.: ORİJİNAL ARAŞTIRMA
Dirençli Pediatrik Glokom Olgularında Ahmed Glokom Valvi İmplantasyonunun Klinik Sonuçları: Retrospektif ve Gözlemsel Çalışma
Clinical Outcomes of Ahmed Glaucoma Valve Implantation in Refractory Pediatric Glaucoma Cases: Retrospective and Observational Study
Turkiye Klinikleri J Ophthalmol. 2022;31(3):140-4
doi: 10.5336/ophthal.2021-87789
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Bu çalışmanın amacı, dirençli pediatrik glokom olgularında Ahmed glokom valvi (AGV) implantasyonu sonuçlarımızı sunmaktır. Gereç ve Yöntemler: Bu retrospektif ve gözlemsel çalışmada, 2014-2018 tarihleri arasında Haydarpaşa Numune Eğitim ve Araştırma Hastanesi glokom biriminde AGV implantasyonu uygulanan dirençli pediatrik glokom hastalarının dosyaları incelendi. Hastaların medikal kayıtlarından yaş, cinsiyet, glokom tipi, eşlik eden oküler hastalık, daha önce geçirilen cerrahi tipi, eşlik eden konjenital anomaliler, düzeltilmiş en iyi görme keskinliği, biyomikroskobik ön segment muayenesi, göz içi basıncı (GİB) ölçümü, santral kornea kalınlığı, aksiyel uzunluk, goniyoskopi, optik disk ve fundus muayeneleri not edildi. Postoperatif her vizitteki GİB ve postoperatif komplikasyonlar kayıt edildi. Bulgular: Çalışmaya 16 hastanın 19 gözü (9 erkek, 7 kadın) dâhil edildi. Çocukların ortalama yaşı 9,82±6,08 idi. Postoperatif ortalama izlem süresi 4,3±1,66 yıldı. Ortalama GİB 1. yılda 16,1±2,84 mmHg, 2. Yılda 18,5±6,18 mmHg, 3. yılda 19,5±7,30 mmHg ve son vizitte 20,25±5,78 mmHg idi. Preoperatif GİB'e göre her vizitteki düşüş istatistiksel olarak anlamlı idi (p<0,05). Kümülatif başarı oranı 1. yılda %95, 2. Yılda %84 ve 5. yılın sonunda %47 idi. Sonuç: Dirençli pediatrik glokom tedavisinde, AGV implantasyonu uzun dönemde orta derecede başarı oranı göstermiştir. İlk 2 yıllık izlemde cerrahi başarı oranı yüksek iken 5. yılın sonunda bu oran %50'nin altına düşmektedir.
Anahtar Kelimeler: Ahmed glokom valvi; cerrahi başarı oranı; pediatrik glokom
Amaç: Bu çalışmanın amacı, dirençli pediatrik glokom olgularında Ahmed glokom valvi (AGV) implantasyonu sonuçlarımızı sunmaktır. Gereç ve Yöntemler: Bu retrospektif ve gözlemsel çalışmada, 2014-2018 tarihleri arasında Haydarpaşa Numune Eğitim ve Araştırma Hastanesi glokom biriminde AGV implantasyonu uygulanan dirençli pediatrik glokom hastalarının dosyaları incelendi. Hastaların medikal kayıtlarından yaş, cinsiyet, glokom tipi, eşlik eden oküler hastalık, daha önce geçirilen cerrahi tipi, eşlik eden konjenital anomaliler, düzeltilmiş en iyi görme keskinliği, biyomikroskobik ön segment muayenesi, göz içi basıncı (GİB) ölçümü, santral kornea kalınlığı, aksiyel uzunluk, goniyoskopi, optik disk ve fundus muayeneleri not edildi. Postoperatif her vizitteki GİB ve postoperatif komplikasyonlar kayıt edildi. Bulgular: Çalışmaya 16 hastanın 19 gözü (9 erkek, 7 kadın) dâhil edildi. Çocukların ortalama yaşı 9,82±6,08 idi. Postoperatif ortalama izlem süresi 4,3±1,66 yıldı. Ortalama GİB 1. yılda 16,1±2,84 mmHg, 2. Yılda 18,5±6,18 mmHg, 3. yılda 19,5±7,30 mmHg ve son vizitte 20,25±5,78 mmHg idi. Preoperatif GİB'e göre her vizitteki düşüş istatistiksel olarak anlamlı idi (p<0,05). Kümülatif başarı oranı 1. yılda %95, 2. Yılda %84 ve 5. yılın sonunda %47 idi. Sonuç: Dirençli pediatrik glokom tedavisinde, AGV implantasyonu uzun dönemde orta derecede başarı oranı göstermiştir. İlk 2 yıllık izlemde cerrahi başarı oranı yüksek iken 5. yılın sonunda bu oran %50'nin altına düşmektedir.
Anahtar Kelimeler: Ahmed glokom valvi; cerrahi başarı oranı; pediatrik glokom
ABSTRACT
Objective: The purpose of this study was to present our results of Ahmed glaucoma valve (AGV) implantation in refractory pediatric glaucoma cases. Material and Methods: In this retrospective and observational study, the files of refractory pediatric glaucoma patients who underwent AGV implantation in the Haydarpaşa Numune Training and Research Hospital between 2014-2018 were reviewed. Medical records of the patients included age, gender, type of glaucoma, concomitant ocular disease, type of previous surgery, congenital anomalies, best corrected visual acuity, slit-lamp examination, intraocular pressure (IOP) measurement, central corneal thickness, axial length, gonioscopy, optic disc and fundus examination. Postoperative IOP and complications were recorded at each visit. Results: Nineteen eyes (9 men, 7 women) of 16 patients were included in this study. The mean age of the children was 9.82±6.08. The mean postoperative follow-up was 4.3±1.66 years. Mean IOP was 16.1±2.84 mmHg at 1 year, 18.5±6.18 mmHg at 2 year, 19.5±7.30 mmHg at 3 year, and 20.25±5.78 mmHg at last visit. The decrease of preoperative IOP at each visit was statistically significant (p<0.05). The cumulative success rate was 95% at 1 year, 84% at 2 year, and 47% at 5 year. Conclusion: The AGV implantation has a moderate long-term success rate in the management of refractory pediatric glaucoma. Although the surgical success rate of AGV implantation in the first 2 years of followup is high, it decreases below 50% at the end of the 5th year.
Keywords: Ahmed glaucoma valve; surgical success rate; pediatric glaucoma
Objective: The purpose of this study was to present our results of Ahmed glaucoma valve (AGV) implantation in refractory pediatric glaucoma cases. Material and Methods: In this retrospective and observational study, the files of refractory pediatric glaucoma patients who underwent AGV implantation in the Haydarpaşa Numune Training and Research Hospital between 2014-2018 were reviewed. Medical records of the patients included age, gender, type of glaucoma, concomitant ocular disease, type of previous surgery, congenital anomalies, best corrected visual acuity, slit-lamp examination, intraocular pressure (IOP) measurement, central corneal thickness, axial length, gonioscopy, optic disc and fundus examination. Postoperative IOP and complications were recorded at each visit. Results: Nineteen eyes (9 men, 7 women) of 16 patients were included in this study. The mean age of the children was 9.82±6.08. The mean postoperative follow-up was 4.3±1.66 years. Mean IOP was 16.1±2.84 mmHg at 1 year, 18.5±6.18 mmHg at 2 year, 19.5±7.30 mmHg at 3 year, and 20.25±5.78 mmHg at last visit. The decrease of preoperative IOP at each visit was statistically significant (p<0.05). The cumulative success rate was 95% at 1 year, 84% at 2 year, and 47% at 5 year. Conclusion: The AGV implantation has a moderate long-term success rate in the management of refractory pediatric glaucoma. Although the surgical success rate of AGV implantation in the first 2 years of followup is high, it decreases below 50% at the end of the 5th year.
Keywords: Ahmed glaucoma valve; surgical success rate; pediatric glaucoma
REFERANSLAR:
- Moore DB, Tomkins O, Ben-Zion I. A review of primary congenital glaucoma in the developing world. Surv Ophthalmol. 2013;58(3):278-85. [Crossref] [PubMed]
- Rabiah PK. Frequency and predictors of glaucoma after pediatric cataract surgery. Am J Ophthalmol. 2004;137(1):30-7. [Crossref] [PubMed]
- Gramer E, Tausch M, Kraemer C. Time of diagnosis, reoperations and long-term results of goniotomy in the treatment of primary congenital glaucoma: a clinical study. Int Ophthalmol. 1996-1997;20(1-3):117-23. [Crossref] [PubMed]
- Ikeda H, Ishigooka H, Muto T, Tanihara H, Nagata M. Long-term outcome of trabeculotomy for the treatment of developmental glaucoma. Arch Ophthalmol. 2004;122(8):1122-8. [Crossref] [PubMed]
- Morales J, Al Shahwan S, Al Odhayb S, Al Jadaan I, Edward DP. Current surgical options for the management of pediatric glaucoma. J Ophthalmol. 2013;2013:763735. [Crossref] [PubMed] [PMC]
- Chen TC, Chen PP, Francis BA, Junk AK, Smith SD, Singh K, et al. Pediatric glaucoma surgery: a report by the American Academy Of Ophthalmology. Ophthalmology. 2014;121(11):2107-15. [Crossref] [PubMed]
- Morad Y, Donaldson CE, Kim YM, Abdolell M, Levin AV. The Ahmed drainage implant in the treatment of pediatric glaucoma. Am J Ophthalmol. 2003;135(6):821-9. [Crossref] [PubMed]
- Djodeyre MR, Peralta Calvo J, Abelairas Gomez J. Clinical evaluation and risk factors of time to failure of Ahmed Glaucoma Valve implant in pediatric patients. Ophthalmology. 2001;108(3):614-20. [Crossref] [PubMed]
- Beck AD, Freedman S, Kammer J, Jin J. Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life. Am J Ophthalmol. 2003;136(6):994-1000. [Crossref] [PubMed]
- Coleman AL, Smyth RJ, Wilson MR, Tam M. Initial clinical experience with the Ahmed Glaucoma Valve implant in pediatric patients. Arch Ophthalmol. 1997;115(2):186-91. [Crossref] [PubMed]
- Chen TC, Bhatia LS, Walton DS. Ahmed valve surgery for refractory pediatric glaucoma: a report of 52 eyes. J Pediatr Ophthalmol Strabismus. 2005;42(5):274-83; quiz 304-5. [Crossref] [PubMed]
- Englert JA, Freedman SF, Cox TA. The Ahmed valve in refractory pediatric glaucoma. Am J Ophthalmol. 1999;127(1):34-42. [Crossref] [PubMed]
- Ou Y, Yu F, Law SK, Coleman AL, Caprioli J. Outcomes of Ahmed glaucoma valve implantation in children with primary congenital glaucoma. Arch Ophthalmol. 2009;127(11):1436-41. [Crossref] [PubMed]
- Razeghinejad MR, Kaffashan S, Nowroozzadeh MH. Results of Ahmed glaucoma valve implantation in primary congenital glaucoma. J AAPOS. 2014;18(6):590-5. [Crossref] [PubMed]
- Pakravan M, Esfandiari H, Yazdani S, Doozandeh A, Dastborhan Z, Gerami E, et al. Clinical outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma. Eur J Ophthalmol. 2019;29(1):44-51. [Crossref] [PubMed]
- O'Malley Schotthoefer E, Yanovitch TL, Freedman SF. Aqueous drainage device surgery in refractory pediatric glaucomas: I. Long-term outcomes. J AAPOS. 2008;12(1):33-9. [Crossref] [PubMed]
- Al-Mobarak F, Khan AO. Two-year survival of Ahmed valve implantation in the first 2 years of life with and without intraoperative mitomycin-C. Ophthalmology. 2009;116(10):1862-5. [Crossref] [PubMed]
- Al-Torbak AA, Al-Shahwan S, Al-Jadaan I, Al-Hommadi A, Edward DP. Endophthalmitis associated with the Ahmed glaucoma valve implant. Br J Ophthalmol. 2005;89(4):454-8. [Crossref] [PubMed] [PMC]
- Kocatürk T, Erkan E, Çakmak H. Glokom drenaj implantı cerrahisi sonrası endoftalmi [Endophthalmitis following glaucoma drainage implant surgery]. Turk J Ophthalmol. 2014;44(2):138-43. [Crossref]
- Khan AO, Almobarak FA. Comparison of polypropylene and silicone Ahmed valve survival 2 years following implantation in the first 2 years of life. Br J Ophthalmol. 2009;93(6):791-4. Erratum in: Br J Ophthalmol. 2013;97(10):1362. Almobarak, F A [corrected to Al-Mobarak, F]. [Crossref] [PubMed]
- Eibschitz-Tsimhoni M, Schertzer RM, Musch DC, Moroi SE. Incidence and management of encapsulated cysts following Ahmed glaucoma valve insertion. J Glaucoma. 2005;14(4):276-9. [Crossref] [PubMed]
- Thieme H, Choritz L, Hofmann-Rummelt C, Schloetzer-Schrehardt U, Kottler UB. Histopathologic findings in early encapsulated blebs of young patients treated with the Ahmed glaucoma valve. J Glaucoma. 2011;20(4):246-51. [Crossref] [PubMed]
.: İşlem Listesi