Jacobi P C, Dietlein T S, Krieglstein G K
Department of Ophthalmology, University Eye Hospital Cologne, Germany.
Ophthalmology. 1999 Mar;106(3):538-44. doi: 10.1016/S0161-6420(99)90113-6.
To evaluate the safety and efficacy of trabecular surgery under microendoscopic control in the management of advanced chronic open-angle glaucoma when the presence of corneal opacification obscures adequate visualization of the anterior segment.
Comparative interventional case series.
Fifteen eyes of 15 patients with medically uncontrolled open-angle glaucoma and moderate-to-severe corneal opacification underwent trabecular surgery under microendoscopic control. Seven eyes were treated by photoablative laser goniopuncture and eight eyes by goniocurettage.
The intraocular pressure (IOP) and number of medications before and after surgery were measured. Intraoperative and postoperative complications were analyzed.
The ophthalmic microendoscope was successfully used in visualizing and identifying the anterior chamber angle structures and in controlling the trabecular surgical procedures in all eyes. The IOP dropped from 34.5 +/- 6.9 millimeters of mercury (mmHg) (range, 27-46 mmHg) under maximal-tolerated medical therapy before surgery to 18.5 +/- 3.0 mmHg (range, 15-23 mmHg) at 21 months after surgery. Medication averaged 2.3 +/- 0.6 before surgery and dropped to 1.0 +/- 0.7 at last follow-up. No difference was observed in the surgical outcome between the laser-treated eyes and those receiving goniocurettage. No severe intraoperative or postoperative complications relating to either the trabecular surgery or to the use of the microendoscope were observed.
The ophthalmic microendoscope appears to be safe and effective in simultaneously providing illumination, video recording, and clear endoscopic view of the fine details of the anterior chamber angle structures. Microendoscopy enables various trabecular surgical procedures, such as goniocurettage or photoablative laser goniopuncture, which can be performed in the presence of corneal opacification that might otherwise preclude adequate visualization and treatment. It thus appears that microendoscopic trabecular surgery may in the future be considered as an alternative choice of surgical treatment in some cases of open-angle glaucoma.
评估在存在角膜混浊而使眼前节无法得到充分可视化的情况下，微内镜控制下小梁切除术治疗晚期慢性开角型青光眼的安全性和有效性。
对比性干预病例系列。
15例药物治疗无法控制的开角型青光眼且伴有中度至重度角膜混浊患者的15只眼接受了微内镜控制下的小梁切除术。7只眼接受了光凝激光房角穿刺术，8只眼接受了房角刮除术。
测量手术前后的眼压（IOP）和用药数量。分析术中及术后并发症。
眼科微内镜成功用于所有眼中眼前房角结构的可视化和识别以及小梁手术操作的控制。眼压从术前最大耐受药物治疗下的34.5±6.9毫米汞柱（mmHg）（范围27 - 46 mmHg）降至术后第21个月时的18.5±3.0 mmHg（范围15 - 23 mmHg）。术前平均用药2.3±0.6种，最后一次随访时降至1.0±0.7种。激光治疗组眼与接受房角刮除术组眼的手术结果未观察到差异。未观察到与小梁手术或微内镜使用相关的严重术中或术后并发症。
眼科微内镜似乎在同时提供照明、视频记录以及眼前房角结构精细细节的清晰内镜视野方面是安全有效的。微内镜检查能够进行各种小梁手术操作，如房角刮除术或光凝激光房角穿刺术，这些操作可在角膜混浊的情况下进行，否则可能会妨碍充分的可视化和治疗。因此，微内镜小梁切除术在未来某些开角型青光眼病例中可能被视为手术治疗的一种替代选择。
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