摘要目的 观察Ahmed青光眼阀植入术治疗难治性青光眼的远期疗效与并发症.方法 回顾2001年2月至2008年7月北京复兴博爱眼科中心收治的24例26眼难治性青光眼行Ahmed青光眼阀植入手术病例,对比手术前后眼压、视力和联合使用降眼压药物数量,评价手术疗效并对并发症进行分析,随访时间58～ 159个月.结果 术后第1天、1个月及末次随访眼压分别为(13.02±6.79)、(11.43 ±5.24)、(18.56 ±6.43)mmHg,与术前(37.59±10.76) mmHg相比差异均有统计学意义(均P＜0.01);术后视力无变化或提高≥1行者占65.4％,34.6％的患眼视力降低或丧失光感,术后视力与术前比较差异无统计学意义(P =0.110).术后20只眼需联合使用降眼压药物,术后平均用药种类(1.72±0.98)种与术前(2.7±0.7)种相比差异有统计学意义(P =0.001).手术成功率为73.1％,手术失败的原因为眼内炎、角膜内皮失代偿、术后结膜伤口持续不愈、青光眼阀暴露以及丧失光感.术后早期并发症为低眼压、浅前房、前房出血、术后高眼压以及引流管阻塞,远期并发症为盘周包裹形成、引流管暴露、角膜内皮失代偿以及眼内炎.结论 Ahmed青光眼阀植入治疗难治性青光眼远期疗效显著,但需关注并发症的预防和处理.

abstractsObjective To explore the efficacies and complications of Ahmed glaucoma valve implantation for treating refractory glaucoma.Methods A retrospective study of case series was conducted for 24 patients (26 eyes) with refractory glaucoma from February 2001 to July 2008 at our hospital.Ahmed glaucoma valve implantation was performed.Pre-and post-operative best spectacle-corrected visual acuity (BSCVA),intraocular pressure (IOP),number of medications and complications were recorded and analyzed.The follow-up period was 58-159 months.Results The post-operative values of IOP were 13.02 +/-6.79,11.43 +/-5.24 and 18.56 +/-6.43 mmHg at 1 day,1 month and the last follow-up respectively.There were significant difference when compared with pre-operative IOP (37.59 +/-10.76 mmHg,P ＜ 0.01).And 65.38％ of eyes maintained or gained ≥ 1 line of BSCVA.But there was no significant difference with pre-operative BSCVA (P =0.110).Twenty eyes required anti-glaucoma drugs after glaucoma valve implantation and the average number of medication was 1.72 +/-0.98.There was significant difference with the pre-operative medication number 2.7 ± 0.7 (P =0.001).The surgical success rate was 73.1％.And the causes of failure were endophthalmitis,corneal endothelial decompensation,persistent conjunctival wound non-healing,glaucoma valve exposure and loss of light perception.Early postoperative complications were ocular hypotony,shallow anterior chamber,hyphema,transient high IOP and tube occlusion.And long-term complications included encapsulated cyst formation,tube exposure,corneal endothelial decompensation and endophthalmitis.Conclusions Ahmed glaucoma valve implantation is efficacious for refractory glaucoma.However,clinicians should pay attention to the prevention and treatment of complications.