Sight Sciences Inc., Menlo Park, California.
North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas.
Curr Opin Ophthalmol. 2020 Mar;31(2):139-146. doi: 10.1097/ICU.0000000000000639.
Most microinvasive glaucoma surgery (MIGS) procedures bypass outflow resistance residing proximally in the trabecular meshwork and inner wall of Schlemm's canal. A novel procedure combining trabeculotomy with viscodilation adds to this by also addressing distal resistance of the canal and collector channel ostia. This review examines the development and evidence for both trabeculotomy and canaloplasty separately and the combination in a single procedure.
Recent aqueous angiography studies have confirmed the segmental nature of outflow through Schlemm's canal highlighting the need to address distal outflow pathway resistance. Combined trabeculotomy and viscodilation ab interno is a novel approach with a new purpose-designed device (OMNI Surgical System) becoming available to surgeons in early 2018. Recent results as both a standalone and combined with cataract procedure demonstrate significant intraocular pressure reductions with an average 41% reduction from baseline in the pseudophakic group.
Targeting both distal as well as proximal points of outflow resistance in the conventional pathway may prove to be a highly efficacious MIGS modality. Additional large prospective studies are currently ongoing to confirm these preliminary results.
大多数微创青光眼手术（MIGS）通过绕过小梁网和施莱姆管内壁近端的流出阻力来进行。一种新型的小梁切开术联合黏弹剂扩张术，通过解决管和收集管口的远端阻力来增加这种效果。这篇综述分别检查了小梁切开术和房水流出通道成形术的发展和证据，以及在单一手术中联合应用的情况。
最近的房水血管造影研究证实了施莱姆管通过的节段性，突出了需要解决远端流出途径阻力的问题。联合小梁切开术和黏弹剂扩张术是一种新的方法，一种新的、专门设计的设备（OMNI 手术系统）于 2018 年初提供给外科医生。最近的研究结果表明，这种方法无论是作为一种独立的方法还是与白内障手术联合应用，都能显著降低眼内压，在无晶状体组中平均降低 41%。
针对传统途径中流出阻力的近端和远端部位可能是一种非常有效的 MIGS 方式。目前正在进行更多的大型前瞻性研究来证实这些初步结果。
