ĐÁNH GIÁ HIỆU QUẢ CỦA PHẪU THUẬT ĐẶT VAN AHMED KẾT HỢP TIÊM BEVACIZUMAB TRONG ĐIỀU TRỊ GLÔCÔM TÂN MẠCH

Abstract

Objectives: To evaluate the efficacy and safety of Ahmed valve implantation combined with intravitreal bevacizumab in neovascular glaucoma, focusing on success rate, complications, and postoperative interventions. Methods: A longitudinal study (retrospective and prospective) was conducted on 32 eyes undergoing Ahmed valve implantation after intravitreal bevacizumab, with a minimum follow-up of 12 months. Data included demographics, clinical features, intraocular pressure (IOP), visual acuity, complications, and additional interventions. Results: Surgical success was 71.9% at 6 months and 68.8% at 12 months. Ocular comorbidities and diabetic retinopathy were negatively associated with success, while peripheral anterior synechiae impacted outcomes at 12 months. A shorter interval between the last bevacizumab injection and surgery, as well as postoperative injections, correlated with better results, whereas multiple preoperative injections were associated with poorer prognosis. Common complications included hyphema (12.5%), shallow anterior chamber (6.3%), and tube exposure (3.1%); 18.8% required further intervention. Hypertensive phase occurred in 53.1% of eyes, with additional procedures such as anterior chamber reformation, hyphema washout, tube coverage, and vitrectomy performed as needed. Conclusions: Ahmed valve implantation with bevacizumab is an effective and relatively safe option for neovascular glaucoma. Prognosis is influenced by ocular and systemic comorbidities, PAS, and timing/number of bevacizumab injections. Postoperative complications are common but generally manageable.