Tanito Masaki, Ohtani Hinako, Ida Chisako, Murakami Kana, Iida Mizuki, Takagi Keigo, Harano Akiko, Sugihara Kazunobu, Kaidzu Sachiko
Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2024 Dec 17;16(12):e75899. doi: 10.7759/cureus.75899. eCollection 2024 Dec.
We report three cases demonstrating the efficacy and versatility of the micro-incision scleral tunnel (MIST) technique, a novel method for Ahmed glaucoma valve (AGV) tube insertion. MIST is characterized by its small incision, sutureless approach, anterior-to-posterior tunnel creation, and allograft-free design. The technique involves creating a scleral tunnel using a 1-mm crescent knife (Bleb Knife II), allowing for secure tube placement into the anterior chamber, ciliary sulcus, or vitreous cavity. Case 1 involved a male patient in his 70s with primary angle-closure glaucoma, where the tube was inserted into the vitreous cavity. Pars plana vitrectomy was combined, achieving an intraocular pressure (IOP) of 6 mmHg without medication at three months postoperatively. Case 2 described a male patient in his 70s with secondary angle-closure glaucoma due to iridocyclitis, where the tube was inserted into the ciliary sulcus. Postoperatively, the IOP was reduced to 7 mmHg without medication at three months. Case 3 was a male patient in his teens with Axenfeld-Rieger syndrome-associated glaucoma, who underwent anterior chamber tube insertion, achieving an IOP of 8 mmHg with two medications at eight months postoperatively. In addition, postoperative anterior segment findings for the other two cases were presented. These cases demonstrate that MIST simplifies surgical procedures, eliminates the need for suturing, and achieves effective IOP control. The flexibility and promising outcomes of MIST suggest its potential as an alternative technique for tube insertion in allograft-free glaucoma tube shunt surgeries.
我们报告了三例病例，展示了微切口巩膜隧道（MIST）技术的有效性和多功能性，这是一种用于艾哈迈德青光眼阀（AGV）植入管插入的新方法。MIST的特点是切口小、无需缝合、从前向后创建隧道以及无同种异体移植设计。该技术包括使用1毫米新月形刀（Bleb Knife II）创建巩膜隧道，以便将植入管安全地放置在前房、睫状沟或玻璃体腔中。病例1涉及一名70多岁的男性原发性闭角型青光眼患者，植入管插入玻璃体腔。联合进行了玻璃体切割术，术后三个月未用药时眼压为6 mmHg。病例2描述了一名70多岁的男性因虹膜睫状体炎导致继发性闭角型青光眼患者，植入管插入睫状沟。术后三个月未用药时眼压降至7 mmHg。病例3是一名十几岁的患有Axenfeld-Rieger综合征相关性青光眼的男性患者，接受了前房植入管插入术，术后八个月使用两种药物时眼压为8 mmHg。此外，还展示了其他两例病例的术后眼前节检查结果。这些病例表明，MIST简化了手术操作，无需缝合，并实现了有效的眼压控制。MIST的灵活性和良好结果表明其有可能成为无同种异体移植青光眼植入管分流手术中植入管插入的替代技术。
