Schlemm管手术是否适用于原发性闭角型青光眼的治疗

Is Schlemm canal surgery suitable for primary angle-closure glaucoma?

原发性闭角型青光眼(PACG)是亚洲人群常见的青光眼类型,致盲率高,小梁切除术是其主要的手术治疗方式,但并发症较多。近年来,不依赖于滤过泡的青光眼微创手术治疗PACG逐渐引起研究者的关注。其中Schlemm管手术通过对Schlemm管的扩张、成形或切开,解决Schlemm管和小梁网功能障碍,重新开放房水引流通道,达到降低眼压的目的,既往多用于原发性开角型青光眼(POAG)的治疗。然而,基于PACG的发病机制及其与POAG有共同的病理机制,Schlemm管手术是否可用于PACG的治疗引起了较多的争议。既往已有一些回顾性研究或前瞻性单臂研究表明,各类Schlemm管手术联合白内障摘出和房角分离术在PACG治疗中显示出良好的效果,相关高质量、高循证等级的临床随机对照试验有望为PACG的治疗方式带来革新。

Primary angle-closure glaucoma(PACG)is a common subtype of glaucoma and one of the leading causes of blindness in Asia.Trabeculectomy has been recognized as an effective filtering surgery for PACG and is widely used in clinical practice,but its high risk of postoperative complications,especially bleb scarring over time can not be ignored.Nowadays,non-bleb-based minimally invasive glaucoma surgeries(MIGS)have attracted much attention.Surgeries opening,restoring,or expanding Schlemm canal to reconstruct aqueous humor outflow pathway is one of the MIGS and able to achieve moderate intraocular pressure(IOP)reduction,which has been widely used in the treatment of primary open-angle glaucoma(POAG)for a long time.However,based on the pathogenesis of PACG and its similar pathological changes in Schlemm canal to POAG,some retrospective studies and prospective single-arm studies discovered that Schlemm canal surgery combined with phacoemulsification and/or goniosynechialysis appears to lower IOP well and safe in PACG eyes in recent years.Whether Schlemm canal surgery is also suitable or effective for PACG is getting some attention and is still controversial up to now,mostly due to some differences in pathogenesis between PACG and POAG,it is necessary to perform randomized controlled trials to confirm the efficacy of Schlemm canal surgery for PACG and upgrade the therapeutic strategy of PACG.