Ahmed青光眼阀植入术治疗挫伤早期继发性青光眼的疗效  

The efficacy of Ahmed glaucoma valve implantation in the management of early stage of glaucoma secondary to blunt ocular trauma

作　　者：刘杏[1] 余芬芬[1] 钟毅敏[1] 毛真[1] 曹丹[1] 李媚[1] 

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼科杂志》2012年第6期492-496,共5页Chinese Journal of Ophthalmology

基　　金：眼科学国家重点实验室创新基金（2010C03）;广东省自然科学基金（S2011010006046）

摘　　要：目的观察Ahmed青光眼阀（AGV）植入术治疗挫伤早期继发性青光眼的疗效及安全性。方法回顾性病例系列研究。对用最大剂量药物不能控制眼压的29例（29只眼）挫伤早期继发性青光眼患者，在伤后2个月内行AGV植入术。29例患者挫伤后发生高眼压时间1～30d，平均（6．10±1．13）d；挫伤至AGV植入术时间16—60d，平均（40．03±2．97）d；术后随访时间6～42个月，平均（20．75±1．66）个月。术后观察不同随访时间点的手术成功率。手术前后不同时期的眼压比较采用重复测量资料的方差分析，应用抗青光眼药物的种类数比较采用Kruskal—Wallis秩和检验，最佳矫正视力比较采用配对符号秩和检验。结果AGV植入术后末次随访，18例患者中，手术完全成功15例，完全成功率83．33％；条件成功3例，条件成功率16．67％。患者平均眼压（15．12±0．56）mmHg（1mmHg=0．133kPa），较术前（42．59±1．82）mmHg明显下降；手术前后不同随访时间点的眼压差异有统计学意义（F=124．09，P〈0．05）。平均使用抗青光眼药物（0．21±0．12）种，较术前（3．93±0．15）种明显减少；手术前后不同随访时间点的用药种类数差异有统计学意义（H：131．73，P〈0．05）；最佳矫正视力中位数0．40（10gMAR视力0．40），较术前0．15（IogMAR视力0．70）提高（t=-3．466，P〈0．05）。术后早期2例发生浅前房，3例出现前房积血；无持续性低眼压、浅前房、局部感染及引流管暴露等严重并发症。结论AGV植入术是治疗挫伤早期难治性、继发性青光眼的安全、有效滤过术式之一。Objective To evaluate the efficacy and safety of Ahmed glaucoma valve （AGV） implantation in the early stage of glaucoma secondary to contusion injuries. Methods A retrospective case series study. The study was made in 29 consecutive patients with glaucoma secondary to blunt trauma who were uncontrolled by multiple medications and then performed AGV implantations in less than 2 months after the trauma. The duration from injury to IOP elevation was 1 to 30 （6. 10 ± 1.13） days. The time fi＇om injury to AGV implantation was 16 to 60 （40. 03 ± 2.97 ） days. The patients were followed-up for a period of 6 to 42 （20. 75 ± 1.66） months. The main outcome measures included intraocular pressure （IOP） , visual acuity （VA） , number of glaucomatous medications, intra- and postoperative complications. IOPs were analyzed by repeated measures analysis of variance, numbers of medication assessed by Kruskal-Wallis rank sum test followed by Bonferroni test, and VA comparison was performed using paired Student t-test. Results The absolute success rate was 86.21% and the conditional success rate was 13.79% ＇after AGV implantation. Compared with pre-operation, the IOP was significantly （F = 124.09, P 〈 0. 05 ） lowered at the last following-up of post-operafion（42. 59 ± 1.82） vs （ 15.12 ± 0. 56） mm Hg（ 1 mm Hg = 0. 133 kPa） , the numbers of glaucomatous medications were significantly （ H = 131.73, P 〈 0. 05 ） reduced post-operatively （ 3.93 ± 0. 15 ） vs （0. 21 ± 0. 12 ） species, and the VA was significantly （ t = - 3. 466, P 〈 0. 05 ） improved post-operatively（logMAR 0. 40 vs logMAR 0. 70）. Two cases with shallow anterior chamber and three cases with hyphaemia were observed in the early stage after the surgery. No persistent hypotony, tube exposure or other serious complications were noted. Conclusion AGV implantation is safe and effective in the management of intractable secondary glaucoma at early stage of contusion injuries.

关 键 词：眼损伤 挫伤 青光眼 青光眼引流植入物 

分 类 号：R779.6[医药卫生—眼科]