Aqueous shunts in glaucoma - A report by the American Academy of Ophthalmology
Aqueous shunts in glaucoma - A report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2008.03.031
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发表时间：
2008-06-01
期刊：
影响因子：
13.7
通讯作者：
Singh, Kuldev
中科院分区：
文献类型：
--
作者：
Minckler, Don S.;Francis, Brian A.;Singh, Kuldev
目的：为目前大量用于控制眼压的商业上可用的房水分流术(Ahmed[New World Medical，Inc.，Ranco Cucmona，CA]，Baerveldt[Advanced Medical Optics，Inc.，Santa Ana，CA]，Krupin[Eagle Vision，Inc.，Magle Vision，TN]，Molteno[Molteno Ophual Ltd.，Dunedin，新西兰])提供循证总结。方法：17项先前发表的随机试验，1项前瞻性非随机对照试验，1项病例对照研究，2篇全面的文献综述，并发表了英语，结果：在内科、激光和传统的青光眼滤过手术失败后，房水分流术主要用于治疗青光眼，并已成功地控制了各种青光眼的眼压。前房置管的主要远期并发症是角膜内皮衰竭。最具分流性的延迟并发症是通过覆盖结膜的管子侵蚀。在目前所有可用的分流术中，这种情况的发生率很低，最常见的是在前房植入后角巩膜交界处几毫米内发生。赤道板通过结膜表面的侵蚀较少发生。随着时间的推移，各种装置的临床失败率约为每年10%，这与小梁切除术的失败率大致相同。结论：基于I级证据，房水分流术在复杂青光眼(先前失败的小梁切除术后的有晶状体或人工晶状体眼)的治疗中似乎具有与小梁切除术相当的益处(眼压控制，受益时间)。I级证据表明，目前可用的分流术辅助使用抗纤维化药物或全身性皮质类固醇没有好处。除了表面积更大的植入物可以提供更持久和更好的眼压控制之外，目前还没有发表关于各种可用分流装置的高质量直接比较，以评估特定装置的相对疗效或并发症发生率。鼓励进行长期跟踪和比较研究。
Objective: To provide an evidence-based summary of commercially available aqueous shunts currently used in substantial numbers (Ahmed [New World Medical, Inc., Rancho Cucamonga, CA], Baerveldt [Advanced Medical Optics, Inc., Santa Ana, CA], Krupin [Eagle Vision, Inc, Memphis, TN], Molteno [Molteno Ophthalmic Ltd., Dunedin, New Zealand]) to control intraocular pressure (IOP) in various glaucomas.Methods: Seventeen previously published randomized trials, 1 prospective nonrandomized comparative trial, 1 retrospective case-control study, 2 comprehensive literature reviews, and published English language, noncomparative case series and case reports were reviewed and graded for methodologic quality.Results: Aqueous shunts are used primarily after failure of medical, laser, and conventional filtering surgery to treat glaucoma and have been successful in controlling IOP in a variety of glaucomas. The principal long-term complication of anterior chamber tubes is corneal endothelial failure. The most shunt-specific delayed complication is erosion of the tube through overlying conjunctiva. There is a low incidence of this occurring with all shunts currently available, and it occurs most frequently within a few millimeters of the corneoscleral junction after anterior chamber insertion. Erosion of the equatorial plate through the conjunctival surface occurs less frequently. Clinical failure of the various devices over time occurs at a rate of approximately 10% per year, which is approximately the same as the failure rate for trabeculectomy.Conclusions: Based on level I evidence, aqueous shunts seem to have benefits (IOP control, duration of benefit) comparable with those of trabeculectomy in the management of complex glaucomas (phakic or pseudophakic eyes after prior failed trabeculectomies). Level I evidence indicates that there are no advantages to the adjunctive use of antifibrotic agents or systemic corticosteroids with currently available shunts. Too few high-quality direct comparisons of various available shunts have been published to assess the relative efficacy or complication rates of specific devices beyond the implication that larger-surface-area explants provide more enduring and better IOP control. Long-term follow-up and comparative studies are encouraged.