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目的 :分析Ahmed青光眼阀 (Ahmedglaucomavalve ,AGV)植入术后高眼压原因 ,介绍及评价高眼压处理方法。方法 :选择一组采用AGV及其联合手术治疗 6个月以上的难治性青光眼 2 0 6例 2 2 1只眼 ,分析及总结术后发生高眼压的发生率、原因及处理方法 ,并采用logistic回归法分析影响引流盘周纤维包裹的相关因素。结果 :AGV术后早期 (≤ 1个月 )导致眼压升高的原因主要是引流管口堵塞 (8 1% )、恶性青光眼 (1 8% )及引流管后移 (0 5 % ) ;晚期 (>1个月 )主要是引流盘周纤维包裹 (10 9% )、引流管与角膜接触 (0 9% )及引流管后移 (0 5 % )。采用药物治疗、眼球指压按摩、Nd :YAG激光、补救性手术等处理后降眼压总成功率提高至 76 %。经统计学分析发现 ,表面积较小的AGV S3 型及 0 4mg/ml丝裂霉素 (mitomycinC ,MMC)接触时间 <3分钟者发生引流盘周纤维包裹的可能性较大。结论 :AGV植入术后高眼压原因早期主要是引流管口堵塞 ,晚期主要是引流盘周纤维包裹。采取积极有效的处理可明显提高其手术成功率。
Objective: To analyze the causes of high intraocular pressure (IOP) after Ahmed glaucoma valve (AGV) implantation and to introduce and evaluate the treatment of intraocular hypertension. Methods: A group of 206 refractory glaucoma patients with more than 2 months treated with AGV and its combined surgery was selected. The incidence, causes and treatment of intraocular hypertension were analyzed and summarized. Logistic regression analysis was used to analyze the factors that affected the pericranonuclear fibrosis. Results: The main causes of the intraocular pressure (IWG) occlusion (81%), malignant glaucoma (18%) and drainage tube retrograde (0 5%) in the early stage of AGV (≤ 1 month) (> 1 month) was mainly due to perioperative fibrous wrap (109%), drainage tube contact with cornea (0.9%) and drainage tube retrograde (0 5%). With medication, eye acupressure, Nd: YAG laser, salvage surgery and other treatment, the IOP reduction rate increased to 76%. According to the statistical analysis, there was a high possibility of peri-week fiber wrapping in AGV S3 and 0 4 mg / ml mitomycin C (MMC) with contact time less than 3 minutes. Conclusion: The reason of high intraocular pressure (IOP) after AGV implantation is that the drainage orifice is blocked mainly in the early stage and the peri-fiber is wrapped around the drainage plate in the late stage. Take an active and effective treatment can significantly improve the success rate of surgery.