中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2015年
8期
502-505
,共4页
Ahmed青光眼引流阀植入术%改良技术%难治性青光眼%青光眼手术治疗
Ahmed青光眼引流閥植入術%改良技術%難治性青光眼%青光眼手術治療
Ahmed청광안인류벌식입술%개량기술%난치성청광안%청광안수술치료
Ahmed glaucoma valve implantation%Modified technique%Refractory glaucoma%Surgical treatment
目的 观察改良Ahmed青光眼引流阀植入术治疗难治性青光眼的临床疗效.方法 回顾性系列病例研究.收集2011年1月至2013年12月采用改良Ahmed青光眼引流阀植入术治疗难治性青光眼患者46例(47眼)的临床资料,术中将引流盘置入筋膜下间隙,无需缝线固定,距离角膜缘约5 mm处以及角膜缘处各做一放射状浅层巩膜隧道(长约6 mm),将引流管穿入浅层巩膜隧道并遮盖.患者随访时间为术后1周、1个月、6个月以及以后每6个月复查一次,直至末次复查,随访内容主要包括患者术后眼压、最佳矫正视力(BCVA)、并发症、应用抗青光眼药物种类等.手术后不同时间点的眼压比较采用重复测量资料的方差分析,手术前后应用抗青光眼药物种类比较采用秩和检验,术前与末次随访视力比较采用等级资料秩和检验.结果 术前与末次复查视力比较,差异无统计学意义.术前眼压为(43.3±8.1)mmHg,术后末次随访眼压为(15.3±5.9)mmHg,差异有统计学意义(F=12.16,P＜0.05).术前、术后末次随访抗青光眼药物使用种类分别为4、1种,比较差异有统计学意义(Z=7.32,P＜0.05).Ahmed青光眼引流阀植入术完全成功率为72％,条件成功率为87％.术后并发症主要包括前房出血、引流管口堵塞、浅前房、引流盘周围包裹性囊状泡,对症处理后眼压均可控制.结论 改良Ahmed青光眼引流阀植入术治疗难治性青光眼,操作简便,手术时间短,术后并发症少,是治疗难治性青光眼的有效方法.
目的 觀察改良Ahmed青光眼引流閥植入術治療難治性青光眼的臨床療效.方法 迴顧性繫列病例研究.收集2011年1月至2013年12月採用改良Ahmed青光眼引流閥植入術治療難治性青光眼患者46例(47眼)的臨床資料,術中將引流盤置入觔膜下間隙,無需縫線固定,距離角膜緣約5 mm處以及角膜緣處各做一放射狀淺層鞏膜隧道(長約6 mm),將引流管穿入淺層鞏膜隧道併遮蓋.患者隨訪時間為術後1週、1箇月、6箇月以及以後每6箇月複查一次,直至末次複查,隨訪內容主要包括患者術後眼壓、最佳矯正視力(BCVA)、併髮癥、應用抗青光眼藥物種類等.手術後不同時間點的眼壓比較採用重複測量資料的方差分析,手術前後應用抗青光眼藥物種類比較採用秩和檢驗,術前與末次隨訪視力比較採用等級資料秩和檢驗.結果 術前與末次複查視力比較,差異無統計學意義.術前眼壓為(43.3±8.1)mmHg,術後末次隨訪眼壓為(15.3±5.9)mmHg,差異有統計學意義(F=12.16,P＜0.05).術前、術後末次隨訪抗青光眼藥物使用種類分彆為4、1種,比較差異有統計學意義(Z=7.32,P＜0.05).Ahmed青光眼引流閥植入術完全成功率為72％,條件成功率為87％.術後併髮癥主要包括前房齣血、引流管口堵塞、淺前房、引流盤週圍包裹性囊狀泡,對癥處理後眼壓均可控製.結論 改良Ahmed青光眼引流閥植入術治療難治性青光眼,操作簡便,手術時間短,術後併髮癥少,是治療難治性青光眼的有效方法.
목적 관찰개량Ahmed청광안인류벌식입술치료난치성청광안적림상료효.방법 회고성계렬병례연구.수집2011년1월지2013년12월채용개량Ahmed청광안인류벌식입술치료난치성청광안환자46례(47안)적림상자료,술중장인류반치입근막하간극,무수봉선고정,거리각막연약5 mm처이급각막연처각주일방사상천층공막수도(장약6 mm),장인류관천입천층공막수도병차개.환자수방시간위술후1주、1개월、6개월이급이후매6개월복사일차,직지말차복사,수방내용주요포괄환자술후안압、최가교정시력(BCVA)、병발증、응용항청광안약물충류등.수술후불동시간점적안압비교채용중복측량자료적방차분석,수술전후응용항청광안약물충류비교채용질화검험,술전여말차수방시력비교채용등급자료질화검험.결과 술전여말차복사시력비교,차이무통계학의의.술전안압위(43.3±8.1)mmHg,술후말차수방안압위(15.3±5.9)mmHg,차이유통계학의의(F=12.16,P＜0.05).술전、술후말차수방항청광안약물사용충류분별위4、1충,비교차이유통계학의의(Z=7.32,P＜0.05).Ahmed청광안인류벌식입술완전성공솔위72％,조건성공솔위87％.술후병발증주요포괄전방출혈、인류관구도새、천전방、인류반주위포과성낭상포,대증처리후안압균가공제.결론 개량Ahmed청광안인류벌식입술치료난치성청광안,조작간편,수술시간단,술후병발증소,시치료난치성청광안적유효방법.
Objective To explore the efficacy of a modified technique with Ahmed glaucoma valve (AGV) implantation in the treatment of refractory glaucoma.Methods This retrospective study included a total of 47 eyes of 46 refractory glaucoma patients who underwent a modified Ahmed glaucoma valve implantation in Wuhan Aier Hospital from January 2011 to December 2013.The sutureless AGV implantation technique was as follows:The drainage plate was secured between the episclera and Tenon's capsule with no suture placement.An approximate 6 mm radical scleral tunnel was made from 5 mm to the limbus and near the limbus respectively,and the drainage tube was inserted through the tunnel,followed by a sclerotomy at the limbus through which the tube was introduced into the anterior chamber.The extraocular portion of the tube was covered.Best corrected visual acuity (BCVA),intraocular pressure (IOP) and the number of anti-glaucoma medications before and after the surgery and postoperative complications were evaluated.Patients were followed up and postoperative data was obtained at 1 week,1 month,6 months,and then at 6-month intervals after surgery.Comparsions of IOP at different time points after surgery were performed by using repeat mesured ANOVA;while a paired nonparametric rank sum test was used to compare the number of glaucoma medications,and visual acuity preoperatively and postoperatively or at the last follow-up.Results Visual acuity was not significantly different between pre-operation and the final follow-up (Z=1.826,P＞O.05).Preoperative IOP varied from 15 to 69 mmHg,and IOP was between 9 and 23 mmHg at the final follow-up.The mean IOP was significantly reduced from a preoperative 43.26±8.14 mmHg to a postoperative 15.3±5.9 mmHg (F=12.16,P＜0.05).The number of anti-glaucoma medications was significantly reduced from 4 at preoperation to 1 postoperatively (Z=7.32,P＜0.05).At the last visit,the complete success rate of the AVG implantation reached 72.3％,and the conditional success rate hit 87.2％.Postoperative complications included anterior chamber hemorrhage,obstruction of the drainage tube,a shallow anterior chamber and encapsulated cystic blebs around the plate,which could all be controlled with additional treatments.Conclusion The modified Ahmed glaucoma valve implantation is confirmed as an effective way to treat refractory glaucoma,and it is worth being used routinely in the clinic because it is a less complicated procedure,reduces surgery time and has fewer postoperative complications.
