关注内引流与外引流微创青光眼手术的合理选用

Rational selection between internal and external drainage approaches for microinvasive/minimally invasive glaucoma surgery in intraocular pressure control

青光眼是不可逆性致盲眼病的首要原因,原发性开角型青光眼是其中的主要类型,其致病机制复杂,但降眼压仍是目前公认的最有效治疗手段。主流的抗青光眼手术是通过增加房水引流达到降低眼压的效果。近二十年来,微创/微小切口抗青光眼手术(MIGS)逐渐成为青光眼手术的热点,国内也逐步开展相关术式,但临床效果并非完全理想。建议眼科医师应在充分理解房水流出路径的解剖、病理生理学特点和各种MIGS手术方式设计原理的基础上,了解各术式的优势和局限性,合理选择内引流和外引流MIGS,规范化开展微创青光眼手术。期待未来能利用无创的多模式影像学手段协助术前评估术眼的结构和功能,为患者个体化选择和规划治疗方式,实现青光眼的精准治疗。

Glaucoma stands as the leading cause of irreversible blindness,with primary open-angle glaucoma being the predominant type.Although its pathogenic mechanisms are intricate,lowering intraocular pressure remains the most effective treatment.Mainstream glaucoma surgeries aim to lower intraocular pressure by increasing aqueous humor outflow.Over the past two decades,microinvasive/minimally invasive glaucoma surgery(MIGS)has emerged as a hotspot in this field,focusing on minimizing incisions.Domestic practices have followed closely,but clinical outcomes have not been ideal.Based on a comprehensive understanding of the anatomy and pathophysiology of the aqueous outflow pathway and the design principles of various MIGS procedures,ophthalmologists should recognize the advantages and limitations of each technique.It is important to rationally choose between internal and external drainage MIGS and standardize their implementation.In the future,the use of non-invasive multimodal imaging techniques for preoperative assessment of the structural and functional aspects of the eye is expected to facilitate personalized selection and planning for precise treatment.