青光眼             1261                                      PO0456

　　Comparison of Silicone and Polypropylene Ahmed Glaucoma Valves: 4-Year Results of One Surgeon’s Experience

　　赵平1, James C. Tsai2

　　沈阳市爱尔眼科医院 110003

　　Objective: To compare the efficacy and safety of polypropylene plate (S2) model with more recent silicone plate (FP7) model of Ahmed glaucoma valve (AGV) implant.

　　Methods: Retrospective chart-review of the consecutive patients underwent AGV implantation by one surgeon (JCT) in one hospital (Edwards S. Harkness eye institute) from Sep. 2001 to Mar. 2006. Patients with age older than 18 at the date of surgery and follow-up more than 3 months were included in the study. Survival analysis up to 4 years was made. Surgical success was defined as IOP greater than 6 mmHg and less than 21 mmHg without additional glaucoma surgery or devastating complications. IOP and number of medications used at the post-op visits at day 1, 1 week, 1 month, 3 months, 6 months and every 6 months thereafter (up to 48 months) and complications were recorded and compared.

　　Results: Seventy-seven patients were enrolled in the study, with 17 S2 implants and 60 FP7 implants. Basically S2 model was mainly inserted before Mar. 2003 and thereafter substituted by FP7 gradually. There was no difference for the ethnicity (P=0.644) and age (70.1 vs 71.8, P=0.706) in the two groups. FP7 group had 30.0% POAG patients compared with 5.9% for S2 group which was significantly different (P=0.042). IOP decreased form 38.3mmHg to 10.5 mmHg in S2 group and from 31.3mmHg to 15.0 mmHg in FP7 group. IOP of FP7 group was slightly lower at day one, 1w, 1m, 3m, 6m, and 1.5y postoperative visits, but was not statistically different. Number of medications dropped from 3.5 to 2.0 and from 3.7 to 2.0 in the two groups respectively. No difference was observed preoperatively or at any postoperative visits. 76.5% S2 patients and 53.3% FP7 patients had hypertensive phase postoperatively but had no difference (P=0.0875). Cumulated success rate was 93.3% for S2 patients at 4 years and 68.9% for FP7 patients at 2.5 years (P=0.2450). One (5.9%) and 7 (11.7%) patients failed in the two groups respectively (P=0.490).

　　Conclusions: Silicone FP7 Ahmed glaucoma valve has similar clinical effects as previous polypropylene S2 model. It is not superior to the latter at least in our limited number of patients. Prospective study is needed to confirm. Ahmed glaucoma valve tends to be implanted in more primary glaucoma and to be implanted earlier as a result of surgeon’s greater experience.
 
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