Outcome of combined Ahmed glaucoma valve implant and penetrating keratoplasty in refractory congenital glaucoma with corneal opacity

PURPOSE: To investigate surgical outcomes following simultaneous Ahmed glaucoma valve implant and penetrating keratoplasty (PKP) in the management of refractory congenital glaucoma with corneal opacity. METHODS: A retrospective review was undertaken of pediatric patients who underwent simultaneous Ahmed glaucoma valve implant and PKP at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, between January 1994 and September 1999. RESULTS: Twenty eyes of 17 patients were included in the study. Cumulative probabilities of success by Kaplan-Meier analysis showed 85%, 44%, and 33% IOP control and 85%, 43%, and 17% graft success at 2, 24, and 48 months. The most common cause of glaucoma failure that required subsequent surgery was subconjunctival scarring, which resulted in loss of long-term IOP control. Main graft-related complications included failure (13/20) and graft ulceration (6/20), and in 4/6 ulcerated grafts, Streptococcus pneumoniae was cultured positively. Subsequent surgery was the only significant clinical factor associated with poor outcome of glaucoma. However, low graft survival rate was significantly associated with delinquency of follow-ups, corneal ulcer, subsequent surgery, and postoperative complications. CONCLUSIONS: The long-term success of simultaneous Ahmed glaucoma valve implant and PKP in refractory congenital glaucoma associated with corneal opacity is low, and the complication rate is high.     

A clinical study of the Ahmed glaucoma valve implant in refractory glaucoma

OBJECTIVE: To assess clinical outcomes of the Ahmed glaucoma valve implant in patients with refractory glaucoma. PARTICIPANTS: 15 patients (16 eyes), including 7 women and 8 men; patients with glaucoma: phakic- 10 eyes, pseudophakic - 4 eyes, and aphakic - 2 eyes, average age: 47.2 (18-72 years old), average IOP before the intervention: 47 mmHg (32-71 mmHg), average number of medications taken before the intervention: 3.0. MAIN OUTCOME MEASURES: Success was defined as IOP less than or equal to 21 mmHg and no need to perform another surgical intervention. Average period of observation was 23.2 months (6-42 months). RESULTS: Intervention was successful in 12 out of 16 eyes. Average number of medicaments taken after the intervention decreased to 1.2. 4 out of 16 patients had a hypertensive phase. Cumulative probabilities of success at 1 and 2 years were 88% and 72% respectively. Complications: hyphema - 4 eyes (25%), tube exposure - 1 eye (6.25%), corneal graft failure - 4 eyes (25%), hypertensive phase - 4 eyes (25%) anterior chamber shallowing - 2 eyes (12.5%) CONCLUSIONS: The Ahmed glaucoma valve implant is an effective way of treating the patients with refractory glaucoma.     

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。     

Follow-up of the original cohort with the Ahmed glaucoma valve implant.

PURPOSE: To study the long-term results of the Ahmed glaucoma valve implant in patients with complicated glaucoma in whom short-term results have been reported. METHODS: In this multicenter study, we analyzed the long-term outcome of a cohort of 60 eyes from 60 patients in whom the Ahmed glaucoma valve was implanted. Failure was characterized by at least one of the following: intraocular pressure greater than 21 mm Hg at both of the last two visits less than 6 mm Hg at both of the last two visits, loss of light perception, additional glaucoma surgery, devastating complications, and removal or replacement of the Ahmed glaucoma valve implant. Devastating complications included chronic hypotony, retinal detachment, malignant glaucoma, endophthalmitis, and phthisis bulbi; we also report results that add corneal complications (corneal decompensation or edema, corneal graft failure) as defining a devastating complication. RESULTS: The mean follow-up time for the 60 eyes was 30.5 months (range, 2.1 to 63.5). When corneal complications were included in the definition of failure, 26 eyes (43%) were considered failures. Cumulative probabilities of success at 1, 2, 3, and 4 years were 76%, 68%, 54%, and 45%, respectively. When corneal complications were excluded from the definition of failure, 13 eyes (21.5%) were considered failures. Cumulative probabilities of success at 1, 2, 3, and 4 years were 87%, 82%, 76%, and 76%, respectively. Most of the failures after 12 months of postoperative follow-up were because of corneal complications. CONCLUSIONS: The long-term performance of the Ahmed glaucoma valve implant is comparable to other drainage devices. More than 12 months after the implantation of the Ahmed glaucoma valve implant, the most frequent adverse outcome was corneal decompensation or corneal graft failure. These corneal problems may be secondary to the type of eyes that have drainage devices or to the drainage device itself. Further investigation is needed to identify the reasons that corneal problems follow drainage device implantation.     

Long-term results of eyes with penetrating keratoplasty and glaucoma drainage tube implant

PURPOSE: To present long-term results of eyes with penetrating keratoplasty (PK) and glaucoma tube implant. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: We retrospectively reviewed medical records of all patients who underwent both PK and glaucoma tube implant (Baerveldt or Ahmed) at the University of Iowa between July of 1988 and December of 1997 (55 eyes). METHODS: Success of the tube implant or PK was evaluated using Kaplan-Meier survival analysis. Association of relevant clinical factors with glaucoma or corneal graft outcome was evaluated using log-rank test or Cox proportional hazard regression analysis. The factors evaluated were glaucoma and cornea diagnoses; prior, simultaneous, and subsequent surgeries; type of tube implant; relative timing of surgeries; and postsurgical complications. MAIN OUTCOME MEASURES: Glaucoma outcome was assessed by postoperative intraocular pressure (IOP), number of medications, and need for further glaucoma surgery. Corneal outcome was assessed by graft rejection, failure, and Snellen visual acuity. Surgical procedures before and during the study period, and their complications were evaluated. RESULTS: The mean preoperative intraocular pressure was 29.8 mmHg with an average of 2.9 medications. At last postoperative follow-up, the mean IOP decreased to 14.3 mmHg with 0.7 medication. The tube implant successfully controlled glaucoma in 45 eyes (82%) at 3 years. More severe postsurgical complications were associated with greater glaucoma failure. Graft rejection occurred in 17 eyes, and 7 of these progressed to failure. Nonimmunologic graft failure occurred in an additional 17 eyes (31%). The remaining 31 eyes (56%) had a clear graft. The corneal grafts remained clear in 70% and 55% of eyes at 2 and 3 years, respectively. Corneal graft failure was associated with glaucoma and cornea diagnoses groups, type of tube implant, and relative timing of the two surgeries. Complications occurred in 23 eyes (42%), and 10 of these were serious. CONCLUSIONS: A drainage tube implant can successfully control glaucoma in a majority (82%) of keratoplasty eyes at 3 years. However, the success of corneal grafts is low (55%) at 3 years. Postsurgical complications are not uncommon and are associated with poor glaucoma outcome. Other clinical factors are associated with poor graft outcome.     

Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma

PURPOSE: To present long-term outcomes of Ahmed glaucoma valve implantation for uveitic glaucoma. DESIGN: Interventional case series. METHODS: Retrospective chart review of 60 patients (60 eyes) with uveitic glaucoma who underwent Ahmed valve implantation over a four-year period at a tertiary uveitis referral center. Success definition 1 included patients with an intraocular pressure (IOP) between 5 and 21 mm Hg, reduced by 25% from that before implantation. Success definition 2 (qualified success) excluded those patients in whom serious complications occurred. RESULTS: Mean follow-up time was 30 months (range, six to 87 months; four-year results relate to a cohort of 15 patients). Success rates were 77% and 50% and qualified success rates were 57% and 39% at one and four years, respectively. At four years, 74% of the patients required glaucoma medication to maintain IOP control. The overall complication rate was 12%/person-years. The rate of visual acuity loss was 4%/person-years; that was most commonly attributed to corneal complications that were more likely to occur in patients with preoperative corneal disease (P = .01, Fisher exact test). CONCLUSIONS: Ahmed glaucoma valve implantation is a safe yet moderately successful procedure for uveitic glaucoma. Long-term success rates are enhanced with the use of glaucoma medications, and corneal complications are the most common of all potential serious complications.     

Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract

PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 +/- 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 +/- 5 months (range 6 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSION: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.     

Management of uveitic glaucoma with Ahmed glaucoma valve implantation

OBJECTIVE: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for the management of glaucoma associated with chronic uveitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Nineteen patients (21 eyes) with chronic uveitis underwent Ahmed glaucoma valve implantation for uncontrolled glaucoma between 1995 and 1998. INTERVENTION: All patients had their uveitis controlled before surgery via immunomodulatory therapy. Ahmed glaucoma valve implantation was performed. Immunosuppression was continued in the early postoperative period for strict control of inflammation. MAIN OUTCOME MEASURES: Control of intraocular pressure (IOP). A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired IOP. Visual acuity and complications associated with the surgery were monitored. RESULTS: The postoperative follow-up averaged 24.5 months. At the most recent visit, all 21 eyes had IOPs between 5 and 18 mmHg. The average pressure reduction after Ahmed glaucoma valve implantation was 23.7 mmHg. The average number of antiglaucoma medicines required to achieve the desired IOP was reduced from 3.5 before surgery to 0.6 after surgery. No eye lost even a single line of Snellen acuity at the most recent postoperative visit. Two eyes developed hypotony in the course of follow-up. One resolved without specific intervention, and the other eye required two autologous blood injections and tube ligature to correct the hypotony. One eye underwent Ahmed glaucoma valve replacement for abrupt valve failure. Two eyes underwent penetrating keratoplasty for reasons believed to be unrelated to the glaucoma surgery. Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 94% at 1 year. CONCLUSIONS: Ahmed glaucoma valve implantation can be an effective and safe method in the management of uveitic glaucoma. The authors hypothesize that control of the patients' uveitis, through preoperative and long-term postoperative immunomodulatory therapy, may have contributed to the success rate reported herein.     

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

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依7.28mmHg,术后1、2wk,1、3、6、12mo 平均眼压分别降至10.15依3.34、11.23依3.56、15.63依5.72、17.17依5.47、17.73依6.23、19.76依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。     

睫状体平坦部青光眼阀植入联合玻璃体切除全视网膜光凝治疗新生血管性青光眼的临床观察

目的:评估平坦部青光眼阀植入联合玻璃体切除全视网膜光凝术治疗继发性闭角型新生血管性青光眼(neovascular glaucoma,NVG)的临床效果。方法:对2007-05/2008-08在我科治疗的连续伴玻璃体积血的继发性闭角型NVG患者14例16眼行玻璃体切除视网膜光凝联合平坦部青光眼阀植入术并随访观察。结果:术后追踪随访3～13(平均7.3)mo。16只术眼中,除3眼外视力均不同程度提高。经秩和检验术前和术后两组相差显著。眼压由术前用降压药后的38～67(平均48.5±9.3)mmHg降至15.6～25.3(平均16.5±6.9)mmHg,两组相差有统计学意义。4眼出现术后并发症。其中2眼角膜水肿、前房炎症。1眼脉络膜脱离。经药物对症治疗后缓解。1眼出现医源性白内障。结论:玻璃体切除全视网膜光凝联合平坦部青光眼阀植入术是有效和安全的。特别是对于伴浅前房的NVG患者是一种新的治疗选择。     

Ahmed青光眼引流阀植入治疗先天性青光眼术后眼压失控疗效分析

目的：探讨Ahmed青光眼引流阀植入治疗先天性青光眼术后眼压失控的疗效与安全性。

方法：回顾分析了2011-01/2014-12因先天性青光眼术后眼压失控患者22例22眼,行青光眼引流阀植入术。主要检查指标包括手术前后眼压、角膜直径以及并发症。

结果：术前平均年龄3.74±2.24岁,距上次手术平均2.59±1.78a,术前平均眼压35.22±6.36mmHg,平均水平角膜直径12.79±0.75mm。所有眼术中使用丝裂霉素C 0.3～0.5mg/mL 3～5min,青光眼引流阀植入颞上或鼻上方巩膜赤道部。术后1wk眼压11.4±4.45mmHg,术后12mo随访眼压16.73±7.23mmHg。以眼压<21mmHg为成功标准,术后12mo 16眼(73%)眼压控制。术后6例发生浅前房,均自行恢复。所有患者未发生引流阀排斥及眼内炎、角膜失代偿等严重并发症。

结论：Ahmed青光眼引流阀植入治疗先天性青光眼术后眼压失控,是一种安全、有效的方法。     

Efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucoma

AIMS: To evaluate the efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucomas. METHODS: This retrospective study reviewed the final intraocular pressure, visual outcome, and incidence of complications in all patients with the Ahmed glaucoma valve implant performed at the Prince of Wales Hospital, Hong Kong, between June 1996 and November 1998. RESULTS: A total of 65 eyes from 60 patients were treated with the Ahmed glaucoma implant. At a mean follow up (SD, median) of 21.8 (9.2, 28. 0) months (range 6-37 months), the mean intraocular pressure was reduced from 37.0 (SD 12.1) mm Hg before the implant surgery to 16.1 (12.4) mm Hg at the last follow up after surgery. The success rate of intraocular pressure control of <22 mm Hg was achieved in 73.8% of operated eyes. Transient postoperative hypotony with shallow anterior chamber occurred in 10.8% of cases. The most common postoperative complication was the formation of encapsulated bleb (24.6%). CONCLUSIONS: The Ahmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas in Chinese eyes. The success rate is comparable with those reported in non-Asian eyes. Formation of postoperative encapsulated bleb is, however, more commonly encountered.     

Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience

AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery. METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference (P<0.001). The success rate was 85.2% during the first semester, 76.8% at 12mo and 50.3% at the end of follow up period (18 to 120mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.     

小梁切除术与Ahmed植入术治疗穿透性角膜移植术后继发青光眼的疗效比较

目的 探讨小梁切除(TRA)术与Ahmed 阀(AGV)植入术治疗穿透性角膜移植术后继发青光眼(post-penetrating keratoplasty glaucoma,PKG)的临床疗效与角膜植片安全性.方法 回顾分析我院2015 年4 月至2018年4 月PKG患者47例47 眼,按手术方式分TRA组与AGV组...     

Ahmed引流阀植入联合玻璃体腔注射Bevacizumab治疗NVG

目的：观察Ahmed引流阀植入联合玻璃体腔注射bevacizumab(贝伐珠单抗)治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。

方法：对22例22眼新生血管性青光眼患者先进行玻璃体腔注射bevacizumab 0.1mL(2.5mg),待虹膜新生血管消退后行Ahmed青光眼阀门植入术。术后观察视力、眼压、虹膜新生血管消退情况、术中及术后并发症,随访6～36(平均24)mo。

结果：玻璃体腔注药后1wk内22眼虹膜新生血管均有不同程度消退,Ahmed引流阀植入术后随访22眼中仅有3眼联合使用1～3种抗青光眼药物,眼压控制在21mmHg之内,1眼因眼压失控而行睫状体光凝术(810激光),其余18眼均无需加用抗青光眼药物眼压控制在正常范围内,最后一次随访,平均眼压15.59±3.21mmHg,与术前平均眼压(45.36±8.13mmHg)相比,差异有统计学意义(P<0.05)。视力提高者9眼(41%),保持术前视力者13眼。全部病例在玻璃体腔注射bevacizumab及Ahmed引流阀植入术中术后均未观察到严重手术并发症。

结论：Ahmed引流阀植入联合玻璃体腔注射bevacizumab治疗NVG安全有效,手术成功率高,并发症少,有利于保护残留视功能。     

Baerveldt-350 implant versus Ahmed valve for refractory glaucoma: a case-controlled comparison

PURPOSE: To compare the efficacy of intraocular pressure (IOP) control of the Baerveldt-350 implant with tube ligature and the Ahmed valve in patients with refractory glaucoma. PATIENTS AND METHODS: Four hundred seventy glaucoma drainage device procedures from July 1995 to July 2001 (6 years) were reviewed retrospectively. Thirty-two cases of Baerveldt-350 implantation performed in patients with glaucoma refractory to medical treatment and filtering procedures, without previous drainage device or cyclodestructive procedures, and with a minimum of 1-year follow-up were identified. Thirty-two cases of Ahmed valve implantation were matched case by case with 32 Baerveldt-350 cases for age, race, gender, glaucoma subtype, previous ocular history, preoperative IOP, and surgeon who performed the implantation. The two groups were compared for IOP control, visual outcome, complication rate, and surgical success rate. Surgical success rate was defined as an IOP reduction greater than or equal to 30% and final IOP more than 5 mm Hg and less than 22 mm Hg, without devastating complications. RESULTS: Over a follow-up period of 1 year, no statistically significant differences were detected between the Baerveldt-350 implant versus Ahmed valve for IOP control (12.1 +/- 5.3 mm Hg vs. 13.6 +/- 5.6 mm Hg respectively, at a power of 90% to detect a difference of 3.2 mm Hg between the two groups and P = 0.05), surgical success rate (65.6% vs. 65.6% respectively, complete and qualified combined), postoperative hypotony rate (37.5% vs. 34.4% respectively), and visual acuity changes of more than 1 line in Snellen visual acuity (43.3% vs. 29.0% respectively). CONCLUSION: In a case-controlled comparison, the Baerveldt-350 implant and the Ahmed valve had similar IOP control and surgical outcomes in patients with refractory glaucoma at 1-year follow-up.     

AGV植入联合MMC及视网膜光凝治疗NVG

目的：观察 Ahmed青光眼阀(Ahmed glaucoma valve,AGV)植入术中应用丝裂霉素C(MMC)联合视网膜光凝治疗新生血管性青光眼(neovascular glaucoma,NVG)的临床疗效。

方法：回顾性分析行AGV植入术中应用MMC联合视网膜光凝术治疗的41 例41眼NVG患者临床资料,观察患者眼压变化、视力变化、手术成功率及并发症情况。

结果：患者术前平均眼压49.8±4.3mmHg,术后1,3,6,12mo分别为18.30±4.50,19.40±5.37,18.45±4.60,17.85±3.66mmHg。末次随访平均眼压20.25±4.2mmHg,与术前眼压相比差异均具有统计学意义(P<0.05)。随访6～24mo,手术成功率为93% ,其中完全成功36眼(88%),部分成功2眼(5%),失败3眼(7%)。手术前后视力差异无统计学意义(P>0.05)。术后常见并发症为术后早期低眼压4眼(10%); 术后浅前房1眼(2%); 前房少量出血3眼(7%); 引流管内口阻塞1眼(2%)。

结论：AGV植入术中应用MMC联合视网膜光凝治疗NVG临床疗效显著,可以有效降低NVG患者的眼压。     

Long-term results of Ahmed glaucoma valve and Molteno implant in neovascular glaucoma

AIMS: To evaluate the surgical success results of Ahmed glaucoma valve (AGV) and Molteno single-plate implant (MSPI) in cases of neovascular glaucoma (NVG). METHODS: Between May 1997 and May 2002, 38 of 38 NVG patients that underwent implantation of AGV and 27 eyes of 27 NVG patients that underwent MSPI (a total 65 eyes of 65 patients) included to the study. RESULTS: The cumulative probabilities of success were 63.2% at 1 year, 56.2% at 2 years, 43.2% at 3 years, 37.8% at 4 years, and 25.2% at 5 years in AGV group whereas the cumulative probabilities of success were 37.0% at 1 year, 29.6% at 2 years, 29.6% at 3 years, 29.6% at 4 years, and 29.6% at 5 years in MSPI group (P=0.141). Preoperative visual acuity <2/200 (P=0.003), diagnosis of diabetes mellitius (P=0.050), and preoperative IOP>or=35 mmHg (P=0.038) were found to be poor prognostic factors for surgical success. CONCLUSIONS: Both AGV and single plate MSPI were successful for early and intermediate-term of IOP control but in long term both implants were failed to achieve control of IOP in patients with NVG.     

Ahmed引流阀植入联合玻璃体腔注射Avastin治疗NVG

观察Ahmed阀植入联合玻璃体腔注射avastin治疗新生血管性青光眼(neovascular glaucoma, NVG)的疗效。 方法：对NVG患者20例20眼先行玻璃体腔注射avastin 0.1mL(2.5mg),待虹膜新生血管消退后行Ahmed青光眼引流阀植入术。术后观察视力、眼压、虹膜新生血管消退情况、术中及术后并发症,随访6～36(平均24)mo。 结果：玻璃体腔注射avastin后1wk内20眼虹膜新生血管均不同程度消退。Ahmed引流阀植入术后最后一次随访20眼中仅有3眼联合1～3种抗青光眼药物眼压≤21mmHg,1眼因眼压无法控制而行睫状体冷凝术（术后眼压控制）,其余16眼无需加用抗青光眼药物眼压控制在正常范围。最后一次随访,平均眼压13.62±3.81mmHg,与术前平均眼压（44.17±16.17mmHg）比较,差异有统计学意义(t=11.028,P=0.000)。视力提高者8眼（40％）,保持不变者12眼。全部病例在玻璃体腔注射avastin及Ahmed引流阀植入术中术后均未观察到严重手术并发症。 结论：Ahmed引流阀植入联合玻璃体腔注射avastin治疗NVG安全有效,手术成功率高,并发症少,有利于保护残留的视功能,但其长期疗效还需进一步观察,同时要注意原发病的处理。 关键词：新生血管性青光眼;Ahmed引流阀;玻璃体腔注射;avastin     

Ahmed阀门在青光眼手术中的疗效分析

目的：评价Ahmed青光眼阀门在多种类型青光眼中的治疗效果。方法：对研究期间住院94例102眼青光眼患者予Ahmed青光眼阀门植入术,新生血管性青光眼患者术后1～2wk予全视网膜光凝。术后随访6mo以上,了解各期眼压、视力情况。结果：平均眼压从术前48.52±6.42mmHg降到术后6mo11.20±3.34mmHg。术后各时期平均眼压均低于21mmHg,与术前相比差异有显著性（P〈0.01）。102眼手术完全成功者96眼,基本成功者2眼,总有效率为96.1%。术后并发症包括短暂性前房出血、早期低眼压、浅前房等。结论：尽管Ahmed阀门植入存在一些并发症,但是对于青光眼是一种新的有效治疗方法。