Voykov Bogomil, Prokosch Verena, Lübke Jan
University Eye Hospital, University Clinic Tuebingen; Department of Ophthalmology, University Hospital Cologne; Eye Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Dtsch Arztebl Int. 2025 Jan 10;122(1):23-30. doi: 10.3238/arztebl.m2024.0240.
Approximately 1.4 % of the German population aged 35 to 74 suffers from glaucoma, which is one of the more common causes of blindness. The only evidence-based treatment option at present is lowering the intraocular pressure. Modern minimally invasive surgical procedures hold out the prospect of lowering the intraocular pressure without the risk of serious complications.
This is a selective review of pertinent publications retrieved by a search in PubMed, including randomized, controlled trials and meta-analyses.
The intraocular pressure can be lowered with eyedrops, laser procedures, and surgery. Trabeculectomy is the reference standard in glaucoma surgery but leads to complications in 3-15% of cases. In minimally invasive glaucoma surgery, very small stents can be implanted to lower the intraocular pressure. These proce - dures have a better safety profile but are only indicated for mild or moderate glaucoma. The Kahook Dual Blade, iStent inject, and Hydrus Microshunt procedures have been studied in randomized, controlled trials. An additional pressure-lowering effect beyond that of cataract surgery was demonstrated only for the latter two procedures (1.9 mmHg and 1.8 mmHg, respectively). Other procedures have only been investigated in cohort studies to date; a pressure-lowering effect was found for some of them. Moreover, iStent and Hydrus Microshunt have been found to slow the progression of visual field defects.
There are robust data documenting the effect of iStent and Hydrus Microshunt in lowering the intraocular pressure and lessening the need for eyedrops. High-quality controlled trials are still needed to test the efficacy of other procedures.
在德国35至74岁的人群中，约1.4%患有青光眼，这是导致失明的较常见原因之一。目前唯一基于证据的治疗选择是降低眼压。现代微创手术有望在不产生严重并发症风险的情况下降低眼压。
这是一项对通过在PubMed中检索获得的相关出版物的选择性综述，包括随机对照试验和荟萃分析。
眼压可以通过眼药水、激光手术和外科手术降低。小梁切除术是青光眼手术的参考标准，但在3%至15%的病例中会导致并发症。在微创青光眼手术中，可以植入非常小的支架来降低眼压。这些手术具有更好的安全性，但仅适用于轻度或中度青光眼。Kahook双刃刀、iStent注射和Hydrus微分流手术已在随机对照试验中进行了研究。仅后两种手术（分别为1.9 mmHg和1.8 mmHg）显示出超出白内障手术的额外降压效果。其他手术迄今为止仅在队列研究中进行了调查；其中一些手术发现有降压效果。此外，已发现iStent和Hydrus微分流可减缓视野缺损的进展。
有确凿数据证明iStent和Hydrus微分流在降低眼压和减少眼药水使用需求方面的效果。仍需要高质量的对照试验来测试其他手术的疗效。
