Viscotrabeculotomy with anterior chamber irrigation versus Ahmed glaucoma valve implantation for silicone oil glaucoma in the pseudophakic eye

ABSTRACT Purpose: To compare viscotrabeculotomy with anterior chamber irrigation to Ahmed glaucoma valve implantation for secondary glaucoma following silicone oil removal. Methods: A prospective study was conducted on 43 vitrectomized pseudophakic eyes with persistent glaucoma after silicone oil removal. Patients were randomized to either viscotrabeculotomy with anterior chamber irrigation or Ahmed glaucoma valve implantation. All patients were examined on day 1, week 1, and months 1, 3, 6, 9, 12, 18, and 24 postoperatively. Postoperative complications were noted. Success was defined as an intraocular pressure between 6 and 20 mmHg and with an intraocular pressure reduction of >30% compared with the preoperative intraocular pressure. Results: There were 22 eyes in the viscotrabeculotomy with anterior chamber irrigation and 21 eyes in the Ahmed glaucoma valve implantation group. The mean preoperative and postoperative intraocular pressure in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 35.5 ± 2.6 mmHg and 35.5 ± 2.4 mmHg and 16.9 ± 0.7 mmHg and 17.9 ± 0.9 mmHg respectively (p˂0.0001). There was a statistically significant intraocular pressure reduction at all follow-up time points compared to preoperative values (p˂0.0001) in both groups. The unqualified success rate in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 72.73% and 61.9%, respectively. A minimal self-limited hyphema was the most common complication. Conclusions: Both viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation are effective in lowering the intraocular pressure in glaucoma after silicone oil removal with viscotrabeculotomy with anterior chamber irrigation providing greater reduction, higher success rates, and minimal complications.

摘要
研究目的：比较黏弹剂辅助小梁切开术（viscotrabeculotomy）联合前房灌洗（anterior chamber irrigation）与Ahmed青光眼引流阀植入术（Ahmed glaucoma valve implantation）治疗硅油取出术（silicone oil removal）后继发性青光眼的临床疗效。
方法：本研究为前瞻性研究，纳入43例经玻璃体切除术后合并人工晶状体眼的硅油取出术后持续性青光眼患者。采用随机分组方案将患者分为黏弹剂辅助小梁切开术联合前房灌洗组与Ahmed青光眼引流阀植入术组。所有患者均于术后第1天、第1周及术后1、3、6、9、12、18、24个月接受随访检查，并记录术后并发症情况。手术成功定义为眼压（intraocular pressure）介于6~20 mmHg之间，且较术前眼压降幅超过30%。
结果：黏弹剂辅助小梁切开术联合前房灌洗组共纳入22眼，Ahmed青光眼引流阀植入术组共21眼。两组患者术前平均眼压分别为35.5±2.6 mmHg与35.5±2.4 mmHg，术后平均眼压分别为16.9±0.7 mmHg与17.9±0.9 mmHg（p<0.0001）。两组患者各随访时间点的眼压较术前均存在统计学意义上的显著降低（p<0.0001）。黏弹剂辅助小梁切开术联合前房灌洗组与Ahmed青光眼引流阀植入术组的手术成功率分别为72.73%与61.9%。轻微自限性前房积血（hyphema）是两组最常见的术后并发症。
结论：黏弹剂辅助小梁切开术联合前房灌洗与Ahmed青光眼引流阀植入术均可有效降低硅油取出术后继发性青光眼患者的眼压，其中黏弹剂辅助小梁切开术联合前房灌洗的眼压降幅更显著、手术成功率更高且并发症更少。