Ahmed房水引流阀植入治疗新生血管性青光眼的远期疗效评价

目的：评价前房型Ahmed房水引流阀植入治疗新生血管性青光眼（neovascular glaucoma,NVG）的远期疗效。方法：对24例（24只眼）NVG患者施行Ahmed房水引流阀植入术并观察术后眼压、视力及并发症情况,以随访结束时眼压〈21 mm Hg（1 mm Hg=0.133 kPa）、无严重并发症为手术成功标准,降眼压药物控制下眼压〈21 mm Hg为条件成功标准。随访13～26个月,平均（18.05±3.81）个月。结果：24例NVG患者中,1例合并细菌性角膜溃疡穿孔予取出引流盘,1例出现顽固性浅前房并角膜失代偿,7例需降眼压药物治疗,15例获得成功。Ahmed房水引流阀植入NVG成功率为66.67%,条件成功率为83.33%。术前平均眼压（40.24±13.80）mm Hg,随访结束时平均眼压（15.14±8.56）mm Hg,较之术前明显降低,差异有统计学意义（P=0.00）。术后视力维持术前水平10例（41.67%）,视力提高14例（58.33%）。术后早期并发症有暂时性前房出血6例（25.00%）、浅前房10例（41.67%）、结膜瓣松脱4例（16.67%）,经治疗后均好转;远期并发症有并发性白内障1例（4.17%）、角膜内皮失代偿1例（4.17%）。结论：青光眼引流物植入术为治疗NVG的有效手段,能显著降低眼压,且远期疗效肯定,挽救患者残余视功能,提高患者生活质量。

Long-term implantation effect on the Ahmed glaucoma valve treatment for neovascular glaucoma

Objective：To evaluate the long-term implantation effect on the Ahmed glaucoma valve treatment for neovascular glaucoma.Methods：24 patients（24 eyes） with neovascular glaucoma were given aqueous drainage valve,and the intraocular pressure,visual acuity and complications were observed for 13-26 months [average（18.05±3.81） months],with the surgical success criteria of intraocular pressure 〈21 mm Hg,without serious complications,and intraocular pressure lowering IOP〈21 mm Hg under medicine control.Results：After the end of follow-up,among the 24 cases of patients with neovascular glaucoma,there was 1 case with bacterial corneal ulcer perforation and had to remove the drainage tray,1 case of intractable shallow anterior chamber and corneal decompensation,7 cases required IOP lowering medication,15 cases successed.The success rate of Ahmed aqueous drainage valve implantation for neovascular glaucoma was 66.67%,qualified success rate was 83.33%.The mean preoperative IOP was（40.24±13.80） mm Hg,the average IOP was（15.14±8.56） mm Hg at the end of the follow-up,which was significantly lower than that before surgery,the difference was statistically significant（P=0.00）.The visual acuity before compared with after the operation,10 eyes（41.67%） was leveled,14 eyes（58.33%） was improved and no eye worsened.Among the early postoperative complications,there were 6 cases（25.00%） with the transient hyphema,10 patients（41.67%） with the shallow anterior chambe,4 cases（16.67%） with the conjunctival flap loose,and all cases were improved after treatment.Among the long-term complications,there was 1 case（4.17%） with the complicated cataract,1 case（4.17%） with the corneal endothelial decompensation.Conclusion：Glaucoma drainage implantation surgery is an effective means to cure neovascular glaucoma,the surgery can significantly reduce intraocular pressure,provide long-term positive effect,save the residual visual function,and improve the patients′life quality.