宋青山 陈子林

[摘要] 目的 探讨改良Ahmed青光眼引流阀植入术治疗难治性青光眼的临床效果。 方法 选取2012年9月～2014年9月入住本院的30例（32眼）难治性青光眼患者作为研究对象，行改良Ahmed青光眼引流阀植入术治疗，比较手术前后的眼压、视力，记录术后并发症发生情况。 结果 术后1、3、12个月的平均眼压显著低于术前，差异有统计学意义（P<0.05）。术后1、3、12个月的总成功率比较，差异无统计学意义（P>0.05）。术后的视力水平显著优于术前，差异有统计学意义（P<0.05）。术后并发症包括短暂性浅前房6眼、前房积血6眼和引流管后移1眼，经保守治疗均好转。 结论 改良Ahmed青光眼引流阀植入术能有效治疗难治性青光眼，提高手术成功率，值得临床推广应用。

[关键词] 改良；Ahmed青光眼引流阀植入术；难治性青光眼；眼压

[中图分类号] R775.9 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0095-03

Clinical effect of modified Ahmed glaucoma drainage valve implantation in the treatment of refractory glaucoma

SONG Qing-shan CHEN Zi-lin

Department of Ophthalmology，Central People′s Hospital of Huizhou City in Guangdong Province，Huizhou 516001，China

[Abstract] Objective To explore the clinical effect of modified Ahmed glaucoma drainage valve implantation in the treatment of refractory glaucoma. Methods 30 patients （32 eyes） with refractory glaucoma from September 2012 to September 2014 in our hospital were selected as study group.All patients were treated with modified Ahmed glaucoma drainage valve implantation.Intraocular pressure，eyesight before and after treatment was compared，and the incidence situation of postoperative complication was recorded. Results Average intraocular pressure at 1，3，12 months after operation was lower than that before operation，with significant difference （P<0.05）.There was no significant difference in the total success rate among 1，3，12 months after operation （P>0.05）.The level of eyesight after operation was better than that before operation，with significant difference （P<0.05）.The postoperative complication included transient shallow anterior chamber （6 eyes），hyphema （6 eyes） and drainage tube backwards （1 eye），but all of that improved after conservative treatment. Conclusion Modified Ahmed glaucoma drainage valve implantation can effective treat refractory glaucoma，increase operation success rate，it is worthy of clinical promotion and application.

[Key words] Modification；Ahmed glaucoma drainage valve implantation；Refractory glaucoma；Intraocular pressure

难治性青光眼属于临床常见疾病，是指经最大耐受药物或常规滤过手术联合抗代谢药物治疗仍难以控制病情，将眼压降至正常范围的青光眼[1-2]，其主要类型包括无晶状体性青光眼、新生血管性青光眼、严重外伤性青光眼、滤过手术失败的青光眼、发育性或先天性青光眼、玻璃体或视网膜术后青光眼等[3]。难治性青光眼的眼部病情复杂，常规滤过术治疗仅有11%～15%的成功率，大量患者无法通过手术恢复目标眼压，是目前眼科临床治疗中的棘手问题之一[4]。1969年，Molteno发明了青光眼引流植入物并将其成功应用于难治性青光眼的治疗，以此为基础的Ahmed青光眼引流阀作为一种新型引流植入物被广泛应用于该病的临床治疗并取得了满意的治疗效果[5]，但受手术操作的影响，Ahmed青光眼引流阀置入术术后易形成引流盘纤维包裹，从而降低了手术成功率。本研究旨在探讨改良Ahmed青光眼引流阀植入术治疗难治性青光眼的临床疗效，为难治性青光眼的治疗提供帮助。……