Szurman Peter
Eye Clinic Sulzbach, Knappschaft Hospital Saar, 66280 Sulzbach, Germany.
Klaus Heimann Eye Research Institute (KHERI), 66280 Sulzbach, Germany.
J Clin Med. 2023 Apr 21;12(8):3031. doi: 10.3390/jcm12083031.
For decades, trabeculectomy (TE) was considered the gold standard for surgical treatment of open-angle glaucoma owing to its powerful intraocular pressure (IOP)-lowering potency. However, owing to the invasive nature and high-risk profile of TE, this standard is changing, and minimally invasive procedures are becoming more preferable. In particular, canaloplasty (CP) has been established as a much gentler alternative in everyday life and is under development as a full-fledged replacement. This technique involves probing Schlemm's canal with a microcatheter and inserting a pouch suture that places the trabecular meshwork under permanent tension. It aims to restore the natural outflow pathways of the aqueous humor and is independent of external wound healing. This physiological approach results in a significantly lower complication rate and allows considerably simplified perioperative management. There is now extensive evidence that canaloplasty achieves sufficient pressure reduction as well as a significant reduction in postoperative glaucoma medications. Unlike MIGS procedures, the indication is not only mild to moderate glaucoma; today, even advanced glaucoma benefits from the very low hypotony rate, which largely avoids a wipeout phenomenon. However, approximately half of patients are not completely medication-free after canaloplasty. As a consequence, a number of canaloplasty modifications have been developed with the goal of further enhancing the IOP-lowering effect while avoiding the risk of serious complications. By combining canaloplasty with the newly developed suprachoroidal drainage procedure, the individual improvements in trabecular facility and uveoscleral outflow facility appear to have an additive effect. Thus, for the first time, an IOP-lowering effect comparable to a successful trabeculectomy can be achieved. Other implant modifications also enhance the potential of canaloplasty or offer additional benefits such as the possibility of telemetric IOP self-measurement by the patient. This article reviews the modifications of canaloplasty, which has the potential to become a new gold standard in glaucoma surgery via stepwise refinement.
几十年来，小梁切除术（TE）因其强大的降眼压效力，一直被视为开角型青光眼手术治疗的金标准。然而，由于小梁切除术具有侵入性且风险较高，这一标准正在发生变化，微创手术正变得更受青睐。特别是，睫状体光凝术（CP）已成为日常治疗中一种更为温和的替代方法，并且正在发展成为一种成熟的替代方案。该技术包括用微导管探查施莱姆管，并插入一个袋状缝线，使小梁网处于永久张力之下。其目的是恢复房水的自然流出通道，且与外部伤口愈合无关。这种生理方法导致并发症发生率显著降低，并使围手术期管理大大简化。现在有大量证据表明，睫状体光凝术能实现充分的眼压降低，以及术后青光眼药物使用的显著减少。与微创青光眼手术（MIGS）不同，其适应症不仅包括轻度至中度青光眼；如今，即使是晚期青光眼也能从极低的低眼压发生率中获益，这在很大程度上避免了眼压骤降现象。然而，大约一半的患者在接受睫状体光凝术后并不能完全停用药物。因此，人们开发了一些睫状体光凝术的改良方法，目的是在避免严重并发症风险的同时，进一步增强降眼压效果。通过将睫状体光凝术与新开发的脉络膜上腔引流手术相结合，小梁网功能和葡萄膜巩膜流出功能的个体改善似乎具有相加作用。因此，首次能够实现与成功的小梁切除术相当的降眼压效果。其他植入物改良也增强了睫状体光凝术的潜力，或提供了额外的益处，例如患者可进行眼压遥测自我测量。本文综述了睫状体光凝术的改良方法，通过逐步完善，其有可能成为青光眼手术的新金标准。
