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·临床研究·两种术式植入 Ahmed 青光眼阀治疗难治性青光眼的疗效比较吴摇 越,郭晓红作者单位:(315040)中国浙江省宁波市第六医院眼科作者简介:吴越,毕业于武汉科技大学医学院,本科,主治医师,研究方向:眼底病、青光眼、白内障。通讯作者:吴越. wuyue1207@163. com收稿日期: 2015-12-06 摇 摇 修回日期: 2016-03-15Evaluation of two different operations toimplant the Ahmed glaucoma valve inpatients with refractory glaucomaYue Wu,Xiao-Hong GuoDepartment of Ophthalmology, Ningbo No. 6 Hospital, Ningbo315040, Zhejiang Province, ChinaCorrespondence to: Yue Wu. Department of Ophthalmology,Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang Province, China.wuyue1207@163. comReceived:2015-12-06摇 摇 Accepted:2016-03-15Abstract誗 AIM: To evaluate the efficacy and safety of Ahmedglaucoma valve ( AGV ) implantation surgery usingdifferent methods.誗 METHODS:This was a retrospective study of patientswith refractory glaucoma in whom AGV implantation wasperformed between June 2011 and September 2014.According to the method of tube insertion into the anteriorchamber, the sample was divided into two groups,needle - generated scleral tunnel and scleral flap. Thesurgical success rate, intraocular pressure(IOP), numberof antiglaucoma medications used, best correct visualacuity, postoperative complications, and operationduration were analyzed between the two groups.誗 RESULTS: Compared with preoperative data, the twogroups showed statistically significant decrease on IOPand the number of antiglaucoma medication used at allfollow - up points ( P < 0. 01 ). Differences on meanpostoperative IOP, mean number of postoperativeantiglaucoma medications, and best correct visual acuitywere not significant between the two groups at all follow-up intervals. Kaplan- Meier survival curves showed thatthe success rate was 79% for the needle-generated scleraltunnel group and 80% for the scleral flap group at thefollow - up endpoint of 1a. There was no significantdifference between the two groups(P = 0. 932);however,statistically significant differences were detected when flatanterior chamber complications between the needle -generated scleral tunnel group (6%) and the scleral flapgroup (24%) were compared(P=0.032).誗 CONCLUSION: AGV implantation may be an effectivemethod in managing refractory glaucoma, since the twomethods have similar efficacy. However, the needle -generated scleral tunnel technique application couldgreatly decrease the incidence of flat anterior chambercomplications and decrease the duration of the operation.誗 KEYWORDS: refractory glaucoma; Ahmed glaucomavalve;needle-generated scleral tunnelCitation: Wu Y, Guo XH. Evaluation of two different operations toimplant the Ahmed glaucoma valve in patients with refractoryglaucoma. Guoji Yanke Zazhi(Int Eye Sci) 2016;16(4):690-694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。关键词:难治性青光眼;Ahmed 青光眼阀;巩膜隧道穿刺DOI:10. 3980/ j. issn.1672-5123. 2016.4. 25引用: 吴越,郭晓红. 两种术式植入 Ahmed 青光眼阀治疗难治性青光眼的疗效比较. 国际眼科杂志 2016;16(4):690-6940 引言摇 摇 难治性青光眼是指包括眼内炎症继发,眼外伤继发,先天性或青少年性青光眼、角膜移植术后的继发性青光眼、无晶状体眼或人工晶状体性青光眼,以往滤过性手术0 9 6国际眼科杂志摇 2016 年 4 月摇 第 16 卷摇 第 4 期摇 摇 http:/ / ies. ijo. cn电话:029鄄82245172摇 摇 82210956摇 摇 电子信箱:IJO.2000@163. com