Costagliola Ciro, Sbordone Mario, Gandolfi Stefano, Cesari Luca, Furneri Gianluca, Fea Antonio Maria
Department of Medicine & Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
Ophthalmology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy.
Clin Ophthalmol. 2020 Sep 14;14:2639-2655. doi: 10.2147/OPTH.S264839. eCollection 2020.
Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.
药物治疗是大多数青光眼患者的首选治疗方法；然而，在相当一部分患者中，需要通过联合治疗和/或高治疗剂量才能降低眼压（IOP）。当药物治疗无效或无法耐受时，传统手术是药物治疗的标准替代方法。最近，选择性激光小梁成形术（SLT）已被提倡作为一线治疗方法，并且“微创青光眼手术”（MIGS）已被开发出来，作为对青光眼患者更安全、创伤更小的手术干预措施。施莱姆管手术已成为需要进行白内障手术的青光眼患者中风险效益比最有利的方法之一。然而，尽管取得了令人鼓舞的结果，但MIGS在意大利的使用极低。我们旨在调查意大利基于施莱姆管的MIGS设备使用低于预期的原因，分享我们对其在治疗中潜在地位的看法，并提出改善青光眼患者管理的实用建议。
