The Gavin Herbert Eye Institute, University of California, Irvine, CA, USA.
Expert Rev Med Devices. 2010 Sep;7(5):661-6. doi: 10.1586/erd.10.32.
The main goal of surgical glaucoma treatment is to reduce the intraocular pressure. The standard procedure over the past 40 years has been trabeculectomy, first described in 1968. This procedure comes with a very high risk profile, and results in moderate long-term results at best. Tube shunt devices were introduced as an alternate means to divert fluid out of the glaucomatous eye, attempting to improve upon the poor long-term outcomes of trabeculectomy, particularly in refractory cases that had failed attempts at prior glaucoma surgeries. They are currently available in a handful of different designs and have evolved from representing a second- or third-line treatment in refractory cases, to their current standing of accepted first-line surgical intervention for many surgeons. The designs of the aqueous shunts are simple and installation involves straightforward principles of ophthalmic surgery. Recent additions to the literature, as well as the development of the Ex-PRESS Miniature Shunt, are changing the way shunts are employed in the treatment algorithm for surgical glaucoma. The outcomes of these procedures are encouraging, and support their use as first-line surgical options for the treatment of adult and juvenile glaucoma.
手术治疗青光眼的主要目标是降低眼内压。过去 40 年来的标准手术方法是小梁切除术，该手术于 1968 年首次被描述。这种手术方法风险很高，其长期效果最多也只是中等。引流管分流装置被引入作为一种替代方法，将眼内液从青光眼眼中引出，试图改善小梁切除术的不良长期效果，特别是在先前青光眼手术失败的难治性病例中。目前有几种不同的设计，它们已经从难治性病例的二线或三线治疗手段发展到目前许多外科医生认可的一线手术干预手段。水流畅通装置的设计简单，安装遵循眼科手术的基本原则。最近文献中的新增内容以及 Ex-PRESS 微型分流器的发展，正在改变青光眼手术治疗方案中对分流器的使用方式。这些手术的结果令人鼓舞，支持将其作为成人和青少年青光眼的一线手术选择。
