucoma medications needed for adequate IOP control, visual acuity, complications associated with the surgery, and the effect of subsequent surgery on the ability of the device to control IOP. Success was defined as IOP >/=5 and 相似文献