微创青光眼手术研究进展  

Systemic research update of minimally invasive glaucoma surgery

作　　者：王琳艳(综述) 叶娟(审校)[1] Wang Linyan;Ye Juan(Department of Ophthalmology,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院眼科中心,杭州310009

出　　处：《中华实验眼科杂志》2024年第6期576-583,共8页Chinese Journal Of Experimental Ophthalmology

基　　金：浙江省重点研发项目(2019C03020)。

摘　　要：青光眼是全球主要的不可逆性致盲眼病,传统的青光眼手术存在损伤结膜和巩膜组织,影响二次手术等缺点。近年来,有诸多关于微创青光眼手术(MIGS)的研究探索,旨在降低眼压、减少患者药物负担的同时,尽量减少对眼部的创伤。从解剖上考虑,房水经小梁网流出的阻力同时来自于近端(小梁网、Schlemm管内壁)和远端(Schlemm管外壁、集液管、房水静脉、巩膜内静脉丛),因此可以把小梁网相关的MIGS手术根据作用位点的不同,分为解除近端阻力(增加小梁网旁路、扩张Schlemm管及小梁网切开)和同时解除远端、近端阻力的手术(Xen Gel Stent和PRESERFLO Microshunt)。此外,还有一些MIGS术式通过增加经脉络膜上腔途径引流或破坏睫状体减少房水生成,达到降低眼压的目的。增加脉络膜上腔引流的术式具有不依赖于眼压高低的优势,代表术式有Cypass Micro-Stent、iStent Supra和iSTAR MINIject。微创的睫状体破坏手术则包括超声睫状体成形术、微脉冲睫状体光凝术、内镜下睫状体光凝术等。MIGS虽然具有创伤更小、可有效控制眼压的优势,但其远期有效性及安全性仍有待严密观察。由于各种新型MIGS术式种类繁多,且大多仍处于临床试验阶段,尚未进入我国市场,因此对国内眼科医生来说相对陌生。本文就目前主流的MIGS术式原理及术后效果进行综述。Glaucoma is the leading cause of irreversible blindness worldwide.Conventional glaucoma surgeries have disadvantages like injuring the tissue of conjunctiva and sclera.Recently,there have been many new treatments called minimally invasive glaucoma surgery(MIGS)sprung up,which aims to lower intraocular pressure and reduce the use of glaucoma medications with less ocular injury.The resistance of aqueous outflow comes from both proximal and distal anatomically.The proximal resistance comes from trabecular meshwork and the inner wall of Schlemm canal(SC),while the distal resistance is decided by the outer wall of SC,aqueous vein,collector canals,episcleral veins and intrascleral venous plexus.Therefore,we could classify the MIGS by anatomical site and the mechanism to control intraocular pressure into different types.First,the MIGS acts on trabecular meshwork,which could be separated into removing proximal resistance including increasing trabecular meshwork bypass,expanding SC,cutting through trabecular meshwork and removing both proximal and distal resistance including Xen Gel Stent and PRESERFLO Microshunt.Second,MIGS procedures reduce intraocular pressure by increasing suprachoroidal drainage or by disrupting the ciliary body to reduce aqueous humor production.The MIGS expanding suprachoroidal drainage is independent of intraocular pressure level,like Cypass Micro-Stent,iStent Supra and iSTAR MINIject.The MIGS destroying ciliary body to reduce humor production include ultrasound cycloplasty,micropulse cyclophotocoagulation,and endocyclophotocoagulation.Despite MIGS can control intraocular pressure effectively in a less invasive way,close follow-ups are still necessary to see its long-term effectiveness and safety.However,the emerging implants are quite confusing to many ophthalmologists.It is especially true for Chinese surgeons as most MIGS are still under clinical trial and have not entered Chinese market.Therefore,this article summarizes the current mainstream MIGS and discussed the design and surgical outcomes

关 键 词：青光眼 微创青光眼手术 眼压 

分 类 号：R779.6[医药卫生—眼科]