Servicio de Oftalmología, Hospital Clínico San Carlos; IdISSC, Madrid, Spain.
Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
Adv Ther. 2022 Sep;39(9):3916-3932. doi: 10.1007/s12325-022-02230-1. Epub 2022 Jul 7.
The surgical management of glaucoma has been revolutionized by the introduction of minimally invasive glaucoma surgery (MIGS). The various MIGS options aim to meaningfully lower intraocular pressure with a better safety profile than traditional glaucoma surgery. The key clinical attributes and the emerging potential of an ab externo MicroShunt (PreserFlo™) are reviewed in the context of published evidence and clinical experience. This novel MicroShunt consists of an 8.5-mm-long tube that is implanted in the eye via an ab externo approach enabling aqueous humor drainage into the sub-Tenon's space through the formation of a bleb, similar in appearance to that created by trabeculectomy. The efficacy and safety of this procedure, the concomitant use of antimetabolites, the impact of tube positioning, and its future value in clinical practice are critically reviewed. Recent evidence has demonstrated the MicroShunt to be less effective than traditional filtration surgery, but with a significant improvement in safety. Cumulative data suggest that the new implant provides tangible clinical benefits to selected patients with glaucoma in need of further intraocular pressure (IOP) lowering. Future research should delineate the precise role of this and other MIGS options in the rapidly evolving glaucoma treatment algorithm.
微创青光眼手术 (MIGS) 的引入彻底改变了青光眼的手术治疗方式。各种 MIGS 方案旨在通过比传统青光眼手术更安全的方式显著降低眼内压。本文结合现有证据和临床经验，对一种新型经外路引流微管（PreserFlo™）的临床特点和潜在应用前景进行了综述。该新型微管长 8.5mm，通过经外路植入眼球，使房水通过形成的滤过泡引流至眼外肌与巩膜之间的潜在腔隙，外观类似于小梁切除术所形成的滤过泡。本文对该手术的疗效和安全性、抗代谢药物的联合应用、引流管位置的影响，以及其在临床实践中的未来价值进行了批判性评估。近期的研究证据表明，与传统的滤过性手术相比，微管的疗效较低，但安全性显著提高。累积数据表明，对于需要进一步降低眼内压（IOP）的特定青光眼患者，这种新型植入物具有明显的临床获益。未来的研究应明确这种植入物和其他 MIGS 方案在快速发展的青光眼治疗方案中的确切作用。
