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...

Comparison in clinical outcomes of trabeculectomy and Ahmed glaucoma valve implantation in patients with penetrating keratoplasty

Objective　To observe the clinical outcomes of trabeculectomy and Ahmed glaucoma valve (AGV) implantation in penetrating keratoplasty glaucoma (PKG) patients and the safety of corneal grafts.Methods　A retrospective interventional comparative study was designed. Forty-seven PKG（47 eyes）patients in Henan Provincial People’s Hospital from April 2015 to April 2018 were divided into two group, 22 patient（22 eyes）in trabeculectomy group (TRA group) and 25 patients（25 eyes）in Ahmed glaucoma valve implantation group (AGV group). The follow time was (24.3±5.2) months. The intraocular pressure (IOP), complications, corneal graft survival rates were analyzed, and the risk factors for corneal graft were performed using multivariate Cox regression analysis.Results　Infectious keratitis was the most common primary disease in TRA group and AGV group（45.45% vs. 52.00%, respectively, χ²=0.201，P=0.654）,burning followed（18.18% vs. 16.00%，respectively, P>0.05）. The preoperative IOPs were (34.95±5.36)mmHg （1 kPa=7.5 mmHg） vs.（33.93±4.88)mmHg（P=0.231）, and the last postoperative IOPs were（21.83±5.14)mmHg vs. ( 17.23±3.93）mmHg. Postoperative mean IOP decreased significantly in both groups, and which in AGV group was more lower than TRA group at 3rd months, 1st year and 2nd years, respectively（all P<0.05）. The total success rate was 63.64% vs. 88.00%, respectively（P=0.033）. No server complication occurred, but the early shallow anterior chamber and the later filtering bleb encapsulated occured（χ²=3.166，P=0.075）. Transscleral cyclophotocoagulation was performed for eyes with poor IOP control in both groups, and the overall survival rate of corneal grafts was 90.90%, 96.00%, and the comparison between groups was not statistically significant (Z=-1.544, P=0.123). Although the shallow anterior chamber affected the transparency of corneal implantation, the analysis of the multi-factor cox proportional hazard model suggested that only infectious keratitis，recurrent increased IOP were risk factors for poor graft healing.Conclusion　AGV implantation is more effective to control IOP than trabeculectomy for PKG, and the incidence of shallow anterior chamber is low. However, corneal graft opacity has nothing to do with the operations. Infectious keratitis and recurrent increased IOP are risk factors for graft opacity.