Ömer KARTI, Bora YÜKSEL, Anıl KORKMAZ, Tuncay KÜSBECİ

PENETRAN KERATOPLASTİLİ HASTALARDA AHMED VALF İMPLANT CERRAHİSİ SONUÇLARI

Giriş: Bu çalışma penetran keratoplastili (PK) hastalarda Ahmed valf implant cerrahisinin 1 yıllık takip sonuçlarını sunmayı amaçladı. Gereç ve Yöntem: PK cerrahisinden sonra glokom gelişen 13 hastanın 13 gözü çalışmaya alındı. Glokom ilk başta anti-glokomatöz göz damlaları ve trabekülektomi cerrahisi ile tedavi edildi. Başarısızlık durumunda Ahmed valf implantı uygulandı. Ahmed valf implantı tüm hastalarda üst temporal kadrana yerleştirildi. Greft yetmezliği, göz içi basıncı (GİB) ve implantasyon cerrahisi ile ilişkili komplikasyonlar değerlendirildi Bulgular: 13 PK hastasının 12’si erkek idi. Ortalama yaş 52.8 ± 17.1 yıl idi. PK için primer endikasyon 4 gözde travma sonrası lökom, 6 gözde büllöz keratopati, 1 gözde alkali yanık sonrası vaskülarize lökom, 1 gözde keratit sekeli lökom ve 1 gözde korneal distrofi idi. Trabekülektomi ve maksimum medikal tedaviye rağmen implant cerrahisi öncesi ortalama GİB 40.9 ± 7.9 mmHg idi. Hastaların postoperatif 1.ay, 3.ay, 6.ay ve 1.yılda ortalama GİB’i sırasıyla 18.3 ± 11.8, 18.8 ± 9.9, 19.3 ± 9.6 ve 21.7 ± 14.4 mm Hg idi. Hastalarda postoperatif dönemde cerrahi ile ilişkili hifema, diplopi ve şaşılık gibi komplikasyonlar görülmedi. Bununla beraber, 3 hastada tüp ekspojuru ve 1 hastada persistan hipotoni izlendi. Takip sırasında hiçbir hastada greft yetmezliği görülmedi. Sonuç: Trabekülektomi cerrahisi ve maksimum medikal tedaviye rağmen GİB’I kontrol edilemeyen PK'li hastalarda Ahmed glokom valf cerrahisi alternatif bir yöntem olarak düşünülebilir.

THE RESULTS OF AHMED VALVE IMPLANT SURGERY IN PATIENTS WITH PENETRATING KERATOPLASY

Introduction: This study aimed to present the results of 1 year follow-up of Ahmed valve implant surgery in penetrating keratoplasty (PK) patients. Material and Method: 13 eyes of 13 patients who developed glaucoma after PK surgery were included in the study. Glaucoma was initially treated anti-glaucomatous eye drops and trabeculectomy surgery. In the case of failure, Ahmed valve implant was performed. Ahmed glaucoma valve implants were placed in the superior temporal quadrant in all patients. Graft failure, intraocular pressure (IOP) and complications associated with implant surgery were assessed. Results: 12 of the 13 PK patients were male. The mean age was 52.8 ± 17.1 years. Primary indication for PK was post-traumatic leukomas in 4 eyes, bullous keratopathies in 6 eyes, post-alkaline-burned vascularized leukoma in 1 eye, keratitis sequelae leukoma in 1 eye, and corneal dystrophy in 1 eye. Despite trabeculectomy and maximal medical treatment, the mean IOP was 40.9 ± 7.9 mmHg before implant surgery. Mean postoperative IOP were 18.3 ± 11.8, 18.8 ± 9.9, 19.3 ± 9.6 and 21.7 ± 14.4 mm Hg at the 1 month, 3 months, 6 months and 1 year, respectively. There were no complications such as hyphema, diplopia and strabismus associated with surgery. However, tube exposures in 3 patients and persistant hypotonia in 1 patient were seen. Graft failure was not seen any patients during the follow-up. Conclusions: In patients with PK whose intraocular pressure can not be controlled despite trabeculectomy surgery and maximum medical treatment. Ahmed glaucoma valve surgery can be considered as an alternative method.

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