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小儿青光眼Ahmed青光眼引流阀修复预后 Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma

Al-Omairi, A.M., Al, A.A.H., Al-Shahwan, S., et al.

期刊名称:American journal of ophthalmology

卷期:2017年第183卷

摘要

摘要:目的:Ahmed青光眼阀(AGV)包裹是术后眼压升高的常见原因,特别是儿童。许多报道已经描述了成人AGV修复的结果。但是,儿童AGV修订的结果文献记载不清。本研究的目的是确定儿童AGV修正的预后。设计:回顾性横断面研究。方法:进行了一项回顾性研究,对15岁以下行AGV修正术,且最小术后随访6个月的患者进行了分析。预后指标包括眼压下降(与基线相比),生存分析和减少抗青光眼药物的数量。也注意了术后并发症。完全成功定义为眼压不超过21mmHg或更低,而合格的成功定义为眼压在21mmHg或更少的药物治疗。结果:共有44只眼符合纳入标准。原发性先天性青光眼39只眼(88.6%),无晶状体青光眼4只眼(9.1%),Peters异常相关性青光眼1只眼(2.3%)。平均手术次数为1.4次,平均年龄为6.7岁(1.9-13岁),中位随访12个月(范围6-24个月)。术后6个月,眼压由术前平均30.4(±10.3)降至24.9(±10.6mm Hg Kaplan-Meier分析显示1个月完全成功率为100%,随后快速下降至6个月38.6%,127.7%,25.5%。 1个月合格成功率为100%,随后的6个月、1年存活率约为50%,和2年存活率为16%。中位生存时间为14个月。没有确定具体的失败风险因素。修正后视力保持不变。最常见的并发症是包裹复发伴IOP升高(15.9%)。其他并发症包括前房积血(n = 3; 6.8%),眼内炎(n = 1; 2.3%),伤口渗漏(n = 1; 2.3%)和脉络膜脱离(n = 2; 4.5%)。儿童AGV修复短期成功率高,但长期随访成功率明显下降。

PURPOSE:Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children.DESIGN:Retrospective cross-sectional study.METHODS:A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of 6months was conducted. Outcome measures included reduction in intraocular pressure from baseline, survival analysis, and reduction in the number of antiglaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21mm Hg or less without medications, while qualified success was defined as having an IOP of 21mm Hg or less with medications.RESULTS:A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly-associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range, 1.9-13 years) with a median follow-up of 12months (range, 6-24months). The IOP was reduced from a preoperative mean of 30.4 (± 10.3) to 24.9 (± 10.6) mm Hg at 6months postoperatively. Kaplan-Meier analysis showed that the complete success rate at 1month was 100% followed by a rapid decline at 6months to 38.6%, 27.7% at 1 year, and 5.5% at 2 years. Qualified success rate was 100% at 1month followed by a 6-month and 1-year survival rate of approximately 50% and a 2-year survival rate of approximately 16%. The median survival time was 14months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other complications included hyphema (n= 3; 6.8%), endophthalmitis (n= 1; 2.3%), wound leak (n= 1; 2.3%), and choroidal detachment (n= 2; 4.5%).CONCLUSION:Although the short-term success rate of AGV revision in children is high, with longer follow-up the success rate decreases significantly.


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