康柏西普玻璃体腔注射联合EX-PRESS青光眼引流器植入治疗NVG

目的：观察康柏西普玻璃体腔注射应用EX-PRESS青光眼引流器植入治疗新生血管性青光眼的疗效。

方法：选择2015-01/2018-01在我院眼科就诊的新生血管性青光眼患者37例37眼,随机分为试验组与对照组,两组在术前均行康柏西普玻璃体腔注射,试验组和对照组分别选择EX-PRESS青光眼引流器植入术和小梁切除术。对比两组术后成功率、最佳矫正视力、眼压、滤过泡、并发症。

结果：术后12mo, 两组手术成功率、BCVA及滤过泡率均无差异(P>0.05)。两组不同时间点眼压比较有差异(F_组间=10.0,P_组间=0.003; F_时间=496.27,P_时间<0.0001)。所有并发症经对症处理后改善。

结论：EX-PRESS青光眼引流器植入联合康柏西普玻璃体腔注射治疗新生血管性青光眼对降低眼压、减少术后并发症有一定的临床价值。     

康柏西普联合EX-PRESS青光眼引流器植入对NVG患者视力及并发症的影响

目的：探讨玻璃体腔注射康柏西普联合EX-PRESS青光眼引流器植入对新生血管性青光眼(NVG)患者视力及并发症的影响。

方法：选取2016-02/2018-10我院眼科收治的NVG患者128例,依据患者的治疗方法分为EX-PRESS组(n=66)和小梁切除术组(n=62),两组患者接受玻璃体腔注射康柏西普治疗,EX-PRESS组患者加行EX-PRESS青光眼引流器植入术治疗,小梁切除术组患者则加行小梁切除术治疗。比较两组手术疗效及术后眼压变化、视力改善情况及并发症发生情况。

结果：术后12mo时,EX-PRESS组、小梁切除术组手术治疗总成功率分别为81.8%(54/66)、72.6%(45/62)(P>0.05); 术后1、7d,1、3、6、12mo,两组患者眼压均显著低于术前(P<0.05),但两组患者眼压无差异(P>0.05); 术后6mo,EX-PRESS组患者视力改善情况显著优于小梁切除术组患者(P<0.05); EX-PRESS组、小梁切除术组术后并发症总发生率分别为27.3%(18/66)、37.1%(23/62)(P>0.05)。

结论：玻璃体腔注射康柏西普联合EX-PRESS青光眼引流器植入术与联合小梁切除术治疗NVG的有效性、安全性相似,而前者在改善视力方面更具优势。     

EX-PRESS引流器植入联合超声乳化术治疗难治性青光眼合并白内障

目的：观察EX-PRESS青光眼引流器植入联合白内障超声乳化术+人工晶状体植入术治疗难治性青光眼合并白内障的治疗效果。

方法：选取2013-01/2016-01在我院眼科确诊并住院治疗的60例60眼难治性青光眼患者作为研究对象,根据手术方式分为研究组和对照组,研究组采用EX-PRESS青光眼引流器联合超声乳化白内障吸出术+人工晶状体植入术,对照组采用小梁切除联合白内障超声乳化+人工晶状体植入术进行治疗。研究组29例29眼,对照组31例31眼。检查并记录两组患者术后1d,1、3、6mo的视力、眼压、手术成功率等临床指标及并发症发生情况。

结果：本组60例60眼患者均顺利完成手术,研究组成功率为93%,对照组成功率为81%; 研究组手术成功率虽明显高于对照组,但差异无统计学意义(P=0.26)。在术后6mo时两组患者的最佳矫正视力均有所提高,组内比较,研究组和对照组最佳矫正视力均高于术前,但差异无统计学意义。两组患者术后最佳矫正视力情况比较差异无统计学意义。在眼压方面,两组间眼压差异有统计学意义(P<0.05),时间点对眼压的影响有统计学意义(P<0.05)。术后1d,1、3mo,研究组患者的眼压均显著低于对照组患者,差异均有统计学意义(P<0.05); 而在术后第6mo时,两组患者的眼压情况差异无统计学意义(P>0.05)。术后各时间点与术前比较均有统计学意义(P<0.05),术后1d与术后6mo比较有统计学意义(P=0.007),其他两两比较结果无统计学意义。

结论：EX-PRESS青光眼引流器植入联合白内障超声乳化+人工晶状体植入术治疗难治性青光眼合并白内障有较好的临床效果,是一种有较高可行性、安全性以及有效性的治疗方案。     

EX-PRESS植入联合超声乳化治疗原发性慢性闭角型青光眼合并白内障

目的：探讨EX-PRESS引流器植入术联合超声乳化术治疗原发性慢性闭角型青光眼(CPACG)合并白内障的临床疗效,并与小梁切除术联合超声乳化术进行比较。

方法：回顾性病例对照研究。收集2017-01-01/2019-01-01在我院眼科确诊并住院治疗的CPACG合并白内障患者(29例36眼)作为研究对象,按手术方式不同分为两组,研究组(13例16眼)采用EX-PRESS引流器植入术联合超声乳化白内障摘除人工晶状体植入术,对照组(16例20眼)采用小梁切除术联合超声乳化白内障摘除人工晶状体植入术。记录两组术前,术后1wk,1、3、6mo最佳矫正视力(BCVA)、眼压,术前,术后1、6mo的中央前房深度(ACD)、中央角膜内皮细胞数、手术时间、手术至出院时间、术中术后并发症、术后随访情况等。

结果：两组患者的人口基线特征无差异(均P>0.05)。研究组术后6mo与术前相比视力改善眼数增多(Z=-2.066,P=0.039),术后6mo时两组的视力无差异(Z=-0.319,P=0.765)。研究组术后1wk,1、3、6mo的眼压与术前相比均下降(均P<0.001),两组的眼压无差异(F=0.003,P=0.956)。两组术后1、6mo ACD均较术前加深(均P<0.001),两组的ACD、中央角膜内皮细胞数均无差异(P>0.05)。手术时间研究组26.1±4.5min,对照组31.5±5.1min,两组有差异(t=-3.307,P=0.002)。手术至出院时间研究组7.2±1.6d,对照组7.7±1.5d,两组无差异(t=-0.880,P=0.388)。研究组1眼EX-PRESS触及虹膜,因眼压正常未做处理。对照组2眼术后2度浅前房,采用散瞳及加压包扎1wk后恢复。术后6mo时两组各有1眼用1种降眼压滴眼液维持眼压正常。对照组1眼12mo后因眼压升高行EX-PRESS引流器植入术,1眼8mo后行睫状体光凝术。

结论：EX-PRESS引流器植入术联合超声乳化术治疗CPACG可以提高视力、降低眼压,取得良好疗效,手术时间短于小梁切除术联合超声乳化术。     

EX-PRESS联合贝伐单抗治疗难治性青光眼

目的：探究EX-PRESS联合贝伐单抗治疗难治性青光眼的疗效。

方法：回顾性分析2014-06/2016-12我院采用EX-PRESS青光眼引流器植入术治疗的难治性青光眼患者150例150眼的病历资料,将只采用EX-PRESS治疗的患者70例70眼设为对照组,在此基础上运用玻璃体腔注射贝伐单抗治疗的患者80例80眼设为观察组。评价手术成功率; 采用非接触式眼压计测量术前、术后7d,1、3、6mo眼压,并记录术前、术后6mo视力情况以及术后并发症发生情况。

结果：术后6mo,观察组手术完全成功率(72.5%)显著高于对照组(58.6%),部分成功率(17.5%)显著低于对照组(30.0%),差异均有统计学意义(χ²=5.453,P=0.028,χ²=4.213,P=0.047); 两组手术失败率比较,差异无统计学意义(χ²=0.000,P=1.000)。两组手术前后视力比较,差异均无统计学意义(P>0.05)。两组患者治疗前后眼压比较,差异有统计学意义(F_组间=982.27,P_组间<0.05; F_时间=941.88,P_时间<0.05); 两组治疗后眼压均显著降低,术后7d观察组显著高于对照组,差异有统计学意义(P<0.05); 术后1、3、6mo,两组眼压比较,差异均无统计学意义(P>0.05)。观察组低眼压、前房出血、浅前房发生率均显著性低于对照组,差异均有统计学意义(P<0.05)。

结论：玻璃体腔注射贝伐单抗联合EX-PRESS治疗难治性青光眼能够提升手术的完全成功率,有效控制术后短期眼压,前房出血、低眼压等并发症发生率较低。     

超声乳化联合EX-PRESS引流钉植入治疗难治性开角型青光眼合并白内障

目的：观察超声乳化联合EX-PRESS引流钉植入治疗难治性开角型青光眼合并白内障的疗效。

方法：选取难治性开角型青光眼合并白内障患者共66例67眼。试验组采用超声乳化吸除联合EX-PRESS引流钉植入术,对照组采用超声乳化吸除联合小梁切除术。术前进行BCVA、IOP检查; 观察并发症、手术时间,术后观察视力、眼压、滤过泡改变; 随访时间为术后1d,1wk,1、6mo,1a。

结果：试验组手术时间为23.26±2.00min,对照组手术时间为31.73±2.17min,两组间有差异(t=16.68,P<0.01)。试验组术后发生浅前房和滤过泡瘢痕化者各1眼; 对照组术后发生低眼压3眼,前房出血和脉络膜脱离各1眼,滤过泡瘢痕化者5眼。滤过泡Kronfeld 分型无差异(Z=-0.775, P=0.438)。两组干预因素及时间对患者术后眼压均有影响(F_组间=8.67,P_组间<0.01; F_时间=127.58,P_时间<0.01; F_{组间×时间}=7.5,P_{组间×时间}<0.01)。干预因素对患者术后视力无影响,两组术后视力同术前相比均有差异(F_组间=0.35,P_组间=0.55; F_时间=34.92,P_时间<0.01; F_{组间×时间}=0.38,P_{组间×时间}=0.86)。

结论：超声乳化联合EX-PRESS引流钉植入治疗难治性开角型青光眼合并白内障安全有效、手术时间短,可作为一种常规青白联合手术方式。     

超声乳化吸除联合房角分离术治疗PACG合并年龄相关性白内障

目的：探讨超声乳化吸除术联合房角分离术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并年龄相关性白内障的临床疗效。

方法：回顾性分析2014-02/2017-02于我院治疗原发性闭角型青光眼合并年龄相关性白内障患者66例70眼,按照治疗方式不同分为两组。将采用超声乳化白内障吸除人工晶状体植入术+房角分离术治疗的患者36例38眼设为观察组,未联合房角分离术的患者30例32眼设为对照组。比较两组患者手术总成功率,手术前后视力、眼压、前房深度,并记录并发症发生情况。

结果：观察组手术绝对成功率为63%,对照组为47%,观察组显著高于对照组,差异有统计学意义(P<0.05),观察组总成功率为87%,对照组为84%,差异无统计学意义(P>0.05)。两组手术前后视力<0.1、0.1～<0.3、0.3～0.5、>0.5人数比较差异具有统计学意义(Z_观察组=7.545,P_观察组<0.05; Z_对照组=7.213,P_对照组<0.05),术后两组间比较差异无统计学意义(Z=-1.456,P>0.05)。两组患者术后眼压较术前降低,差异有统计学意义(t_观察组=3.323,P_观察组=0.001; t_对照组=10.394,P_对照组<0.01); 观察组眼压低于对照组,差异有统计学意义(t=14.802,P<0.01)。两组患者术后前房深度较术前增加,差异有统计学意义(t_观察组=0.411,P_观察组<0.01; t_对照组=15.621,P_对照组<0.01); 观察组前房深度大于对照组,差异有统计学意义(t=15.246,P<0.01)。观察组术后并发症发生率为11%,对照组并发症发生率为25%,观察组显著低于对照组,差异有统计学意义(χ²=4.409,P=0.036)。

结论：超声乳化吸除术联合房角分离术治疗原发性闭角型青光眼合并年龄相关性白内障疗效确切,术后眼压控制效果更佳,且并发症发生率更低。     

原发性闭角型青光眼合并白内障两种手术方式疗效研究

目的：比较单纯小梁切除术和青光眼白内障联合手术(青白联合手术)治疗原发性闭角型青光眼(primary angle-closure glaucoma ,PACG)合并白内障的效果。

方法：回顾性分析我院2010-01/2013-10间收治的PACG合并白内障患者80例90眼,分为观察组(青白联合手术组,45眼)和对照组(单纯小梁切除术组,45眼)。术后对所有患者随访6mo,观察术后眼压、视力以及术后并发症等情况。

结果：两组术后眼压比术前眼压均明显的降低,而观察组眼压降低更明显(P=0.003)。观察组患者术后视力明显上升,而对照组术后视力与术前上升不明显,两组对比差异有统计学意义(P=0.036)。对照组术后发生低眼压性浅前房、黄斑水肿、前房炎症的患眼均较观察组多,差异均有统计学意义(P=0.002,P=0.003,P=0.001)。

结论：对PACG合并白内障的患者行青白联合手术治疗能有效提高视力,控制眼压,且并发症少。     

飞秒激光辅助超声乳化联合Ahmed青光眼引流阀植入术治疗合并难治性青光眼的白内障

目的：评估飞秒激光辅助超声乳化联合Ahmed青光眼引流阀植入术治疗合并难治性青光眼的白内障的有效性和安全性。

方法：回顾性病例对照研究。2019-10/2021-10入院合并难治性青光眼的白内障患者53例53眼，依据自愿选择分为飞秒激光辅助白内障超声乳化(FLACS)组26例26眼和常规白内障超声乳化(CPCS)组27例27眼。两组分别行FLACS和CPCS联合Ahmed青光眼引流阀植入术。比较两组患者术中超声乳化能量释放量(CDE)、有效超声时间(EPT)的差异和术前与术后抗青光眼药物数量的变化，以及术后观察不同时期(1d，1wk，1、3mo)在提高最佳矫正视力(BCVA)，降低眼压、角膜内皮细胞损伤程度和手术并发症及成功率状况。

结果：FLACS组术中CDE和EPT明显低于CPCS组(t=8.50、5.16； P<0.01、=0.001)。两组术后抗青光眼药物较术前均明显减少(t=9.12、7.76； P=0.011、0.016)，但两组间无差异(t=1.79，P=0.082)。两组术后BCVA均较术前改善，眼压均较术前降低(P<0.05)。FLACS组在术后早期(1d，1wk)BCVA的改善较CPCS组更显著(t=9.74、8.49； P=0.008、0.012)，但在术后1、3mo的BCVA改善程度并无不同(t=0.62、0.44； P=1.415、2.021)。CPCS组在术后随访不同时期的角膜内皮细胞损伤较FLACS组更明显(P<0.05)。术后随访的不同时期FLACS组和CPCS组在控制眼压方面无差异(F_组间=0.64，P_组间=0.421)。FLACS组的手术并发症发生率27%(7/26)较CPCS组89%(24/27)低(χ²=20.95，P<0.01)，其中角膜水肿(8% vs 41%)、前囊撕裂(0 vs 11%)在FLACS组中明显低于CPCS组，后囊破裂(0 vs 7%)、玻璃体脱出(0 vs 4%)及人工晶状体偏位(0 vs 7%)也均发生在CPCS组。但两组的治疗总成功率相近(P=28.718)。

结论：飞秒激光辅助超声乳化联合Ahmed青光眼引流阀植入术可充分发挥联合手术的精准微创可控优势，帮助合并难治性青光眼的白内障患者有效降低眼压及更早获得视力恢复。     

XEN引流管植入联合丝裂霉素C治疗开角型青光眼

目的：探讨XEN引流管植入联合丝裂霉素C(MMC)治疗开角型青光眼(OAG)的临床疗效和安全性。

方法：回顾性纳入OAG患者37例37眼,按初始接受抗青光眼手术治疗与否分为初次青光眼手术组17例17眼,多次青光眼手术组20例20眼,记录各随访时间点眼压、降眼压药物种类及并发症,术后随访时间大于1 a。

结果：术后1 a,初次与多次青光眼手术组眼压分别从术前27.56±9.94、28.43±14.18 mmHg降至15.16±3.65、17.18±5.83 mmHg,分别下降55.01%和60.43%(t=4.863,P<0.001; t=3.255,P=0.004)。术后不同时间点两组眼压均较术前降低,时间有差异(F_时间=6.876,P_时间<0.001),组间及交互均无差异(F_组间=0.242,P_组间=0.626; F_{时间×组间}=0.959,P_{时间×组间}=0.458)。两组手术完全成功率分别为47%、45%,条件成功率为76%、75%(Z=-0.115,P=0.909),完全成功与条件成功累积生存率分析均无差异(χ²=0.042,P=0.838; χ²=0.004,P=0.949)。术后1 a随访时两组降眼压药物均由术前的3(2,3)种减少为1(0,2)种(Z=-3.289、-3.796,均P<0.001),组间无差异(Z=-0.581,P=0.561)。术后短期并发症以低眼压为主,前房出血次之,远期并发症以滤过泡包裹为主,除外引流管暴露及脱落各1眼,无其他严重并发症发生。

结论：XEN引流管植入联合MMC治疗初次与多次青光眼手术OAG患眼均安全有效,但多次青光眼手术组滤过泡包裹发生率高。     

XEN‐45 collagen implant for the treatment of uveitic glaucoma

Importance

The XEN‐45 implant, a hydrophilic collagen implant which drains aqueous to the subconjunctival space, has not been investigated in the context of uveitic glaucoma.

Background

To determine the safety and efficacy of the XEN‐45 collagen implant in eyes with uveitic glaucoma.

Design

Exploratory prospective case series.

Participants

patients with medically uncontrolled uveitic glaucoma.

Methods

Twenty‐four consecutive patients (mean age ± standard deviation [SD] = 45.3 ± 18.1 years) were implanted with the XEN‐45 implant.

Main Outcome Measures

The primary outcome measure was intraocular pressure (IOP) reduction at 12 months as compared to baseline. Secondary outcome measures included ocular hypotensive medication use at 12 months, the requirement for further glaucoma surgery and failure. Intraoperative and postoperative complications were documented.

Results

The baseline mean ± SD IOP was 30.5 ± 9.8 mmHg and the mean ± SD number of glaucoma medications required was 3.3 ± 0.8. In 20 eyes (83.3%) in whom conventional glaucoma surgery was originally perceived to be inevitable, further surgery was not required after XEN‐45 implantation. The mean IOP was reduced by 60.2% from baseline to 12.2 ± 3.1 mmHg and mean medication usage was reduced to 0.4 ± 0.9 at 12 months (both P < 0.001). One patient had hypotony persisting beyond 2 months that required surgical revision and one patient developed blebitis. The 12‐month cumulative Kaplan–Meier survival probability was 79.2%.

Conclusions and Relevance

The XEN‐45 implant is effective for the treatment of patients with medically uncontrolled uveitic glaucoma. Potentially sight‐threatening complications, including bleb‐related ocular infection and persistent hypotony, may occur.     

Translational neuroprotection research in glaucoma: a review of definitions and principles

The maintenance of vision, through prevention and attenuation of neuronal injury in glaucoma, forms the basis of current clinical practice. Currently, the reduction of intraocular pressure is the only proven method to achieve these goals. Although this strategy enjoys considerable success, some patients progress to blindness; hence, additional management options are highly desirable. Several terms describing treatment modalities of neuronal diseases with potential applicability to glaucoma are used in the literature, including neuroprotection, neurorecovery, neurorescue and neuroregeneration. These phenomena have not been defined within a coherent framework. Here, we suggest a set of definitions, postulates and principles to form a foundation for the successful translation of novel glaucoma therapies from the laboratory to the clinic.     

穿刺巩膜隧道植入Ahmed青光眼阀治疗难治性青光眼的疗效

目的:观察用23G针头直接穿刺制作巩膜隧道的方式植入Ahmed青光眼阀(Ahmed glaucoma valve,AGV)治疗难治性青光眼的临床疗效及并发症。方法:观察44例44眼难治性青光眼患者,应用23G针头直接穿刺制作巩膜隧道,行青光眼阀植入术进行治疗。观察患者术后眼压、视力、并发症,并与术前进行对比。结果:本组患者成功率84.1%。术前眼压:52.1±10.1mm Hg,最后一次随访眼压15.6±6.9mm Hg。视力提高者11眼,视力无改变者27眼,视力降低者6眼。并发症包括:浅前房4例,脉络膜脱离3例,引流管移位1例,前房积血6例,引流管阻塞1例,脉络膜驱逐性出血1例,引流盘包裹5例。结论:直接穿刺巩膜隧道的方法植入青光眼阀,手术操作简单可行,避免了制瓣及异体巩膜移植,并简化了手术操作,防止术后房水管周渗漏,术后浅前房发生率低,为切实可行的手术方法。     

房角金环植入术治疗顽固性青光眼的临床观察

目的　观察房角金环植入术治疗顽固性青光眼的近期和中期疗效。方法　对29例(29只眼)药物难以控制的青光眼行房角金环植入术。结果　随访2～23月,平均73±53月。眼压由术前(5134±1369)mmHg降至术后(2659±1127)mmHg。总成功率为7241%,其中非新生血管性青光眼的成功率为7692%,新生血管性青光眼的成功率为3333%。并发症包括前房积血、浅前房、术后早期低眼压、前部葡萄膜炎、金环与角膜内皮接触、金环外露、渗出性脉络膜脱离等。结论　房角金环植入术是一种治疗顽固性青光眼的有效方法。     

Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

Background

To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)-lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open-angle glaucoma (POAG).

Methods

This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either ‘success’ or ‘failure’ based on three scores: IOP at follow-up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re-surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re-surgery (Score C).

Results

The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C.

Conclusions

In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP-lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.     

Phacotrabeculectomy in Treatment of Primary Angle-closure Glaucoma and Primary Open-angle Glaucoma

Purpose To evaluate the surgical outcome of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy) in patients with primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG).Methods The records of 57 consecutive patients (65 eyes) with PACG or POAG that were treated with phacotrabeculectomy were reviewed retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean follow-up period was 21.0 ± 8.3 months. The visual acuity, intraocular pressure (IOP), number of medications, and complications were evaluated.Results The mean IOP and the number of glaucoma medications decreased significantly after phacotrabeculectomy in both groups. The mean IOP reduction was significantly greater in eyes with PACG (P < 0.05). The absolute success rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the success rates was not significant (P = 0.297). The early postoperative complication rates were similar in both groups.Conclusions Phacotrabeculectomy results in greater IOP reduction in eyes with PACG than in those with POAG, but the overall success rates were not significantly different. Jpn J Ophthalmol 2004;48:408–411 © Japanese Ophthalmological Society 2004     

Glaucoma in China

The motivation for this paper is that, having come from China, a country which had closed herself to the outside world for three decades, I thought it might be interesting to compare glaucoma in the two countries. Since I am from only a municipal hospital of a small city Hangzhow (a sister city of Boston), whatever I say can only be accepted as personal view points. Presently I have this wonderful opportunity to be a research fellow at the world wide famous Massachusetts Eye & Ear Infirmary, which is affiliated with Harvard Medical School. The comparison therefore may not be exactly appropriate but may help to see where my country stands, what we have, what we lack and what goals to strive for to better the health of China. There may be some confusing terms in this paper such as Liberation, Cultural Revolution, etc. Table 1 may help give a clearer conception.     

Glaucoma neuroprotection: What is it? Why is it needed?

The glaucomas are a group of ocular diseases characterized by progressive optic nerve damage and visual loss. Although there is good laboratory evidence for glaucoma neuroprotection by several drugs, the evidence from randomized clinical trials is lacking.     

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.