Guedes Ricardo Augusto Paletta, Guedes Vanessa Maria Paletta
Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brasil.
Arq Bras Oftalmol. 2006 Jul-Aug;69(4):605-13. doi: 10.1590/s0004-27492006000400029.
Recently, many discussions occurred concerning non-penetrating filtering surgery. Viscocanalostomy and deep sclerectomy with external trabeculectomy are the most practiced techniques. Their goal is to reduce intraocular pressure by enhancing the natural aqueous outflow, while reducing its resistance. Both techniques involve the removal of a deep scleral flap, the external wall of Schlemm's canal and corneal stroma behind the anterior trabecular meshwork and Descemet membrane, thus creating a scleral lake, where the aqueous humor remains until it is absorbed in many different ways. In viscocanalostomy, a high-molecular viscoelastic substance is injected into the ostia of Schlemm's canal in order to enlarge it and its collectors channels. In deep sclerectomy with external trabeculectomy, the inner wall of Schlemm's canal is removed with adjacent trabecular layers. Studies, both retrospective and prospective, demonstrated similar tensional results when compared to classical trabeculectomy, with fewer complications and better visual recovery after non-penetrating procedure. The aim of this study is to expose the non-penetrating surgery techniques, mechanism of action and results based on the analysis of published literature.
最近，关于非穿透性滤过手术有许多讨论。粘小管切开术和联合外路小梁切除术的深层巩膜切除术是最常用的技术。它们的目标是通过增强房水自然流出同时降低其阻力来降低眼压。这两种技术都涉及切除深层巩膜瓣、施莱姆管外壁以及小梁网和后弹力层后面的角膜基质，从而形成一个巩膜湖，房水会留在其中，直到通过多种不同方式被吸收。在粘小管切开术中，将一种高分子量粘弹性物质注入施莱姆管的开口处以扩大该管及其集合管。在联合外路小梁切除术的深层巩膜切除术中，切除施莱姆管的内壁及相邻的小梁层。回顾性和前瞻性研究均表明，与经典小梁切除术相比，非穿透性手术的眼压降低效果相似，并发症更少，视力恢复更好。本研究的目的是基于对已发表文献的分析，阐述非穿透性手术技术、作用机制及结果。
