Glaucoma Surgery

多种青光眼手术

Kang KD院长是国内青光眼学术团体韩国青光眼学会的青光眼专科医师,施行专业、安全的青光眼手术。

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YTN science播出画面:三大致盲原因之一“闭角型青光眼”的误解

* YTN science播出画面:三大致盲原因之一“闭角型青光眼”的误解

Jalboneun Seongmo眼科多种青光眼手术

Kang KD院长是国内青光眼学术团体韩国青光眼学会的青光眼专科医师,施行专业、安全的青光眼手术。

Ahmed阀植入术

Ahmed阀植入术是为难治性青光眼治疗而植入可调节眼压的房水引流装置的手术,术后引起眼压下降,从而防止视神经受损。

青光眼的手术治疗在发病时间较短、眼结构变形形成之前施行时,据认为效果较大。

Baerveldt tube植入6个月后裂隙灯照片(Figure 3)

* Figure 2. (A) Slit-⁠lamp photograph demonstrating punctate epithelial erosions of the cornea adjacent to the bleb. (B, C) Slit-⁠lamp photograph of the left eye. Note a large superior filtering bleb with a high profile. / Figure 3. Slit-⁠lamp photograph taken 6 month after Baerveldt tube implantation. Patient was symptom free and the intraocular pressure was satisfactorily maintained.

小梁切除术

这是降低眼压的传统青光眼手术。眼内生成的房水经起排水作用的小梁网流出;当小梁网无法发挥功能、房水不能排出而导致眼压升高时,通过手术切除部分小梁网,重新打通房水流出通道。

微创手术

制作通路使眼内房水能够排出以降低眼压。既往手术切口较大,术后恢复时间长,并有视力下降、低眼压、结膜渗漏、感染、白内障等术后并发症。为减少这些并发症而发展的手术方法是微创手术。

微创手术是尽量减少眼表损伤的手术。因角膜切口小,患者几乎无异物感,与既往手术相比并发症较少、恢复期较短。

也可与白内障手术一并施行,手术次数无限制,并具有可较快恢复日常生活的优点。

微创手术成功率有限,应与专家商量后选择。

国内iStent与iStent Inject白内障联合手术成功率比较及预后因素分析(Short-term Outcomes and Prognostic Factors of Cataract-combined Surgery with iStent versus iStent Inject) — Gong YS、Hwang HB、Kang KD、Kim YC,天主教大学医学院眼科,大韩眼科学会杂志 2021年第62卷第9号(Original Article)

Purpose: To analyze the therapeutic effects, prognostic factors, and complications that occurred after iStent® or iStent inject® implantation in South Korean glaucoma patients. Methods: We retrospectively analyzed 42 eyes of South Korean glaucoma patients, who were followed-up for more than 6 months after iStent® or iStent inject® implantation alone or combined with cataract surgery. Surgical success was defined as an intraocular pressure (IOP) ≤21 mmHg and an IOP reduction ≥20% from preoperative IOP levels. Results: The cumulative success rate at 6 months after surgery was 45.3 ± 8.1% for iStent inject® alone (group A), 28.6 ± 13.1% for iStent® alone (group B), 81.2 ± 6.8% for iStent inject® combined with cataract surgery (group A-1), and 27.3 ± 21.8% for iStent® combined with cataract surgery (group B-1). Group A-1 showed a higher success rate than group B-1 (p = 0.007); the difference in success rates between groups A and B was not statistically significant (p = 0.579). When the success prognostic factors were analyzed by Cox regression analysis, the results showed that a higher preoperative IOP was associated with a higher surgical success rate (hazard ratio 0.80, p = 0.02). Conclusions: In our patient group, iStent inject® was more effective than iStent® in combination with cataract surgery. The higher the preoperative IOP, the higher the surgical success rate; the results were significant. J Korean Ophthalmol Soc 2021;62(9):1243-1251. Keywords: Glaucoma, Intraocular pressure, iStent inject, Micro-invasive glaucoma surgery

激光治疗

仅用眼药水难以控制眼压时,用激光改变眼球结构以降低眼压。

为降低升高的眼压,对眼球房水排出通路照射激光以增加房水流出量。仅用药物治疗无法降低眼压,或因眼内房水循环通路阻塞而发生闭角型青光眼时,进行激光治疗。

激光治疗可不影响正常组织,因此恢复较快、副作用较少。治疗后可能出现暂时性眼压升高、疼痛或异物感,但短期内会恢复。若激光治疗后眼压仍未充分下降,也可施行手术。