Petrov S Yu, Vostrukhin S V, Aslamazova A E, Sherstneva L V
Research Institute of Eye Diseases, 11 A, B Rossolimo St., Moscow, Russian Federation, 119021.
I.M. Sechenov First Moscow State Medical University, Ophthalmology Department, 8-2 Trubetskaya St., Moscow, Russian Federation, 119991.
Vestn Oftalmol. 2016;132(3):96-102. doi: 10.17116/oftalma2016132396-102.
Over the years, glaucoma surgery has improved from iridectomy by A. Graefe and traumatizing procedures performed without magnification tools or microsurgical instrument to high-technology interventions that are not only microscopic, but also pathogenetically oriented. Various modifications of trabeculectomy, initially introduced by J. Cairns back in 1968, had been the gold standard for several decades and were notable for pronounced and stable hypotensive effects. However, there was also a strong association with such complications as choroidal detachment and hyphema, thus, boosting the development of so called nonfistulizing surgeries. Of the latter, the most widely used are non-penetrating procedures, including deep sclerectomy and viscocanalostomy. Although very safe, they appear unable to produce a truly long-lasting hypotensive effect. Moreover, just as fistulizing trabeculectomy, non-penetrating procedures damage the limbus and adjacent conjunctiva reducing the possibility of a second intervention. This fact together with other drawbacks mentioned above, on the one hand, and technical progress, on the other, were essential prerequisites for the appearance of a new type of surgery - minimally invasive glaucoma surgery (MIGS). Parameters that should be met for a procedure to be considered minimally invasive are debated. The main requirement has, however, been established: ab interno approach through a corneal incision. As surgical tools are enhanced and new techniques arise, options for glaucoma treatment widen greatly, ensuring our future move to higher level standards in the field. This review contains all recent data on minimally invasive techniques currently in use in glaucoma surgery or those under investigation. The authors have also analyzed effectiveness reports and present their conclusions regarding the current state of MIGS worldwide.
多年来，青光眼手术已从A. 格雷费（A. Graefe）实施的虹膜切除术以及在没有放大工具或显微手术器械的情况下进行的创伤性手术，发展到不仅是显微手术，而且是针对发病机制的高科技干预手段。1968年J. 凯恩斯（J. Cairns）首次引入的小梁切除术的各种改良术式，在几十年里一直是金标准，以显著且稳定的降压效果而闻名。然而，它也与脉络膜脱离和前房积血等并发症密切相关，因此推动了所谓的非造瘘手术的发展。在后者中，使用最广泛的是非穿透性手术，包括深层巩膜切除术和粘小管成形术。虽然非常安全，但它们似乎无法产生真正持久的降压效果。此外，与造瘘性小梁切除术一样，非穿透性手术会损伤角膜缘和相邻的结膜，降低二次干预的可能性。一方面，这一事实连同上述其他缺点，另一方面，技术进步，是新型手术——微创青光眼手术（MIGS）出现的重要先决条件。对于一种手术被认为是微创的应满足的参数存在争议。然而，主要要求已经确定：通过角膜切口进行内路手术。随着手术工具的改进和新技术的出现，青光眼治疗的选择大大拓宽，确保我们未来朝着该领域更高水平的标准迈进。这篇综述包含了目前在青光眼手术中使用或正在研究的微创技术的所有最新数据。作者还分析了有效性报告，并就全球MIGS的现状给出了他们的结论。
