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Long-Term Experience of Ahmed Glaucoma Valve Implant in Refractory Congenital/Juvenile Glaucomas-Report of 6 Cases
Resource
中華民國眼科醫學會雜誌 v.43 n.1 pp.40-46
Journal
中華民國眼科醫學會雜誌,v.43
Journal Issue
n.1
Pages
40-46
Date Issued
2004
Date
2004
Author(s)
KUO, SHENG-YEN
HUNG, POR-TYING
LIN, LUKE LONG-KUANG
HSIEH, JUI-WEN
WANG, TSING-HONG
Abstract
目的:報告先天性及幼年性青光眼(congenital/juvenile glaucoma),使用藥物及濾 過性等手術,仍難控制眼壓之六例頑固青光眼(refractory glaucoma),植入Ahmed引 流管的長期觀察。方法:回溯六例已長期追蹤治療中,接受多次手術,包括濾過性等 手術,仍難以控制眼壓的光天性青光眼二例,幼年型隅角開放性青光眼四例,使用 Ahmed青光眼瓣膜引流管手術(Ahmed glaucoma valve implantation),繼續長期觀察 其手術效果,包括視力、眼壓、術後併發症等提出報告。主要結果測量包括手術前後 的最佳矯正視力,術前及術後1,1.5,3,6,9個月,1,1.5,2,2.5,3,3.5,4, 5年的眼壓變化,及視神經盤凹陷的變化,以及手術的併發症。結果:六例病人至少 追蹤5年以上而有五位眼壓仍控制在22mmHg以下,其中三位需要使用降眼壓的藥物, 有一位病人在術後3.5年後眼壓開始無法控制;手術併發症有兩例,包括一位有鞏膜 覆蓋瓣膜的感染,以及另一位病人有引流管位置移位及引流管曝露,再手術後有表皮 性包涵囊體(epithelial inclusion cyst)生成,因而再手術,後來產生大泡性角膜 病變及白內障。結論:Ahmed青光眼瓣膜引流管手術對於難以控制眼壓的青光眼病人 ,依照對先天性及幼年性頑固青光眼長期追蹤的結果,尚可作為可行的另一治療選擇 。 Purpose: To report the long term results after the Ahmed glaucoma valve implant surgery on 6 glaucomas refractory to medical treatment, filtering and cyclodestructive procedures. Methods: A retrospective study of 6 patients who received Ahmed glaucoma implant surgery in 1997. The main outcome measures included pre- and post- operative best corrected visual acuity, pre-operative IOP and IOP after operation at 1, 1.5, 3, 6, 9 months, 1, 1.5, 2 , 2.5, 3, 3.5, 4, 5 years post-operatively. The complications of the surgery were also described. Results: 5 patients had their IOP controlled within 22mmHg more than 5 years, although 3 of them used anti-glaucoma agents. Another patient was noted to have uncontrollable high IOP 3. 5 years post-operatively. The complications of the surgery included infection related to scleral patch graft, malposition of the tube, and the formation of epithelial inclusion cyst in the anterior chamber. Conclusion: For refractory glaucoma, Ahmed glaucoma valve implant surgery proved to be a alternative choice according to our result of long-term follow up. However, long-term follow up is mandatory after the surgery to be able to properly manage the complications.
Subjects
Ahmed glaucoma valve implantation
congenital/juvenile glaucoma