Ahmed青光眼阀植入术后高眼压原因分析及处理  

Evaluation and management of elevation of intraocular pressure after implantation of the Ahmed glaucoma valve

作　　者：陈虹[1] 张舒心[1] 刘磊[1] 唐忻[1] 孙丽[1] 林丁[1] 王宁利[1] 

机构地区：[1]首都医科大学附属北京同仁医院眼科中心,北京100730

出　　处：《眼科》2004年第4期201-205,共5页Ophthalmology in China

摘　　要：目的 :分析Ahmed青光眼阀 (Ahmedglaucomavalve ,AGV)植入术后高眼压原因 ,介绍及评价高眼压处理方法。方法 :选择一组采用AGV及其联合手术治疗 6个月以上的难治性青光眼 2 0 6例 2 2 1只眼 ,分析及总结术后发生高眼压的发生率、原因及处理方法 ,并采用logistic回归法分析影响引流盘周纤维包裹的相关因素。结果 :AGV术后早期 (≤ 1个月 )导致眼压升高的原因主要是引流管口堵塞 (8 1% )、恶性青光眼 (1 8% )及引流管后移 (0 5 % ) ;晚期 (>1个月 )主要是引流盘周纤维包裹 (10 9% )、引流管与角膜接触 (0 9% )及引流管后移 (0 5 % )。采用药物治疗、眼球指压按摩、Nd :YAG激光、补救性手术等处理后降眼压总成功率提高至 76 %。经统计学分析发现 ,表面积较小的AGV S3 型及 0 4mg/ml丝裂霉素 (mitomycinC ,MMC)接触时间 <3分钟者发生引流盘周纤维包裹的可能性较大。结论 :AGV植入术后高眼压原因早期主要是引流管口堵塞 ,晚期主要是引流盘周纤维包裹。采取积极有效的处理可明显提高其手术成功率。Objective:To investigate the reasons of elevation of intraocular pressure (IOP) after implantation of the Ahmed glaucoma valve and to evaluate the managements for various complications that elevate the intraocular pressure. Method:We reviewed refrospectively for the emergence and the management of elevation of intraocular pressure.Histories of 206 consecutive patients (221 eyes) with refractory glaucoma who underwent Ahmed glaucoma valve (AGV) implantation or AGV combined with other intraocular surgery and mitomycin C(MMC) and had a minimum of 6 months of follow up.Logistic regression analysis was used to estimate the relationships between bleb encapsulation and multiple predictors. Result: The reasons of increased intraocular pressure during the early postoperative period (≤1 month) of AGV were tube blockage (8 1%), malignant glaucoma (1 8%), tube retraction (0 5%) and during late postoperative period (>1 month) were bleb encapsulation (10 9%), tube endothelial touch (0 9%) and tube retraction (0 5%). Total success rate was increased to 76% through medicines, ocular massage, Nd:YAG laser, remedial surgery, etc. The results of statistical analysis showed that AGV S 3 model (surface area of the implant body smaller than AGV S 2 modal) and the shorter applied duration of 0 4mg/ml MMC(<3 minutes) had more probability of bleb encapsulated. Conclusion: The major reason of increased IOP during the early postoperative period of AGV is tube blockage and during late postoperative period is bleb encapsulation.Total postoperative success rate can be increased through the positive and effective managements of the complications elevating intraocular pressure.

关 键 词：AHMED青光眼阀 眼压 手术并发症 

分 类 号：R779.6[医药卫生—眼科]