青光眼房水引流装置的研究现状

Development of glaucoma drainage device

青光眼房水引流装置（GDD）植入术是治疗难治性青光眼的有效方法之一。但滤过泡的纤维化一直是导致GDD植入术失败的主要原因，近年来有多数学者致力于从病理组织学角度解释纤维化形成的原因及纤维化对GDD植入术临床疗效的影响。抗代谢药物曾被认为可以抑制滤过泡的纤维化，但近年来的临床试验却对此观点提出了挑战。尽管GDD植入术能够有效地降低难治性青光眼的高眼压，但这种手术也存在较多严重的并发症，如眼内炎、角膜内皮失代偿、低眼压等。针对现有房水引流装置存在的问题，近年来出现了许多新型的引流物和手术方式。眼前节相干光断层扫描技术可以显示GDD植入术后引流管的形态和位置，对术后的治疗有指导意义。另外，新型材料和纳米技术在GDD植入术中的应用，将可能开创引流物植入手术的新时代。

Glaucoma drainage device （GDD） is moderately successful in patients with refractory glaucoma. However, bleb fibrosis appears to be the major cause of long-term GDD failure. In recent years, many researchers tried to explain the cause of fibrosis and its influence on the clinical effects of GDD from histopathological study. It has reported that antifibrotie agents are effective in controlling capsule fibrosis around GDD, but this view has been challenged recently. Although GDD can effectively reduce the intraocular pressure （IOP） in refractory glaucoma, it is associated with many serious complications, such as endophthalmitis, corneal decompensation and hypotony. Because of the disadvantages of GDD, many new implant and modified surgical technique emerged in recent years. The anterior segment OCT is able to visualize the whole outline and the position of the tube, therefore it is useful for guiding the postoperative treatment. Furthermore, the application of novel materials and nanotechnology could open up new avenues for GDD.