Ahmed阀植入联合超声乳化术治疗NVG合并白内障
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国家自然科学基金项目(No.U1904166); 河南省医学科技攻关项目(No.SBGJ2018072)


Efficacy and safety of Ahmed glaucoma valve implantation with lens extraction in neovascular glaucoma with cataract
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National Natural Science Foundation of China(No.U1904166); Henan Provincial Science and Technology Program(No.SBGJ2018072)

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    摘要:

    目的:观察Ahmed阀植入联合超声乳化术治疗新生血管性青光眼(NVG)的疗效。

    方法:回顾性分析我院2015-04/2018-09收治的NVG合并白内障患者93例93眼的临床资料,玻璃体腔抗VEGF注药后行Ahmed阀植入术,根据术中是否联合超声乳化术分为联合组(41眼)与单阀组(52眼)。术后随访6mo以上,记录最佳矫正视力(BCVA)、眼压及并发症发生情况,评定临床疗效。

    结果:末次随访时,联合组视力提高16眼(39%),不变11眼(27%),降低14眼(34%); 单阀组视力提高15眼(29%),不变13眼(25%),降低24眼(46%),两组视力变化情况无差异(P>0.05)。两组患者术前、玻璃体腔注药后、Ahmed阀植入术后1d,1wk,1mo眼压均无差异(P>0.05),但Ahmed阀植入术后3、6mo及末次随访时眼压均较术后1mo增高,且单阀组眼压高于联合组(P<0.05)。末次随访时,联合组绝对治愈率51%,条件治愈率22%,失败率27%,单阀组分别为44%、25%、31%,两组临床疗效无差异(P>0.05)。联合组和单阀组术后并发症总发生率无差异(51% vs 46%,P>0.05),联合组以炎性渗出(56%)为主,前房积血(46%)次之,单阀组以浅前房(35%)居多,其次为炎性渗出(31%)、前房积血(25%),两组间除浅前房、炎性渗出发生率有差异(P<0.05),其余并发症发生率均无差异(P>0.05),且无严重并发症。

    结论:Ahmed阀植入联合超声乳化术能有效控制眼压、改善视力,减少浅前房发生率,且便于眼底疾病后续诊疗,是NVG合并白内障的有效治疗方式。

    Abstract:

    AIM:To assess the efficacy of Ahmed glaucoma valve implantation combined with lens extraction for neovascular glaucoma(NVG)with cataract.

    METHODS: A retrospective comparative study was designed. 93 patients with NVG were enrolled. All patients received preoperative anti-vascular endothelial growth factor(VEGF)injections, 41 eyes underwent Ahmed glaucoma valve(AGV)implantation only, and 52 eyes underwent AGV implantation and lens extraction by phacoemusification. The best corrected visual acuities(BCVA), intraocular pressure(IOP), and surgical complications were evaluated.

    RESULTS: Postoperative visual acuity was improved in 16 eyes(39%), decreased in 14 eyes(34%), unchanged in 11 eyes(27%)in group 2, and 15 eyes(29%)improved,24 eyes(46%)decreased, 13 eyes(25%)unchanged in group 1 respectively(P>0.05). The group 2 demonstrated an 51% complete and 22% qualified success rate and 27% failure rate, and the 44% complete and 25% qualified success rate and 31% failure rate in group 1(P>0.05). Among the complications, fibrous exudation(56%)was the first, hyphema(46%)came second in group 2, while shallow anterior chamber(35%)was the most, fibrous exudations(31%)and anterior chamber hyphema(25%)followed in the group 1. And no tube extrusion serious complication had occurred in both groups(P<0.05). No significant differences in postoperative complications were observed between the groups(P>0.05).

    CONCLUSION: For NVG with cataract, AGV implantation with lens extraction is a priority for reduction of IOP and improvement of visual acuity.

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李海军,任静,董良,等. Ahmed阀植入联合超声乳化术治疗NVG合并白内障.国际眼科杂志, 2021,21(2):331-334.

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  • 收稿日期:2020-04-18
  • 最后修改日期:2020-12-28
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  • 在线发布日期: 2021-01-19
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