【摘要】 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。
【关键词】 Ahmed青光眼阀；新生血管青光眼；玻璃体切除手术
Ahmed glaucoma valve implantation combined with anterior vitrectomy for treatment of neovascular glaucoma
RuiFu Wang，Xia Li，XiaoWei Gao，XiaoYun Dong，ZhouQuan Yang, XiDong Yan，Jie Luo
Department of Ophthalmology, No.474 Hospital, Ophthalmic Center of Chinese PLA, Urumchi 830013, Xinjiang Urgur Autonomous Region, China
Abstract
AIM: To observe the clinical effect of Ahmed glaucoma valve(AGV) implantation combined with anterior vitrectomy for treatment of neovascular glaucoma(NVC).
METHODS: In treating group, 32 eyes of 32 patients with NVG were treated with AGV implantation combined with anterior vitrectomy and conventional AGV implantation were performed in 24 eyes of 22 patients who were taken as control group. The main measure outcomes were the rate of early postoperative complications and the postoperative intraocular pressure(IOP). And the outcomes were compared between the two groups.
RESULTS：Early postoperative shallow anterior chamber occurred in 3 eyes in the treating group and in 8 eyes in control group(χ2 =4.987，P=0.026). Early postoperative hypotomy occurred in 10 eyes in the treating group and in 14 eyes in control group(χ2 =4.108，P=0.043). At the first month of followup, the operation succeeded in 28 eyes (87.5%) in the treating group, and in 15 eyes (62.5%) in the control group. At the 6th month of followup, the operation succeeded in 17 eyes ( 53.1% ) in the treating group and in 13 eyes ( 54.2% ) in the control group. And the difference was not significant.
CONCLUSION：AGV implantation combined with anterior vitrectomy is a simple, safe and effective therapy for the treatment of NVG.
KEYWORDS：Ahmed glaucoma valve; neovascular glaucoma; vitrectomy
0引言
Ahmed青光眼阀(Ahmed glaucoma valve, AGV)是目前公认的治疗难治性青光眼较为有效的手术方法之一。为了减少早期并发症，提高降眼压效果，AGV植入术联合其他手术已成为治疗某些类型难治性青光眼的治疗趋势。现将我们2002年开展单纯AGV植入术和2006年后开展AGV植入术联合前部玻璃体切除的治疗结果资料总结报告如下。
1对象和方法
1.1对象 200205/200806收住本院的54例56眼NVG患者。其病因有糖尿病20例21眼，视网膜中央静脉阻塞19例19眼，视网膜静脉周围炎7例8眼，Coats病4例4眼，陈旧性色素膜炎2例2眼，眼外伤2例2眼。对照组为单纯AGV植入术，观察组为前部玻璃体切除联合AGV植入术。对照组22例24眼，其中男10例女12例，年龄14～78岁，术前眼压38～60（平均39.30±8.52） mmHg（1mmHg =0.133kPa），术前矫正视力2眼NLP，3眼LP，6眼HM，10眼CF，2眼0.05，1眼0.1。观察组32例32眼，其中男14例女8例，年龄22～76岁，术前眼压46～52（平均41.20±8.52） mmHg,术前矫正视力1眼NLP，4眼LP，9眼HM，12眼CF，4眼0.05，2眼0.1。术后随访3～72mo。
1.2方法 对照组：(1)在颞上或颞下象限，做以穹隆部为基底的结膜瓣，距角膜缘后8mm以后的球筋膜下放置0.4g/L的丝裂霉素C(MMC)3min。(2)AGV冲洗通畅后，用80 Vuryl缝线将引流盘的前缘固定于距角膜8～10mm相邻两条直肌之间的赤道部巩膜上。(3)颞上或鼻上角膜缘内做一前房穿刺口，缓慢放出房水减压。(4)在引流管进入前房的角膜缘后相应位置用7号针头平行虹膜面穿刺进入前房，将引流管断端修剪成斜面向上45°、进入前房内2～3mm的长度，经穿刺口置入前房。(5)必要时前房注射部分黏弹剂或/和用80缝线结扎引流管。(6)用4mm×6mm大小的异体巩膜覆盖引流管的角膜缘部，并用80尼龙线缝合固定于浅层巩膜上，原位缝合结膜切口。观察组：按对照组步骤15行AGV术，距角膜缘后4mm行巩膜穿刺，置入玻璃体切割头切除部分前段玻璃体，眼压控制在15～20mmHg之间，拔出玻璃体切除头。按照对照组步骤6结束手术。部分患眼如眼前节情况容许，术后行全视网膜光凝术（对照组4眼，观察组6眼）。
统计学分析：使用SPSS 13.0 软件对数据进行分析，各组数据服从正态分布,两组均数的比较行单因素方差分析，两组间率的比较采用χ2检验，P＜0.05差异有统计学意义。
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