房角镜辅助的内路360°小梁切开术治疗青光眼研究进展  

Research progress in gonioscopy-assisted transluminal trabeculotomy in the treatment of glaucoma

作　　者：王彩霞(综述) 何宇(审校) WANG Caixia;HE Yu(Academy of Ophthalmology,Chengdu University of TCM,Chengdu 610075;Chengdu First People’s Hospital/Chengdu Integrated TCM&Western Medicine Hospital,Chengdu 610041,China)

机构地区：[1]成都中医药大学眼科学院,成都610075 [2]成都市第一人民医院/成都市中西医结合医院,成都610041

出　　处：《眼科学报》2023年第6期478-488,共11页Eye Science

基　　金：四川省科技计划项目(2021YFS0219)。

摘　　要：房角镜辅助的内路360°小梁切开术(gonioscopy-assisted transluminal trabeculotomy,GATT)是近年来国内外开展的新型微创青光眼手术,是一种改良的小梁切开术。GATT将微导管(iTrack)环穿Schlemm’s管后,利用微导管张力全周切开小梁网及Schlemm’s管内壁,重建生理性房水流出通道,避免小梁网阻力,实现房水从前房直接进入集液管,通过增加房水流出机制降低眼压。GATT适应证广泛,主要应用于开角型青光眼,包括原发性开角型青光眼和继发性开角型青光眼,同时可运用于闭角型青光眼。GATT微创且不依赖滤过泡,能明显减少降眼压药物的使用,中远期疗效稳定,安全性高,较少发生威胁视力的并发症,可作为开角型青光眼的首选手术方式。该文对GATT在青光眼中的应用、手术步骤、作用机制、有效性、并发症及影响疗效的因素等进行综述,为其临床应用提供参考。As a modified trabeculotomy,Gonioscopy-Assisted Transluminal Trabeculotomy(GATT)is a new type of minimally invasive glaucoma surgery developed at home and abroad in recent years.GATT inserts a microcatheter(iTrack)into the Schlemm's canal and advance the catheter through the canal circumferentially 360°,then circumferentially fracture the trabecular meshwork and inner wall of Schlemm’s canal.This method can reduce intraocular pressure by increasing the outflow of aqueous humor.The physiological outflow pathway of aqueous humor is reconstructed,which can avoid the resistance of trabecular meshwork and realizing the direct entry of the aqueous humor directly into the collector channel from the anterior chamber.With a wide range of indications,GATT is mainly used in open-angle glaucoma,including primary open-angle glaucoma and secondary open-angle glaucoma,and is also used in primary closed-angle glaucoma.Additionally,GATT can be the preferred surgical modality for open-angle glaucoma,as it has the following advantages:minimally invasive,independent of filtration bleb,can significantly reduce the use of medications,stable medium-and long-term efficacy,high safety,and has fewer sight-threatening complications.In order to provide a reference for clinical application,this article reviews the indications,mechanism of action,surgical procedures,effectiveness,complication and factors affecting therapeutic effect.

关 键 词：青光眼 小梁切开术 房角镜 内路 照明微导管 前房积血 

分 类 号：R779.6[医药卫生—眼科]