重视原发性开角型青光眼Schlemm管相关手术降眼压机制的研究

Pay attention to the mechanism of intraocular pressure lowering in Schlemm related surgery for primary open angle glaucoma

青光眼的治疗方法主要包括药物治疗、激光治疗及手术治疗三种。其中,手术治疗主要包括周边虹膜切除术与滤过性手术。原发性开角型青光眼(POAG)患者房水流出受阻于小梁网-Schlemm管系统,故对小梁网-Schlemm管的治疗是治疗POAG的关键。在治疗POAG的手术方式中,滤过性手术始终占据着重要的位置。在滤过性手术中,与Schlemm管相关的手术主要分为两类,一类是能够引导、帮助房水流入Schlemm管或减少房水流入阻力的手术,如小梁切开术、小梁消融术、Glaukos i Stent微支架植入术及激光选择性小梁成形术等;另一类是恢复、重建Schlemm管形态的手术,如Schlemm管成形术及Schlemm管扩张术等。本文中笔者对上述各手术方式的原理、方法、效果及最新研究进展进行评述。

The treatment of glaucoma mainly includes drug therapy, laser treatment and surgical treatment, three of which mainly include peripheral iridectomy and filtering surgery. Primary open-angle glaucoma （POAG） aqueous outflow blocked by irradiating-Schlemm system, therefore, the trabecular meshwork of-Schlemm tube system treatment is the key to the treatment of POAG. In the treatment of POAG, filtering surgery has always played an important role. Filtration surgery, and Sehlemm related operation is mainly divided into two categories, one is to guide and help the real water flow into the Schlemm tube or reduce the resistance of water flow into the real operation, such as trabeculectomy, trabecular ablation, Glaukos iStent micro stent implantation and selective laser trabeculoplasty; on the other one is the restoration and reconstruction of Sehlemm canal operation, such as Schlemm tube and Schlemm tube dilatation angioplasty etc. In this paper, the principle, method, effect and latest research progress of the above operations are reviewed.