University of Pennsylvania, Philadelphia, Pennsylvania, USA.
University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2018 Jul;191:xxv-xxix. doi: 10.1016/j.ajo.2018.04.009. Epub 2018 Apr 13.
To examine the progress made in glaucoma incisional surgery and determine if there has been sufficient progress to meet the needs of glaucoma patients.
Perspective (literature review).
This is a retrospective assessment of key milestones in the evolution of glaucoma incisional surgery and an evaluation of the risks and the benefits of these procedures. Benefits are defined as effective reduction in intraocular pressure (IOP) and protecting visual function, while risks are defined as safety and complications for our patients. Quality of life is also considered.
Although advances have been made in the last 100 years, the trabeculectomy, a procedure that was described more than 50 years ago, remains the optimal choice for reducing IOP among those patients who require pressures in the teens, who do not respond to medications and prior laser therapy.
Appropriate patient selection, careful attention to surgical technique, and intensive follow-up of patients will optimize the results of a trabeculectomy. Newer procedures must be carefully studied in well-designed clinical trials to determine comparative levels of safety and efficacy to this gold standard. Advances in drug delivery and minimally invasive glaucoma surgery may ultimately produce the best outcome for glaucoma patients in the future.
检查青光眼切口手术的进展情况，并确定是否有足够的进展以满足青光眼患者的需求。
观点（文献回顾）。
这是对青光眼切口手术演变过程中的关键里程碑的回顾性评估，并对这些手术的风险和益处进行评估。益处定义为有效降低眼内压（IOP）和保护视觉功能，而风险则定义为对患者的安全性和并发症。还考虑了生活质量。
尽管在过去的 100 年中取得了进展，但小梁切除术——一种 50 多年前描述的手术——仍然是那些需要眼压在青少年水平、对药物和先前的激光治疗没有反应的患者降低眼压的最佳选择。
适当的患者选择、对手术技术的仔细关注以及对患者的密切随访将优化小梁切除术的结果。新的手术方法必须在精心设计的临床试验中进行仔细研究，以确定与该金标准相比的安全性和疗效水平。药物输送和微创青光眼手术的进步可能会在未来为青光眼患者带来最佳的结果。
