Campos M, Lee P P, Trokel S L, Taylor H R, McDonnell P J
Doheny Eye Institute, University of Southern California, Los Angeles, USA.
Acta Ophthalmol (Copenh). 1994 Dec;72(6):707-11. doi: 10.1111/j.1755-3768.1994.tb04685.x.
Successful surgical management of glaucoma is limited as a consequence of undesired fibroblastic response of episcleral tissues. In 10 rabbit and three human eye bank eyes, we have performed a modified sinusotomy procedure using the 193-nm excimer laser. The technique is minimally invasive. Conjunctiva is pulled over the corneoscleral limbus, and a slit-shaped (1 x 2 mm) excimer beam ablates through conjunctiva and external sclera until penetrating the outer wall of Schlemm's canal, at which time brisk egress of fluid is noted. The conjunctiva is allowed to retract, and a conjunctival bleb is formed. A single suture is used to close the conjunctival defect. Intraocular pressure in the rabbit eye was decreased from 10.0 +/- 1.8 to 4.9 +/- 1.8 mmHg immediately after surgery (p < 0.0001). Histology revealed a partial thickness, smooth-walled ablation consistent with a sinusotomy. This procedure is minimally invasive and may be useful for management of glaucoma, particularly when a substantial component of the impediment to aqueous outflow is external to the trabecular meshwork.
由于巩膜组织出现不期望的成纤维细胞反应，青光眼的成功手术治疗受到限制。在10只兔眼和3只人眼库供体眼上，我们使用193纳米准分子激光进行了改良的鼻窦切开术。该技术具有微创性。将结膜拉至角巩膜缘上方，用狭缝状（1×2毫米）准分子激光束穿过结膜和巩膜外层，直至穿透施莱姆管外壁，此时可见液体快速流出。让结膜回缩，形成结膜下滤过泡。用一根缝线闭合结膜缺损。兔眼术后眼压立即从10.0±1.8毫米汞柱降至4.9±1.8毫米汞柱（p<0.0001）。组织学检查显示为与鼻窦切开术相符的部分厚度、壁光滑的消融。该手术微创，可能对青光眼的治疗有用，尤其是当房水流出受阻的主要部分位于小梁网外部时。
