and|AGS2022創新獎獲得者Murray A. Johnstone教授專訪：青光眼診療技術的創新與變革( 二 ) Murray|組織|診療|患者|調節|an

We also find this whole outflow apparatus to be a beautifully organized organ system, highly unified. By connecting what seemingly is disconnected information using clinical studies–for instance, slit lamp, surgical and gonioscopic procedures, and also laboratory studies at the tissue, cellular and sub-cellular level–we are able to find patterns that emerge and explain and predict pulsatile aqueous outflow. Pulsatile aqueous outflow becomes abnormal in glaucoma, and drugs that treat glaucoma.
The outflow drugs that treat glaucoma restore normal pulsatile flow. That is a real clue that we need to be exploring and finding the mechanisms inside the eye that are inducing the pulsatile flow. We have a compressible system of chambers and valves with the trabecular meshwork through the distal pathways experiencing tensile integration. These pathways rapidly change dimensions in response to pressure changes. The pressure-dependent motion synchrony provides a fluid control system able to maintain a homeostatic set point. The regulation fails in glaucoma due to a process we believe involves a loss of tissue elastance.
We had an article just published that I believe you just mentioned, in Progress in Retinal and Eye Research in 2021, titled: “Aqueous Outflow Regulation: 21st Century Concepts,” which explores these recent findings in detail. The summary is that the system is a regulatory pump that functions somewhat like the lymphatic system – much like the systemic circulation. The pump fails in glaucoma. We need procedures that restore the pump function.
在青光眼研究和臨床工作中，不斷尋找創新靈感
Johnstone教授感慨，他在哈佛醫學院做眼科住院醫師時，很幸運能和Martin Grant教授一起工作。 Martin Grant教授是世界房水外流方面的權威，是一位非常棒的導師——經常提出新的問題讓學生思考，并試圖讓學生始終保持好奇心。 Martin Grant教授非常重視經驗觀察，他曾提出：在科學中，所有的想法都是暫時的，不應該假設任何事情都已經確定了，需要不斷地重新審視舊的概念，重新評估現有的工作，并在獲得新信息時改變想法。作為一名臨床醫生， Johnstone教授多年來一直服務于青光眼患者，在此過程中他逐漸意識到，臨床工作中需要一個更基本的概念來描述房水流出系統是如何工作的。這也是Johnstone教授多年來從事研究工作的主要動力。
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I had my residency in Ophthalmology at Harvard Medical School. I was fortunate enough to work with Doctor Martin Grant, who, at the time, was the foremost authority in the world on aqueous outflow. He was an absolutely wonderful mentor -- always asking new questions, keeping us thinking, and trying to make us curious all the time.
Dr. Grant placed great value on empirical observation. He taught me that in science, all of our ideas are provisional. We should never assume anything is finalized. We need to keep reexamining old concepts, reassess our work, and change our minds as new information becomes available. That, for me, was a wonderful lesson.
As a clinician through the years that I have cared for glaucoma patients, I became very aware that we need a more fundamental idea about what’s going on in the outflow system. That’s my main motivation for pursuing research efforts all these years.
青光眼治療的未來之路：微創手術和針對房水遠端流出系統的新型藥物
Johnstone教授指出，微創青光眼手術有很多不同的類型，他的興趣是Schlemm管和遠端流出通道的微創青光眼手術，包括Schelmm管的減壓和彈性擴張等微創青光眼靶向手術及房角到Schelemm管的分流手術（如Glaukos裝置或小梁切除術等）。此外，各種GATT步驟將套管穿在管道周圍，然后將套管拉入房角。 Johnstone教授表示，對流出系統的損害較小并改善了房水泵的功能的手術，具有巨大的發展潛力。