两种术式植入 Ahmed 青光眼阀治疗难治性青光眼的疗效比较

摘要

目的：：探讨两种不同术式植入Ahmed青光眼阀治疗难治性青光眼的有效性和安全性。方法：采用回顾病例对照研究，收集2011-06/2014-09在我院行Ahmed 阀植入术的难治性青光眼患者资料。根据引流管进入前房的术式不同分为直接巩膜隧道穿刺组和自体巩膜瓣组。观察并比较两组患者手术持续时间、术后手术成功率、眼压、术后抗青光眼用药的数目、术后最佳矫正视力以及并发症。结果：两组患者随访1a时，两组患者在术后眼压，术后抗青光眼药物数目在所有随访时间点均较术前明显降低，差异有显著统计学意义(P<0.01)。术后各个随访时间点两组之间在眼压，抗青光眼用药数目，最佳矫正视力方面，差异均无统计学意义。卡普兰-迈耶( Kaplan-Meier)生存曲线显示：在随访1a时，直接巩膜隧道穿刺组和自体巩膜瓣组手术总成功率分别为79%和80%，差异无统计学意义(P=0.932)。在并发症方面，直接巩膜隧道穿刺组浅前房的发生率(6%)明显低于自体巩膜瓣组(24%)，差异有统计学意义(P=0.032)。结论：Ahmed青光眼房水引流阀植入是治疗难治性青光眼安全有效的方法，两种不同术式有相似的疗效，但直接巩膜隧道穿刺组发生浅前房的机会更低，耗时更短。%AlM:To evaluate the efficacy and safety of Ahmed glaucoma valve ( AGV ) implantation surgery using different methods.METHODS:This was a retrospective study of patients with refractory glaucoma in whom AGV implantation was performed between June 2011 and September 2014. According to the method of tube insertion into the anterior chamber, the sample was divided into two groups, needle- generated scleral tunnel and scleral flap. The surgical success rate, intraocular pressure( lOP) , number of antiglaucoma medications used, best correct visual acuity, postoperative complications, and operation duration were analyzed between the two groups.RESULTS:Compared with preoperative data, the two groups showed statistically significant decrease on lOP and the number of antiglaucoma medication used at all follow - up points ( P < 0. 01 ). Differences on mean postoperative lOP, mean number of postoperative antiglaucoma medications, and best correct visual acuity were not significant between the two groups at all follow-up intervals. Kaplan-Meier survival curves showed that the success rate was 79% for the needle-generated scleral tunnel group and 80% for the scleral flap group at the follow- up endpoint of 1a. There was no significant difference between the two groups(P=0. 932);however, statistically significant differences were detected when flat anterior chamber complications between the needle -generated scleral tunnel group ( 6%) and the scleral flap group (24%) were compared(P=0. 032).CONCLUSlON:AGV implantation may be an effective method in managing refractory glaucoma, since the two methods have similar efficacy. However, the needle-generated scleral tunnel technique application could greatly decrease the incidence of flat anterior chamber complications and decrease the duration of the operation.