Francis Brian A, Akil Handan, Bert Benjamin B
Dev Ophthalmol. 2017;59:127-146. doi: 10.1159/000458492. Epub 2017 Apr 25.
In primary open-angle glaucoma, the site of greatest resistance to aqueous outflow is thought to be the trabecular meshwork (TM) and inner wall of Schlemm's canal. Augmentation of the conventional (trabecular) outflow pathway can facilitate physiologic outflow and subsequently lower intraocular pressure. The most recent approach to enhancing the conventional outflow pathway is via an internal approach to the TM and Schlemm's canal. Ab interno Schlemm's canal surgery includes 4 novel surgical approaches: (1) removal of the TM and inner wall of Schlemm's canal by an internal approach (ab interno trabeculectomy), (2) implantation of a microstent to bypass the TM, (3) disruption of the TM and inner wall of Schlemm's canal via an internal approach (ab interno trabeculotomy), and (4) dilation of Schlemm's canal via an internal approach (ab interno canaloplasty). The first category includes the Trabectome (Neomedix, Tustin, CA, USA), and Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA, USA). The second category includes the iStent (Glaukos, Laguna Hills, CA, USA), as well as the investigational Hydrus Microstent implant (Ivantis, Irvine, CA, USA). The third category includes gonioscopic-assisted transluminal trabeculotomy (iSciences catheter; Ellex, Adelaide, Australia), and 360° suture trabeculotomy (TRAB360, Sight Sciences, Menlo Park, CA, USA). The fourth category includes ab interno canaloplasty or AbiC (Ellex), and Visco360 (Sight Sciences). In contrast to external filtration surgeries, such as trabeculectomy and aqueous tube shunt, these procedures are categorized as internal filtration surgeries and are performed from an internal approach via gonioscopic guidance. Published results suggest that these surgical procedures are both safe and efficacious for the treatment of open-angle glaucoma.
在原发性开角型青光眼中，房水流出阻力最大的部位被认为是小梁网（TM）和施莱姆管内壁。增强传统（小梁）流出途径可促进生理性房水流出，进而降低眼压。增强传统流出途径的最新方法是通过进入TM和施莱姆管的内路方法。内路施莱姆管手术包括4种新的手术方法：（1）通过内路方法切除TM和施莱姆管内壁（内路小梁切除术），（2）植入微支架以绕过TM，（3）通过内路方法破坏TM和施莱姆管内壁（内路小梁切开术），以及（4）通过内路方法扩张施莱姆管（内路管成形术）。第一类包括Trabectome（美国加利福尼亚州图斯廷市的Neomedix公司）和Kahook双刃刀（美国加利福尼亚州兰乔库卡蒙加市的New World Medical公司）。第二类包括iStent（美国加利福尼亚州拉古纳希尔斯市的Glaukos公司），以及正在研究的Hydrus微支架植入物（美国加利福尼亚州欧文市的Ivantis公司）。第三类包括前房角镜辅助经腔小梁切开术（iSciences导管；澳大利亚阿德莱德市的Ellex公司）和360°缝线小梁切开术（TRAB360，美国加利福尼亚州门洛帕克市的Sight Sciences公司）。第四类包括内路管成形术或AbiC（Ellex公司）和Visco360（Sight Sciences公司）。与小梁切除术和房水引流管分流术等外路滤过手术不同，这些手术被归类为内路滤过手术，通过前房角镜引导从内路进行。已发表的结果表明，这些手术方法对于治疗开角型青光眼既安全又有效。
