青光眼白内障联合手术方式的选择与进展

Selection and progress of glaucoma combined with cataract surgery

青光眼白内障联合手术方式将不再局限为小梁切除术与白内障超声乳化手术联合的单一模式,新设备和新技术有望进一步提高青光眼手术的安全性和有效性。青光眼白内障联合手术将朝着微创方向发展。尽管目前的青光眼微创手术(MIGS)(如内窥镜下睫状体光凝术、小梁消融术、iStent植入术、Schlemn管成形术、XEN凝胶植入物等)降眼压幅度与传统小梁手术仍不能媲美,但为轻度或中度开角型青光眼患者提供了良好的安全性,降低了青光眼患者对药物的依赖。联合白内障手术其适应证可能扩大到某些闭角型青光眼,尚需在我国开展多中心临床随机对照研究进行探索。未来微创及其他新的青光眼手术联合白内障手术在青光眼患者,尤其是原发性闭角型青光眼中实践和探索,将为我国青光眼合并白内障患者治疗提供新的思路和新的方法。(眼科,2019, 28:81-85)

Glaucoma combined with cataract surgery will no longer be limited to a single mode of trabeculectomy combined with phacoemulsification. New equipment and new technologies are expected to further improve the safety and effectiveness of glaucoma surgery. Glaucoma combined with cataract surgery will develop in a minimally invasive direction. Although the reduction of intraocular pressure(IOP) in glaucoma minimally invasive surgery(MIGS), such as endoscopic cyclophotocoagulation(ECP), trabeculotomy, iStent implantation, Schlemn canaloplasty, XEN gel implant, is not comparable to traditional trabecular surgery, it provides safety for patients with mild or moderate open angle glaucoma, and reduces the dependence of glaucoma patients on drugs. The indications for MICS combined with cataract surgery may be extended to some primary angle-closure glaucoma(PACG). These need to be explored by carring out multi-center clinical randomized controlled trials in China. In future, MIGS and other new glaucoma surgery combined with cataract surgery in glaucoma patients, especially in PACG, will provide new ideas and new methods for the treatment of glaucoma with cataract.