Ahmed青光眼引流阀植入术治疗新生血管性青光眼对角膜内皮细胞密度及眼压的影响

Effect of Ahmed glaucoma drainage valve implantation on corneal endothelial cell density and intraocular pressure in patients with neovascular glaucoma

摘要:

目的：探究Ahmed青光眼引流阀植入术治疗新生血管性青光眼对角膜内皮细胞密度及眼压的影响。

方法：选择2013-06/2016-06于我院治疗的新生血管性青光眼患者200例200眼，所有患者均采用Ahmed青光眼引流阀植入术治疗。对患者的病历资料进行回顾性分析，评价手术完成情况，记录术前、术后1wk，1mo，1a的眼压、角膜内皮细胞密度，视力、并发症发生情况。

结果：所有患者中手术完全成功率为81.0%，条件成功率92.0%； 手术前后视力无光感、手动～0.01、0.02～0.05、0.06～<0.10、≥0.10人数比例比较差异无统计学意义(P>0.05)； 术前眼压42.43±3.43mmHg，术后1wk，1mo，1a分别为13.45±2.34、15.89±2.67、16.34±2.88mmHg，差异有统计学意义(F=4570.62，P<0.001)； 术前角膜内皮细胞密度为2 453.67±342.34个/mm²， 术后1wk，1mo，1a分别为2 216.67±332.32、2 087.34±326.45、1 959.67±303.34个/mm²， 差异有统计学意义(F=83.42，P<0.001)； 术后发生前房出血20眼，低眼压13眼，引流阀阀体移位8眼，浅前房21眼。

结论：Ahmed青光眼引流阀植入术治疗新生血管性青光眼能够有效控制眼压，但存在角膜内皮细胞丢失现象，能够有效保护并部分改善患者残存视力，并发症较轻且简单干预后好转，是治疗新生血管性青光眼的有效方法。

Abstract:

AIM: To investigate the effect of Ahmed glaucoma drainage valve implantation on corneal endothelial cell density and intraocular pressure in patients with neovascular glaucoma.

METHODS: Totally 200 cases(200 eyes)of patients with neovascular glaucoma in our hospital from June 2013 to June 2016 were enrolled in this study. All patients were treated with glaucoma drainage valve implantation. The medical records of the patients were retrospectively analyzed; the evaluation of operation completion was made; intraocular pressure at preoperative and postoperative 1wk, 1mo, 1a was detected using non-contact tonometry; the corneal endothelial cell density at preoperative and postoperative 1wk, 1mo and 1a was tested by corneal endothelial microscopy, and visual acuity of patients before operation and at 1a after operation was recorded. All patients' complications and intervention methods were followed-up and recorded.

RESULTS: All patients' complete success rate was 81.0%, the conditional success rate was 92.0%. The proportion of preoperative and postoperative vision without light perception, hand moving to 0.01,0.02-0.05, 0.06-<0.10, ≥0.10 had significant difference(P>0.05). Intraocular pressure before treatment was 42.43±3.43mmHg, and were 13.45±2.34mmHg, 15.89±2.67mmHg, 16.34±2.88mmHg at 1wk, 1mo and 1a after operation respectively, showing significant difference(F=4570.62, P<0.001). Before treatment, corneal endothelial cell density was 2453.67±342.34/mm², and were 2216.67±332.32/mm², 2087.34±326.45/mm², 1959.67±303.34/mm² at 1wk, 1mo and 1a after operation respectively,holding significantly different(F=83.42, P<0.001). There were macular degeneration 20 eyes of hyphema, 13 eyes of low pressure, 8 eyes of drainage valve displacement and 21 eyes of shallow anterior chamber.

CONCLUSION: Ahmed glaucoma drainage valve implantation for neovascular glaucoma can effectively control intraocular pressure but the presence of corneal endothelial cell loss exists, can effectively protect and recover residual vision of patients, relief complications and recover it after simple intervention,it is an effective method for neovascular glaucoma.