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