Nguyen Quang H
Glaucoma Service, Division of Ophthalmology, Scripps Clinic, La Jolla, California, USA.
Curr Opin Ophthalmol. 2009 Mar;20(2):122-5. doi: 10.1097/ICU.0b013e32831da828.
Glaucoma drainage implants have an increasing role in the surgical management of glaucoma. Traditionally, trabeculectomy is usually recommended to patients as the initial surgery of choice and glaucoma drainage implant is reserved for patients with high risk of failure for filtering surgery. There is a lack of consensus among glaucoma surgeons regarding the use of tube shunts or trabeculectomy.
The role of glaucoma drainage implants has historically been limited to refractory glaucoma. Peer review publications in recent years suggest that glaucoma drainage implants may have similar efficacy as well as safety profile compared to trabeculectomy with antimetabolites. The tube versus trabeculectomy demonstrated similar intraocular pressure reduction at 1 year of follow-up. Because glaucoma drainage implant is usually offered at the refractory stage, the limited success rate of glaucoma drainage implant in terms of intraocular pressure lowering effect compared to trabeculectomy has been in the mindset of many glaucoma surgeons. If glaucoma drainage implant was offered as the initial procedure, the success rate may be different in terms of intraocular pressure control.
Glaucoma drainage implants should have expanding role in the surgical treatment of glaucoma.
青光眼引流植入物在青光眼手术治疗中的作用日益增加。传统上,小梁切除术通常被推荐为患者的首选初始手术,而青光眼引流植入物则用于滤过手术失败风险高的患者。青光眼外科医生在使用引流管分流术或小梁切除术方面缺乏共识。
青光眼引流植入物的作用历来局限于难治性青光眼。近年来的同行评审出版物表明,与使用抗代谢药物的小梁切除术相比,青光眼引流植入物可能具有相似的疗效和安全性。在随访1年时,引流管与小梁切除术降低眼压的效果相似。由于青光眼引流植入物通常在难治阶段使用,与小梁切除术相比,其在降低眼压效果方面的成功率有限,这已成为许多青光眼外科医生的固有观念。如果将青光眼引流植入物作为初始手术,在眼压控制方面的成功率可能会有所不同。
青光眼引流植入物在青光眼手术治疗中的作用应不断扩大。