Grehn F
Universitäts-Augenklinik, Würzburg.
Klin Monbl Augenheilkd. 2008 Jan;225(1):30-8. doi: 10.1055/s-2008-1027124.
The selection of the surgical approach to glaucoma depends primarily on the type of glaucoma. Filtration surgery (trabeculectomy) is considered the gold standard for the most common form of glaucoma, primary open angle glaucoma. The technique of surgery has been continuously improved during the past years resulting in less immediate postoperative complications such as flat anterior chamber, choroidal detachment and hypotony. The major problem of glaucoma surgery nowadays is wound healing with scarring of the outflow area. By intensified postoperative care using antimetabolites at the time of surgery and during postoperative care, many problems of scar formation can be managed. The absolute success rate may be doubled by using intensified postoperative care. Non-penetrating surgery such as deep sclerectomy or trabeculotomy are effective; however, the amount of IOP lowering achieved is inferior to that of trabeculectomy. To select a special glaucoma surgical procedure, the individual target pressure for the respective patient has to be defined. Recent large randomised prospective studies have shown that a low target pressure is needed to preserve and stabilise the visual field in advanced cases. Glaucoma filtration surgery is an important mainstay of advanced glaucoma treatment.
青光眼手术方式的选择主要取决于青光眼的类型。滤过性手术（小梁切除术）被认为是最常见的青光眼类型——原发性开角型青光眼的金标准。在过去几年中，手术技术不断改进，减少了诸如浅前房、脉络膜脱离和低眼压等术后早期并发症。目前青光眼手术的主要问题是伤口愈合导致流出区域瘢痕形成。通过在手术时和术后护理中使用抗代谢药物加强术后护理，可以处理许多瘢痕形成问题。使用强化术后护理可使绝对成功率翻倍。非穿透性手术如深层巩膜切除术或小梁切开术是有效的；然而，降低眼压的程度不如小梁切除术。要选择一种特殊的青光眼手术方法，必须为各个患者确定个体目标眼压。最近的大型随机前瞻性研究表明，在晚期病例中需要较低的目标眼压来保存和稳定视野。青光眼滤过手术是晚期青光眼治疗的重要支柱。
