Ahmed青光眼阀植入联合玻璃体切割术治疗伴玻璃体积血的新生血管性青光眼

目的探讨Ahmed青光眼阀植入联合玻璃体切割术治疗伴有玻璃体积血的新生血管性青光眼的效果。方法回顾性分析22例(28只眼)患者因新生血管性青光眼伴有玻璃体积血接受玻璃体切割、Ahmed青光眼阀植入及全视网膜光凝。手术前视力光感～0.2,眼压平均44mmHg(38～63mmHg)(1mmHg=0.133kPa)。平均随访10个月(6～15个月)。结果手术后视力光感～0.3;眼压平均17mmHg(10～33mmHg),显著低于手术前眼压(P<0.05)。术后6,12,15个月的累积成功率分别为(85.1±3.2)%、(80.0±2.2)%、(65.0±4.1)%。手术后并发症主要包括一过性低眼压(4只眼),引流管堵塞(2只眼),玻璃体内再出血(2只眼),脉络膜上腔出血(1只眼),视网膜脱离(1只眼)。结论玻璃体切割联合Ahmed青光眼阀植入及全视网膜光凝术可能是治疗某些伴有玻璃体积血的新生血管性青光眼的有效方法。     

玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼

目的:评价玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼的效果。方法:对30例(30眼)伴玻璃体积血的新生血管性青光眼患者采用玻璃体切割联合Ahmed青光眼引流阀植入术治疗,术后随访10~20(平均12)mo。结果:术后眼压控制在6.0~21.0mmHg25眼(其中3例需加用一种降眼压药物),3例眼压>21.0mmHg,2例长期低眼压,成功率83%。结论:玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼,术后成功率高,视力有所提高,并发症少。     

Ahmed阀植入联合23G玻璃体切除治疗伴玻璃体积血的新生血管性青光眼

目的 评价Ahmed青光眼引流阀植入联合23G玻璃体切除术治疗伴玻璃体积血的新生血管性青光眼的效果.方法 对25例(25眼)伴玻璃体积血的新生血管性青光眼采用Ahmed阀植入联合23G玻璃体切除术治疗,统计分析术后不同时间眼压、手术成功率、最佳矫正视力及并发症,术后随访6 ～12个月,平均(9.96±1.93)月.结果 术后1d、1周、1个月、3个月和最后一次随访时平均眼压分别为(15.94±6.05)、(14.76±2.39)、(17.12±6.06)、(17.44±2.75)及(18.96±3.56) mmHg(1 mmHg=0.133 kPa).与术前平均眼压(48.12±7.29)mmHg比较,差异有统计学意义(t=16.733、21.961、16.917、17.609及18.091,P＜0.05);最后一次随访时手术总成功率为84.0％.所有患者视力均有提高.结论 Ahmed阀植入联合23G玻璃体切除术是治疗伴玻璃体积血的新生血管性青光眼比较有效的方法.     

Ahmed青光眼阀植入治疗新生血管性青光眼

目的探讨Ahmed青光眼阀植入治疗新生血管性青光眼的有效性和安全性。方法采用Ahmed青光眼阀治疗新生血管性青光眼32例(32眼)。为视网膜血管性疾病及糖尿病所致的新生血管性青光眼。疗效评价:术后眼压8~21 mmHg,视功能保持或有改善为治愈。术后平均随访14月。结果手术成功率为71.87%,眼压从术前(54.32±15.48)mmHg下降为术后(19.55±5.76)mmHg。主要并发症有:早期低眼压、前房延缓形成、前房导管口阻塞、前房积血。结论Ahmed青光眼阀治疗新生血管性青光眼是一种有效的手术方法。     

玻璃体切割术全视网膜激光光凝联合Ahmed阀植入治疗NVG

目的：回顾分析玻璃体切割全视网膜光凝术联合 Ahmed阀植入治疗新生血管性青光眼的疗效。
　　方法：新生血管性青光眼15例15眼,行玻璃体切割术、全视网膜光凝术、Ahmed阀植入,合并的白内障同时超声乳化吸除,术后随访12~36mo,观察手术前后视力、眼压改变、新生血管消退情况和并发症等。
　　结果：术后15眼中10眼视力不同程度提高。术后1,6,12 mo眼压与术前眼压的差异均具有统计学意义( P<0.01)。术后虹膜新生血管消退。无严重并发症。
　　结论：玻璃体切割全视网膜光凝术联合Ahmed阀植入能有效治疗新生血管性青光眼。     

玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入治疗新生血管性青光眼

目的 观察玻璃体腔注射Bevacizumab联合Ahmed青光眼阀植入治疗新生血管性青光眼(NVG)的术后疗效和并发症.方法 回顾性临床病例对照研究.选择新乡医学院第一附属医院眼科在2007年至2008年2月间接受过玻璃体腔注射Bevacizumab 0.05 mL/1.25 mg和Ahmed青光眼阀植入术的NVG患者...     

Ahmed青光眼阀植入术联合前部玻璃体切除治疗新生血管性青光眼

目的:观察Ahmed青光眼阀(ahmed glaucoma valve,AGV)植入术联合前部玻璃体切除治疗新生血管性青光眼的疗效。方法:对观察组32例32眼新生血管性青光眼患者行AGV植入术联合前部玻璃体切除,观察术后浅前房等早期并发症的发生率及手术效果,并与对照组22例24眼按常规方法行AGV植入术者进行比较。结果:术后前房延缓形成的发生率:观察组为3/32(9.4%),对照组为8/24(33.3%),两组差异有统计学意义(χ2=4.987,P=0.026),术后早期低眼压:观察组为10/32(31.3%),对照组为14/24(58.3%),两组差异有统计学意义(χ2=4.108,P=0.043),引流管阻塞发生率两组差异均无统计学意义。所有病例术后1mo时眼压≤2.8kPa者:对照组15/24(62.5%),观察组28/32(87.5%)。随访6mo,观察组总成功率17/32(53.1%),对照组总成功率13/24(54.2%),两组差异无统计学意义。结论:AGV植入术联合前部玻璃体切除治疗新生血管性青光眼操作简单,并发症少,疗效满意,是值得推荐的治疗方法。     

Ahmed青光眼阀植入术治疗新生血管性青光眼

目的:探讨Ahmed青光眼引流阀植入术治疗新生血管性青光眼的疗效及其并发症的防治。方法:回顾性分析18例18眼新生血管性青光眼行Ahmed青光眼阀植入术的疗效,主要观察指标为手术前后视力、眼压、并发症及手术成功率等,术后随访6~18mo。结果:术后最佳矫正视力不变11眼,提高5眼,下降2眼。术后眼压控制的有效率达到89%,术后并发症主要是早期的短暂性浅前房和高眼压、前房积血以及晚期的滤过道瘢痕纤维化。结论:Ahmed引流阀植入术是治疗新生血管性青光眼的一种比较有效的方法。     

Ahmed青光眼阀植入术治疗有视功能的新生血管性青光眼

目的：评价Ahmed青光眼阀植入术治疗有视功能的新生血管性青光眼的疗效及安全性。方法：对26例26眼有视功能的新生血管性青光眼施行颞上象限到赤道部区域的Ahmed表眼阀值入术,结果：术后经4－26mo（平均8mo)的随访观察,22例视力提高或不变,占86．4％,无1例因手术而失明;17眼眼压控制在0．8－2．8kPa,眼压控制率为65．4％,术后并发症包括;自顾不暇暂性前房出血,术后早期低眼压,引流管口阻塞及植入盘脱出,结论Ahmed青光眼阀植入术治疗有视功能的新生血管性青光眼旭一种有效且安全的方法。     

Ahmed青光眼阀植入术治疗新生血管性青光眼临床观察

目的评价Ahmed青光眼阀（AGV）植入术治疗新生血管性青光眼（NVG）的有效性及安全性。方法收集42例（43只眼）行AGV植入术的病例资料,其中实验组30例（31只眼）NVG行AGV植入术,术中采用可松解缝线（可拆缝线＋可吸收6-0Vcryl缝线结扎引流管）,观察术后并发症、眼压、手术成功率,并与既往未采用可松解缝线的12例（12只眼）对照组进行比较分析。结果术后早期Ⅱ级以上浅前房的发生率：实验组2例,2/31（6.45%）,对照组8例,8/12（66.67%）,浅前房的发生率两组间有显著性差异（P〈0.01）。实验组随访6～48个月,平均（12.29±5.18）个月,最后随访平均眼压（23.4±4.0）mmHg,显效率为54.84%,好转率为19.35%,有效率为74.19%;对照组随访6～48个月,平均（11.08±3.08）个月,最后随访平均眼压（27.8±5.0）mmHg,显效率为50.00%,好转率为16.67%,有效率为66.67%。两组眼压控制情况的比较无显著性差异（P=0.902）。结论 Ahmed青光眼阀植入术是NVG的有效治疗手段,联合丝裂霉素C（MMC）可提高手术成功率,采用可松解缝线可减少术后浅前房的发生。     

睫状体平坦部青光眼阀植入联合玻璃体切除全视网膜光凝治疗新生血管性青光眼的临床观察

目的:评估平坦部青光眼阀植入联合玻璃体切除全视网膜光凝术治疗继发性闭角型新生血管性青光眼(neovascular glaucoma,NVG)的临床效果。方法:对2007-05/2008-08在我科治疗的连续伴玻璃体积血的继发性闭角型NVG患者14例16眼行玻璃体切除视网膜光凝联合平坦部青光眼阀植入术并随访观察。结果:术后追踪随访3～13(平均7.3)mo。16只术眼中,除3眼外视力均不同程度提高。经秩和检验术前和术后两组相差显著。眼压由术前用降压药后的38～67(平均48.5±9.3)mmHg降至15.6～25.3(平均16.5±6.9)mmHg,两组相差有统计学意义。4眼出现术后并发症。其中2眼角膜水肿、前房炎症。1眼脉络膜脱离。经药物对症治疗后缓解。1眼出现医源性白内障。结论:玻璃体切除全视网膜光凝联合平坦部青光眼阀植入术是有效和安全的。特别是对于伴浅前房的NVG患者是一种新的治疗选择。     

Combined pars plana vitrectomy and Baerveldt glaucoma implant placement for refractory glaucoma

AIM: To evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant (PPV-BGI) placement for refractory glaucoma.METHODS: The medical records of 92 eyes (89 patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma (NVG) and 49 eyes with other types of glaucoma (non-NVG).RESULTS: Outcome measures were visual acuity (VA), intraocular pressure (IOP), glaucoma medical therapy, complications, and success [VA>hand motions (HM), IOP≥6 mm Hg and ≤21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at 1y, respectively (P=0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP (mean±SD) was 30.3±11.7 mm Hg in the Non-NVG group and 40.0±10.6 mm Hg in the NVG group, and IOP was reduced to 15±9.5 mm Hg in the non-NVG group and 15±10.5 mm Hg in the NVG at 1y. Number of glaucoma medications (mean±SD) decreased from 2.7±1.3 in the non-NVG group and 2.8±1.3 in the NVG group preoperatively to 0.76±1.18 in the non-NVG group and 0.51±1.00 in the NVG group at 1y. Improvement in VA of ≥2 Snellen lines was observed in 25 (27%) eyes, although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearing vitreous hemorrhage was the most common postoperative complication occurring in 16 (17%) eyes, and postoperative suprachoroidal hemorrhages developed in 5 (5.4%) eyes.#$NLCONCLUSION: PPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities, especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.     

Pars plana Ahmed implantation combined with 23-gauge vitrectomy for refractory neovascular glaucoma in diabetic retinopathy

Purpose

To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR).

Methods

The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up.

Results

The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 ± 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 ± 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 ± 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 ± 0.61 to 0.96 ± 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases.

Conclusions

We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.     

玻璃体切割联合术治疗伴有玻璃体积血的 新生血管性青光眼

目的探讨玻璃体切割联合术治疗伴有玻璃体积血新生血管性青光眼的效果。方法7例患者7只眼因玻璃体积血新生血管性青光眼接受玻璃体切割联合白内障摘除、全视网膜光凝及小梁切除术。手术前视力光感～0.2，眼压平均 54 mm Hg(38～64 mm Hg )(1 mm Hg=0.133 kPa)。平均随访8个月(6～15个月)。结果手术后视力光感～0.4；眼压平均17 mm Hg(10～30 mm Hg)，显著低于手术前眼压(P＜0.05)；并发症主要包括前房炎性渗出(7只眼)，手术后1～2周内高眼压(2只眼)，手术后脉络膜上腔出血(2只眼)。结论玻璃体切割联合白内障摘除、全视网膜光凝及小梁切除手术可能是治疗某些伴有玻璃体积血新生血管性青光眼的有效方法。(中华眼底病杂志,2005,21:148-149)     

Combined pars plana vitrectomy and glaucoma drainage implant placement for refractory glaucoma

PURPOSE:To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a glaucoma drainage implant.METHODS:The medical records of all patients who underwent combined pars plana vitrectomy and placement of a glaucoma drainage implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively.RESULTS:At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7. 5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiglaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further glaucoma surgery for uncontrolled intraocular pressure.CONCLUSIONS:Although combined pars plana vitrectomy and placement of a glaucoma drainage implant is often a successful management option in selected patients with refractory glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.     

Simultaneous pars plana vitrectomy, panretinal photocoagulation, cryotherapy, and Ahmed valve implantation for neovascular glaucoma

AIM: To describe and evaluate the efficacy of Ahmed glaucoma valve implantation (AGV) combined with pars plana vitrectomy (PPV) in a single surgical act for the treatment of advanced neovascular glaucoma (NVG). METHODS: Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV, AGV, and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period (2005-2018). Preoperative, intraoperative and postoperative data at day 1 and months 1, 3, 6, 21, and 24 were systematically collected. Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment. RESULTS: Main indications for surgery were NVG secondary to proliferative diabetic retinopathy (39.2%) and central retinal vein occlusion (37.3%). Mean (±SD) preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12mo and 15.8±9.1 mm Hg at 24mo of follow up. Cumulative incidence of success of IOP control was 76.0% at first postoperative month, reaching 88.3% at 6mo. Prevalence of successful IOP control at long term was 74.4% at 12mo and 71.4% at 24mo. Eye evisceration for unsuccessful NVG management was required in 1 case (2.0%). CONCLUSION: Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.