Ahmed Valve Implant Surgery with Adjunctive Mitomycin C and Selective 5-Fluorouracil Injection

Abstract

PURPOSE: To evaluate the surgical results of Ahmed valve implant surgery with adjunctive mitomycin C and selective postoperative 5-fluorouracil (5-FU) subconjunctival injection with a needling procedure. METHODS: In this retrospective study, 40 eyes of 40 patients who had undergone Ahmed valve implant surgery with adjunctive mitomycin C were observed for at least 1 year. The Ahmed valve was implanted after 5-minute application of 0.04% mitomycin C. Selective 5-FU injection with a needling procedure was performed during the follow- up period based on intraocular pressure (IOP). Hypertensive phase was defined as IOP higher than 21 mm Hg within 3 months after operation. IOP higher than 18 mm Hg regardless of IOP-lowering medications at 2 consecutive visits was considered to be a surgical failure. RESULTS: The mean follow-up period was 35.5 ± 12.4 months. Preoperative intraocular pressure was 32.8 ± 7.5 mm Hg, which decreased to 14.0 ± 4.2 mm Hg post-operatively. The number of glaucoma medications decreased significantly from 3.8 ± 0.5 to 2.0 ± 1.0. Eleven of 40 eyes (27.5%) experienced hypertensive phase at 6.0 ± 3.1 weeks after surgery. Kaplan-Meier survival analysis showed cumulative probability of surgical success rates of 82.5%, 79.6%, 72.7%, and 58.8% at 1, 2, 3, and 4 postoperative years respectively. There were no risk factors that affecting surgical failure except age (hazard ratio = 0.17, p = 0.02). CONCLUSIONS: Ahmed valve implant surgery with adjunctive mitomycin C and selective 5-FU injection with a needling procedure showed good success in refractory glaucoma.

목적: 난치성 녹내장의 치료로 mitomycin C (MMC)를 병용한 Ahmed 밸브 삽입술 후 선택적인 5-fluorouracil (5-FU) 결막하주사와 needling을 받은 환자들의 수술 결과를 평가해 보고자 한다. 대상과 방법: Ahmed 밸브 삽입술 후 최소 1년 이상 관찰이 가능했던 40명 40안을 대상으로 후향적 의무기록 분석을 통한 연구를 진행하였다. MMC 0.04%를 5분간 접촉 후 씻어내고 Ahmed 밸브를 삽입한 후 경과관찰하면서 선택적으로 추가적인 5-FU 결막하주사 및 needling revision을 병행하였다. 술 후 3개월 이내 안압이 22 mmHg 이상 상승한 경우를 고안압기로 정의하였고 이후 약제사용 여부에 관계없이 18 mmHg보다 높은 안압이 연속하여 2회 이상 측정될 때를 수술 실패로 정의하였다. 결과: 평균 추적관찰 기간은 35.5 ± 12.4개월이었다. 안압은 술 전 32.8 ± 7.5 mmHg에서 술 후 14.0 ± 4.2 mmHg, 녹내장 약물은 3.8 ± 0.5개에서 2.0 ± 1.0개로 감소하였다. 11안(27.5%)에서 고안압기를 경험하였으며 평균발생 기간은 6.0 ± 3.1주였다. Kaplan-Meier 생존분석 결과 녹내장 수술 후 1년, 2년, 3년, 4년 누적성공률은 각각 82.5%, 79.6%, 72.7%, 58.8%였다. 수술 실패의 예측인자는 연령(hazard ratio=0.17, p=0.02) 이외에 다른 연관된 인자는 없었다. 결론: 난치성 녹내장에서 술 중 MMC를 병용한 Ahmed 밸브 삽입술은 술 후 선택적인 5-FU needling을 시행하였을 때 좋은 성공률을 보였다.