Konopińska Joanna, Lewczuk Katarzyna, Jabłońska Joanna, Mariak Zofia, Rękas Marek
Department of Ophthalmology, Medical University of Bialystok, Białystok, Poland.
Department of Ophthalmology, Military Institute of Medicine, Warsaw, Poland.
Clin Ophthalmol. 2021 Mar 11;15:1109-1118. doi: 10.2147/OPTH.S293702. eCollection 2021.
Microinvasive glaucoma surgery has gained popularity over the past decade. It can be performed using three different mechanisms. In the present review, we focused on Schlemm's canal (SC)-based surgery, which increases aqueous humor (AH) outflow into the aqueous veins by either removal of the trabecular meshwork (TM) or an increase in the tension in the TM. In primary open-angle glaucoma (POAG), the TM is the most likely region for increased AH outflow resistance. Theoretically, removal of the TM can improve the AH outflow; hence, glaucoma specialists focus on microsurgical dissection of the TM. In this review, we analyzed the available literature to examine SC-related microsurgical modalities based on the histopathological proofs of the localization of resistance of the AH outflow. First, we considered the role, anatomy, and physiology of the TM and SC. We referred to studies that describe the mechanisms and potential pathways, related to increased intraocular pressure in the POAG, that are targeted using the SC-related microsurgical interventions. Next, we took a closer look at the gonioscopic tools necessary for an ab-interno approach and explored incision canal surgery: ab-interno trabeculectomy using different instrumentation (Trabectome, Kahook Dual Blade) and variations of the technique. Thereafter, we discussed ab-interno canaloplasty, explaining the technique and reviewing its effectiveness. Finally, we presented the scope for future research in the field. Although the iStent also targets SC by bypassing it, this device has been reviewed extensively elsewhere.
在过去十年中，微创青光眼手术越来越受欢迎。它可以通过三种不同的机制来实施。在本综述中，我们重点关注基于施莱姆管（SC）的手术，该手术通过去除小梁网（TM）或增加小梁网的张力来增加房水（AH）流入房水静脉。在原发性开角型青光眼（POAG）中，小梁网是房水流出阻力增加最可能的部位。理论上，去除小梁网可以改善房水流出；因此，青光眼专家专注于小梁网的显微手术解剖。在本综述中，我们分析了现有文献，以根据房水流出阻力定位的组织病理学证据来研究与施莱姆管相关的显微手术方式。首先，我们考虑了小梁网和施莱姆管的作用、解剖结构和生理学。我们参考了描述与POAG眼压升高相关的机制和潜在途径的研究，这些途径是使用与施莱姆管相关的显微手术干预措施的目标。接下来，我们仔细研究了内路手术所需的前房角镜工具，并探讨了切开管手术：使用不同器械（Trabectome、Kahook双刀）的内路小梁切除术及该技术的变体。此后，我们讨论了内路管成形术，解释了该技术并回顾了其有效性。最后，我们介绍了该领域未来研究的范围。尽管iStent也通过绕过施莱姆管来靶向它，但该装置已在其他地方得到广泛综述。
