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小梁切除术可以回归其内引流本质吗?

梁远波  程欢欢   

  1. 325027 浙江,温州医科大学青光眼研究所(梁远波);325027 浙江,温州医科大学附属眼视光医院临床与流行病学研究中心(梁远波、程欢欢)
  • 收稿日期:2018-10-10 出版日期:2018-11-25 发布日期:2018-12-11
  • 通讯作者: 梁远波,Email: yuanboliang@126.com E-mail:yuanboliang@126.com
  • 基金资助:

    浙江省医药卫生科技计划项目(2017PY008);浙江省基础公益研究计划项目(LQ18H120010); 浙江省卫生高层次创新人才 (2016025)

Can trabeculectomy go back to "internal drainage"?

LIANG Yuan-bo 1,2, CHENG Huan-huan2   

  1. 1. Institute of Glaucoma, Wenzhou Medical University, Wenzhou 325027, China; 2. Research Center for Clinical and Epidemiology, the Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China
  • Received:2018-10-10 Online:2018-11-25 Published:2018-12-11
  • Contact: LIANG Yuan-bo, Email: yuanboliang@126.com E-mail:yuanboliang@126.com

摘要:

1968年Cairns设计小梁切除术的最初理念是希望房水经小梁切除断端流入Schlemm管而达到内引流降低眼压,但随后的研究发现该手术大部分成功的患者都存在明显的滤过泡,目前普遍认为其属于外引流滤过性手术。历经50年的发展及改良,联合抗代谢药物使用和可拆除缝线技术的复合式小梁切除术已较为完美,一直是青光眼手术治疗的主流术式,但术后远期滤过泡瘢痕化仍是小梁切除术远期疗效的最大挑战。为减少此术式其它一些并发症的发生,一些学者聚焦于“非穿透性”抗青光眼手术,但疗效并不理想。近年来诸多微创青光眼手术(minimally invasive glaucoma surgery,MIGS)逐渐兴起,虽然术后并发症较少,但降眼压幅度有限,且适应证窄。将黏小管成形术整合进小梁切除术中,可望让小梁切除术回归内引流本质,从而回避瘢痕化这一个难以战胜的自然愈合反应。

关键词: 青光眼/外科学, 小梁切除术, 黏小管成形术

Abstract:

The original concept of Cairns' trabeculectomy in 1968 was to expect that aqueous humor flowed into the Schlemm’s canal through the trabeculectomy which achieved the internal drainage to reduce intraocular pressure (IOP). Yet, studies found that even the most successful patients have obvious filtering blebs, and trabeculectomy was subsequently identified as an external drainage filtration surgery. After 50 years of improvement, trabeculectomy supplemented by antimetabolites and releasable sutures has become an almost perfect surgery, and is the leading surgery for treating glaucoma. However, bleb scarring remains a huge challenge for controlling long-term IOP. In order to reduce complication rates, some scholars have turned their attention to non-penetrating glaucoma surgical techniques, but postoperative effect is limited. Recently, minimally invasive glaucoma surgery (MIGS) has demonstrated low postoperative complication rates, but the effectiveness of IOP control is also limited and ranges of operative indications are narrow. We integrate the canaloplasty into trabeculectomy, converting trabeculectomy to an "internal drainage" surgical procedure to avoid bleb scarring, an unbeatable natural healing response.

Key words: glaucoma/surgery, trabeculectomy, canaloplasty