A Clinical And Experiment Analysis Of Implanting Of Ahmed Glaucoma Valve For Refractory Glaucoma

Objective: To evaluate the clinical efficacy and postoperative complications of Ahmedglaucoma valve （AGV） implantation in refractory glaucoma, and examine the functionof MMC on anti-scarring after implantation silicone mat in rabbit eyes.Methods: A retrospective study was designed to test37eyes from35refractoryglaucoma patients who underwent AGV implantation. We statistically analyzed andcompared the results of intraocular pressure （IOP）, visual acuity and complications withpreoperative.42eyes of21rabbits underwent silicone insole implantation, divided intotwo groups （MMC group and blank control group）. The rabbits were sacrificed at10,30and90days after surgery respectively. The histopathological changes were detected byHE, and Masson stain was used to assess the degree of fibroblast proliferation. Theexpression of TGFβ₁and α-SMA was identified by immunohistochemistry study.Results: The patients were followed up for1-12months. The probability of completesuccess was72.97%（27/37）. The rate of part success was16.22%（six eyes） and totalsuccess was89.19%（33/37）. The mean IOP is （40.8±8.7） mmHg （1mmHg=0.133kPa）before operation. The levels of IOP were （13.3±5.1） mmHg,（15.9±7.4） mmHg,（17.1±6.5） mmHg,（19.5±3.9） mmHg for post-operation at1,3,6and12months. Thelevel of IOP between preoperation and postoperation was significant difference（P<0.01）. There was also significant different for post-operation at1and6（P＜0.05）,1and12months（P＜0.01）. However, there was no difference between post-operation at1and3months. Visual acuity between preoperation and postoperation was no difference.There are some early postoperative complications, including6eyes （16.21%） of theshallow anterior chamber,8eyes （21.62%） of hyphema,2eyes （5.4%） of postoperative hypotony cause choroidal detachment,2eyes （5.4%） of drainage tube contact cornealendothelial and one eye （2.7%） of drainage tube blockage, and some late complicationsincluding one eye （2.7%） of drainage pipe exposed and four eyes （10.81%） for thedrainage tray wrapped. The average number of TGFβ₁positive cells in experimentalgroup were15.80±2.39、28.20±1.48、41.60±2.70in post-operative10days,30daysand90days under the original magnification field （400times）. The number of positivecells in control group were27.80±1.64,50.80±3.35,114.80±4.1. There were significantdifference between the experimental group and the control group at10days,30daysand90days after surgery （P <0.01）.The average number of αSMA positive cells inexperimental group were0.169±0.010、0.519±0.031、0.877±0.033in post-operative10days,30days and90days under the original magnification field （400times）. Thenumber of positive cells in control group were0.252±0.021、0.519±0.031、0.877±0.033. There were significant difference between the experimental group and the controlgroup at10days,30days and90days after surgery （P <0.01）.Conclusions: Ahmed drainage valve implantations an effective method for thetreatment of refractory glaucoma. The rate of success is increased obviously. MMCcould effectively and safely inhibit the fibrous proliferating. MMC can be used forresisting the formation of fibrous tissues in clinical Ahmed drainage valve implantation.