经巩膜睫状体光凝术与Ahmed引流阀植入治疗晚期难治性青光眼的疗效对比OA

Objective To assess the clinical efficacy,safety,and cost-effectiveness of transscleral cyclophotoco-agulation(TSCPC)versus ahmed glaucoma valve implantation in patients with advanced refractory glaucoma.Methods Retrospective case analysis.From February 2014 to November 70 patients(72 eyes)with advanced refractory glaucoma were diagnosed and treated in the Ophthalmology Department of Jiangsu Provincial People's Hospital,of whom 36 eyes un-derwent transscleral cyclophotocoagulation(TSCPC)and 36 eyes received ahmed glaucoma valve implantation.The intraocu-lar pressure(IOP)at each follow-up time point before and after the surgery,the ocular pain before and at 6 months after the surgery,the best corrected visual acuity(BCVA),number of anti-glaucoma medications and complications were recorded.Complete success rate of the surgery and conditional success rate of the surgery(6 mmHg≤IOP≤21 mmHg with or without medications)were analyzed.Results IOP and the number of anti-glaucoma medications decreased significantly after the surgery(P<0.05).The IOP in the TSCPC group decreased from(42.3±9.9)mmHg(medications:2.6±0.6 kinds)to(16.4±8.0)mmHg(0.4±0.7),and the IOP in the ahmed valve group decreased from(40.3±7.6)mmHg(2.4±0.7)to(23.0±12.4)mmHg(0.7±0.9).The conditional success rate was 72.2%in the TSCPC group and 66.7%in the ahmed valve group at 6 months postoperatively.The complete success rate was 63.9%in the photocoagulation group and 44.4%in the ahmed valve group(P>0.05).Complications occurred in 2 eyes in the photocoagulation group and 4 eyes in the ahmed valve group.Conclusions Both transscleral cyclophotocoagulation and ahmed glaucoma valve implantation can safely and effectively reduce the IOP and maintain the visual acuity of patients with advanced refractory glaucoma.Transscleral cyclophotocoagu-lation is simpler,safer and more economical.It can more effectively control the IOP,significantly relieve ocular pain,and reduce the variety of medications.