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要約 目的:血管新生緑内障(NVG)に対するアーメド緑内障バルブ(AGV)挿入術の中期成績の検討。
対象と方法:対象はAGV挿入術を実施し1年以上観察したNVG患者16例18眼。平均観察期間32.1±5.3か月,平均年齢61.7±15.4歳で,原疾患は増殖糖尿病網膜症14眼,網膜中心静脈閉塞症4眼。AGV挿入部位は前房7眼,毛様体扁平部11眼。検討項目は眼圧,生存率,挿入部位別生存率,抗緑内障薬物スコア,術後合併症である。
結果:眼圧は,術前28.4mmHgから術後1年15.4mmHg(p<0.001),2年15.7mmHg(p=0.00109),3年16.0mmHg(p=0.0128)と有意に下降した。生存率は,術後1年88.9%,2年88.9%,3年82.5%で,挿入部位別生存率は,前房,毛様体扁平部で術後1年85.7%,90.9%(p=0.77),2年85.7%,90.9%(p=0.77),3年71.4%,90.9%(p=0.37)と両群で有意差はなかった。抗緑内障薬物スコアは,術前3.8点から術後1年1.8点(p=0.00216),2年1.9点(p=0.00721),3年2.2点(p=0.0350)と有意に低下した。術後合併症は,hypertensive phase 9眼,硝子体出血4眼,脈絡膜剝離2眼,浅前房1眼,前房出血1眼であった。
結論:AGV挿入術はNVGに対して有効な術式であることが示唆された。
Abstract Purpose:To investigate the mid-term postoperative results of Ahmed Glaucoma Valve(AGV)insertion in patients with neovascular glaucoma(NVG).
Materials and Methods:Eighteen eyes of 16 patients with NVG who underwent AGV insertion were followed up for>1 year. The mean age and observation period were 61.7±15.4 years and 32.1±5.3 months, respectively. The primary diseases were proliferative diabetic retinopathy and central retinal vein occlusion in fourteen and four eyes, respectively. The AGV insertion sites were the anterior chamber and pars plana in seven and eleven eyes, respectively. The intraocular pressure, survival rate, survival rate according to insertion site, antiglaucoma drug score, and postoperative complications were evaluated.
Results:The intraocular pressure decreased significantly from 28.4±7.4 mmHg preoperatively to 15.4 mmHg(p<0.001), 15.7 mmHg(p=0.00109), and 16.0 mmHg(p=0.0128)1, 2, and 3 years postoperatively, respectively. The 1-, 2-, and 3-years survival rates were 88.9%, 88.9%, and 82.5%, respectively. The survival rates according to insertion site were 85.7% and 90.9% at 1 year(p=0.77), 85.7% and 90.9% at 2 years(p=0.77), and 71.4% and 90.9% at 3 years(p=0.37)for the anterior and pars plana, respectively, indicating no significant differences. The antiglaucoma drug score significantly decreased from 3.8 preoperatively to 1.8(p=0.00216), 1.9(p=0.00721), and 2.2(p=0.0350)1, 2, and 3 years postoperatively, respectively. Postoperative complications included hypertensive phase(nine eyes), vitreous hemorrhage(four eyes), choroidal detachment(two eyes), shallow anterior chamber(one eye), and hyphema(one eye).
Conclusion:The findings of the present study suggest that AGV insertion is an effective technique for NVG.

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