Welsh N H, DeLange J, Wasserman P, Ziémba S L
Department of Ophthalmology, University Witwaterstrand, Johannesburg, Republic of South Africa.
Ophthalmic Surg Lasers. 1998 Mar;29(3):216-26.
A preliminary study was conducted to examine a new surgical approach for the management of patients with open-angle glaucoma in which Schlemm's canal is opened to restore drainage in a nonpenetrating fashion. The authors compared the results of the surgical procedure including the new glaucoma drainage device with the results of standard trabeculectomy.
The authors performed a new type of surgical procedure on 58 consecutive patients with open-angle glaucoma. The procedure entails "deroofing" Schlemm's canal to facilitate the drainage of aqueous without penetrating the eye. This is done by exposing the canal after a partial-thickness sclerectomy and keratectomy along a 5-mm arc. After the canal was deroofed, a new type of collagen glaucoma drainage device was placed in the surgical site to maintain drainage postoperatively. Patient data, including intraocular pressure (IOP), complications, and the number of medications required to maintain adequate pressures, were analyzed for 1 year postoperatively.
Within 1 to 2 months postoperatively, 80.9% of the patients achieved an IOP lower than 21 mm Hg. This improved to 88.9% at 3 to 6 months postoperatively and 87.5% at 6 to 12 months postoperatively. The only major complications were microperforations (8.6%) related to surgical technique and a few cases of high IOP that required repeat operations (10.3%).
The nonpenetrating technique for deroofing the canal effectively allows the drainage of aqueous to acceptable levels (in the range of 15 to 17 mm Hg) without the complications associated with penetrating trabeculectomy. Complications are rare, and the collagen drainage device appears to be effective for allowing the drainage site to remain patent after its dissolution.
开展了一项初步研究，以检验一种治疗开角型青光眼患者的新手术方法，该方法通过非穿透方式打开施莱姆管以恢复引流。作者将包括新型青光眼引流装置的手术结果与标准小梁切除术的结果进行了比较。
作者对58例连续的开角型青光眼患者实施了一种新型手术。该手术需要“掀开”施莱姆管以促进房水引流而不穿透眼球。这是通过沿5毫米弧线进行部分厚度的巩膜切除术和角膜切除术来暴露该管后完成的。在掀开管后，将一种新型胶原青光眼引流装置放置在手术部位以维持术后引流。对患者术后1年的数据进行了分析，包括眼压（IOP）、并发症以及维持适当眼压所需的药物数量。
术后1至2个月内，80.9%的患者眼压降至21毫米汞柱以下。术后3至6个月时这一比例提高到88.9%，术后6至12个月时为87.5%。仅有的主要并发症是与手术技术相关的微小穿孔（8.6%）以及少数需要再次手术的高眼压病例（10.3%）。
非穿透性掀开施莱姆管的技术有效地使房水引流至可接受水平（15至17毫米汞柱范围内），且无穿透性小梁切除术相关的并发症。并发症罕见，并且胶原引流装置在溶解后似乎能有效地使引流部位保持通畅。
