Ahmed青光眼阀在难治性青光眼儿童中的应用

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详细

课题迫切性：许多形式的儿童青光眼并没有手术治疗的最佳方法。在这种情况以及难治性青光眼的情况下，当手术干预没有效果的时候，植入各种类型的引流装置可能是首选手术。

目的：评估Ahmed青光眼阀植入术对儿童难治性青光眼的有效性。

材料和方法：分析了52名年龄在1个月至17岁（6.6±0.6岁）的儿童（67只眼睛）因原发性先天性青光眼、眼球先天性异常的青光眼、继发性青光眼手术不成功的治疗结果。手术治疗成功的标准是眼压稳定正常，没有并发症以及无需重复干预。

结果：97%的患者在6个月内保持手术效果，但在1年、2年和3年后分别下降到91.8%、82%和73.9%， 7年后下降到42.8%。术后并发症包括滤过泡包裹（25.3%），虹膜回缩至引流管合并瞳孔异位（4.5%），睫状体脉络膜脱落（4.5%），白内障（3.0%），结膜糜烂及引流管暴露（4.5%），眼内炎（1.5%），视网膜脱落（6.0%），引流管回缩（1.5%），眼前房积血（3.0%）。导致不良后果的风险因素是眼前后轴与正常年龄的标准值相比增加20%或更多，手术时眼压超过32毫米汞柱，以及以前做过滤性抗青光眼手术。

结论：植入Ahmed青光眼阀适用于以前手术失败的难治性小儿青光眼。然而有必要考虑到该装置的效果会随着时间的推移而下降，再加上有可能出现并发症，因此需要对患者进行长期的动态观察。

作者简介

Natalia N. Sadovnikova

St. Petersburg State Pediatric Medical University

Email: natasha.sadov@mail.ru
ORCID iD: 0000-0002-8217-4594

Cand. Sci. (Med.), Head of Department of Ophthalmology

俄罗斯联邦, 2, Litovsckaya st., Saint Petersburg, 194100

Vladimir V. Brzheskiy

St. Petersburg State Pediatric Medical University

Email: vvbrzh@yandex.ru
ORCID iD: 0000-0001-7361-0270

Dr. Sci. (Med.), Head of Department of Ophthalmology

俄罗斯联邦, 2, Litovsckaya st., Saint Petersburg, 194100

Natalia V. Prisich

St. Petersburg State Pediatric Medical University

Email: prisichnv@rambler.ru
ORCID iD: 0000-0001-7749-7850

Ophthalmologist

俄罗斯联邦, 2, Litovsckaya st., Saint Petersburg, 194100

Marina A. Zertsalova

St. Petersburg State Pediatric Medical University

Email: mazercalova@mail.ru
ORCID iD: 0000-0003-4559-0051

Assistant of Department of Ophthalmology

俄罗斯联邦, 2, Litovsckaya st., Saint Petersburg, 194100

Andrei Yu. Baranov

St. Petersburg State Pediatric Medical University

编辑信件的主要联系方式.
Email: homeandrey@rambler.ru
ORCID iD: 0000-0002-6024-4635

Assistant of Department of Ophthalmology

俄罗斯联邦, 2, Litovsckaya st., Saint Petersburg, 194100

参考

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补充文件

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2. 图1.先天性无虹膜青光眼新生儿的 眼睛Fig. 1. The eye of a newborn child with glaucoma due to congenital aniridia

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3. 图.2.一个16岁无虹膜综合症患儿的眼睛 Fig. 2. The eye of a 16-year-old child with aniridic syndrome

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4. Fig. 3. The eye of a 14-year-old child with aniridic syndrome, pseudophakia with an implanted valve

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5. 图5.滤过泡包裹Fig. 5. Bleb encapsulation

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6. 图6.虹膜向引流管回缩（箭头所示）Fig. 6. Retraction of the iris to the tube (shown by the arrow)

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7. 图7.引流管回缩 Fig. 7. Tube retraction

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8. 图8.一名术后完全性睫状体脱离患者的回声图Fig. 8. Echogram of a patient with postoperative total ciliochoroidal detachment

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9. 图.9. Ahmed青光眼阀植入术后3个月因发生引流管侵蚀引发眼内炎的5岁儿童的眼睛 Fig. 9. The eye of a 5-year-old patient with endophthalmitis due to tube erosion 3 months after implantation of the Ahmed valve

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10. 图4. Ahmed引流阀植入术后随访期间的眼压动态变化 Fig. 4. Dynamics of the hypotensive effect of Ahmed valve implantation during the follow-up period

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版权所有 © Sadovnikova N., Brzheskiy V., Prisich N., Zertsalova M., Baranov A., 2021

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