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( 三 ) Murray|組織|診療|患者|調節|an

多年來，眾多研究人員探索了許多不同的概念，對各種微創青光眼手術有很大的興趣。但在大多數情況下，術后有一個眼壓下降的底限，術后眼壓在14mmHg到15mmHg之間。研究人員希望將眼內壓降低到外靜脈壓，但目前的手術還不能做到這一點。因此，如果能直接將外靜脈壓作為目標，將有希望以一種新穎的方式來降低眼壓。 Johnstone教授認為，本次會議中最有趣的事情之一是由梅奧診所開發的藥物：鉀離子通道劑。該制劑的目標是讓鞏膜外靜脈壓力降低，促使遠端小梁網的房水流出。這種專門針對房水遠端流出系統的新型藥物將是一個令人興奮的新選擇。
（上下滑動可查看）
So there are a number of different types of MIGS procedures, as you know. And some of them target the superciliary space. Also, some MIGS shunt aqueous to the subconjunctival space. But I’m not going to talk about those procedures because they are not my area of interest.
My interest is in MIGS that target the Schlemm’s canal and the distal outflow channels. Those SC-targeting procedures include an unroofing of Schelmm’s canal and viscoelastic dilatation with the concurrent passage of cannulas or sutures. Various ab interno procedures include shunts from the AC to Schelemm’s canal, such as the Glaukos devices or TM removal with the Trabectome, Kahook Dual Blade, or bent needles. Additionally, various GATT procedures thread a needle or cannula around the canal and then pull the cannula into the AC to provide communication with the canal.
So, those are the general categories of procedures. As far as the ones I most like – it’s whatever does the least damage to the outflow system and improves the function of the pump mechanism I’ve described.
There are many different concepts we looked at, and there is a great deal of interest in the various MIGS procedures. But with most of them, there is a floor below which the intraocular pressure does not drop. So most of these procedures cause pressures in the 14 to 15 range.
We would like to get IOP to episcleral venous pressure, but our current procedures generally don’t do that. So if we could get episcleral venous pressure targeted directly, I think we would have a much better chance of reducing pressure in a novel way.
I thought one of the more interesting meeting things was the Qlaris Bio Group drug developed at the Mayo Clinic – a potassium channel agent. The agent targets episcleral venous pressure and outflow distal to the trabecular meshwork. In clinical trials, it shows considerable promise. I think the idea of a new novel drug that specifically targets the outflow system distal to the canal is an exciting new option. So, I’m quite excited about that.
總的來說，隨著青光眼領域技術的發展，手術方式和治療藥物的不斷創新，將不斷為臨床治療青光眼提供新的選擇，讓患者獲得更好的視覺質量和手術預后。

文章圖片

參考文獻：
【1】Dvorak-Theobald G, Kirk HQ. Aqueous pathways in some cases of glaucoma. Am J Ophthalmol. 1956;41:11-21.
【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】【2】Chi HH, Katzin HM, Teng CC. Primary degeneration in the vicinity of the chamber angle; as an etiologic factor in wide-angle glaucoma. II. Am J Ophthalmol. 1957;43:193-203.
（來源：《國際眼科時訊》編輯部）
版權聲明
版權屬《國際眼科時訊》所有。歡迎個人轉發分享。其他任何媒體、網站如需轉載或引用本網版權所有之內容，須經本網同意并在文章頂部注明“轉自《國際眼科時訊》”
點分享