青光眼眼中的超声环成形术
Summary
青光眼是一种慢性疾病, 逐渐退化的视神经纤维, 导致视野下降。眼压升高被认为是最重要和唯一可治疗的危险因素。这份手稿描述了一个简单的, 外科手术友好, 非切口技术, 命名为超声环成形术, 以减少眼压在青光眼患者。
Abstract
青光眼是一种慢性疾病, 由光学神经纤维的渐进变性引起, 导致视力下降, 导致视力严重受损, 最终失明。这份手稿描述了一个简单的, 外科手术友好, 非切口技术, 命名为超声环成形术 (解偶), 以减少眼压 (眼压) 的青光眼患者。该技术决定了睫状体的选择性凝固坏死;此外, 最近还提出了 uveo-巩膜流出通路的超脉络膜和反巩膜部分的刺激。与以前的技术相比, 在超声技术方面有了一些技术上的改进, 为目标区域提供了更精确的聚焦。手术在手术室进行球麻醉。简单地说, 耦合锥是与眼睛和环探头, 其中包含六压电传感器, 产生超声束, 在它里面插入。他们正确的中心在眼表面代表了一个关键的步骤, 正确的靶向睫状体。用无菌平衡盐溶液填充空腔, 保证超声声传播。外科治疗包括在每一个六传感器的顺序自动激活, 总持续时间少于3分钟。病人在手术后离开医院1小时, 用治疗过的眼睛修补。在本研究中, 10 例开角型青光眼患者在术后至少12月内随访。与手术前相比, 每隔一段时间, 眼压降低, 低血压药物的数量也减少。20% 的患者对治疗没有反应, 需要随后的手术来更好地控制眼压。治疗耐受性好, 无眼压或肺结核。与传统的 cyclodestructive 程序相比, 这种方法更简单、更快、更安全、更少侵入, 从而减少眼压。
Introduction
青光眼是导致全世界失明的主要原因之一, 影响约1亿人的1。它是由神经纤维的渐进变性所产生的一种光学神经病, 它会聚在视神经上, 从而在视觉上减少了视力障碍, 最终导致失明而没有足够治疗2。
高眼压仍然被认为是青光眼发病和进展的主要危险因素, 目前唯一可以治疗的参数是减少视觉领域的损失3。通过使用局部或全身药物、激光或外科手术3,4, 可以通过减少水幽默的产生和/或通过小梁网增加其流出来达到眼压降低。在加热或冷冻后, 已经引入了许多物理过程来诱导睫状体的凝固坏死5,6,7,89, 10、11、12。然而, 缺乏选择性的目标组织和不可预知的剂量效应关系, 减少眼压限制他们只使用的眼睛与青光眼的常规医疗和外科治疗4。
在过去的几年中, 一个新的装置, 名为 “统一”, 使用高强度聚焦超声 (HIFU) 已经开发, 目的是克服传统的 cyclodestructive 技术的局限性, 实现更有选择性的凝聚睫状体和避免可能损害相邻眼部结构13,14,15,16,17,18,19,20,21. 此外, 最近还提出了 uveo-巩膜流出通路的超脉络膜和反巩膜部分的刺激, 作为减少眼压的一个可能的辅助机制.迄今为止, 在不同类型和严重程度的青光眼中进行了七项主要临床研究, 证明了这种非切口手术的有效性和安全性14,15, 19,20,21,22,23,24。
本研究的目的是详细描述上述程序, 以便将其介绍的知识传播给科学医学界, 并为想接近这一新领域的外科医生提供有用的技巧和技巧。
Protocol
所有参加者在任何研究程序之前都提供口头和书面的同意。该项研究的议定书是按照《赫尔辛基宣言》进行的, 并得到了桑特·乌苏拉-Malpighi 教学医院人类研究道德委员会的批准。 1. 术前程序和眼科评价 测试距离和接近最佳矫正视力 (BCVA)。 用狭缝灯显微镜评价眼前段。 在注入了局部麻醉眼药水后, 用狭缝灯前房透镜检查前房角。 用非接触眼底?…
Representative Results
根据上述技术, 对开放角型青光眼患者10例 (6 男性和4女性, 平均年龄64.9 ±13.7 岁, 范围39–80岁) 十眼进行治疗。治疗暴露时间为2例, 6 例为4例, 8 患者为4秒。术前平均眼压为24.8 ±9.6 柱 (平均±标准差), 每日低血压下降值为3.9 ± 1.0, 每日胺片平均数为0.6 ±0.5。另外, 平均视力为 0.48 logMAR ± 0.6, 平均视场平均偏差为-12.65 ± 12.1 dB。 八?…
Discussion
青光眼是一种慢性渐进性疾病, 影响视神经, 需要新的有效治疗来改善远期预后。眼压的减少仍然被认为是唯一有效的治疗方法, 以防止或延迟视力领域的损失, 在眼睛和没有高眼压3。
是一种新的非切口 cyclodestructive 术, 可以降低眼压, 采取两种不同的方式: 减少水中的体液流入, 确定睫状体分泌上皮的选择性坏死, 增加水的幽默感。uveo-巩膜流出刺激跨巩膜和?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
作者没有致谢声明。
Materials
| BM 900 Slit Lamp Biomioscropy | Haag-Streit, Koeniz, Switzerland | BM 900 | Slit Lamp Biomiscroscopy |
| G-4 Four-Mirror Glass Gonio Lens | Volk Optical Inc., Mentor, OH, USA | #VG4 | Contact lens for gonioscopy |
| 78D Non Contact Slit Lamp Lens | Volk Optical Inc., Mentor, OH, USA | #V78C | Non contact slit lamp lens |
| HospiFluo strips | AIESI Hospital Service S.a.s., Napoli, Italy | AHS129 | Fluorescein sterile disposable strips |
| AT 900 Goldmann Applanation Tonometer | Haag-Streit, Koeniz, Switzerland | AT 900 | Goldmann applanation tonometer |
| Lenstar LS900 | Haag-Streit, Koeniz, Switzerland | LS900 | Optical biometer |
| Pilocarpina 2% eye drops | Farmigea, Pisa, Italy | S01EB01 | Miotic eye drops |
| Mepivacaina 20mg/ml injectable solution | Angelini, Roma, Italy | N01BB03 | Local anesthetic for injection |
| Naropina 10mg/ml injectable solution | AstraZeneca, Milano, Italy | N01BB09 | Local anesthetic for injection |
| Oftasteril 5% eye drops | Alfa Intes, Napoli, Italy | S01AX18 | 5% povidone-iodine eye drops |
| EyeOP1 | Eye Tech Care, Rillieux-la-Pape, France | UCP device | |
| BSS (balanced salt solution) | Alcon Inc., Forth Worth, TX, USA | 0065-1795-04 | Sterile irrigating solution |
| Tobradex eye drops | Alcon Italia Spa, Milano, Italy | S01CA01 | Antibiotic and steroid eye drops |
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Cite This Article
Giannaccare, G., Sebastiani, S., Campos, E. C. Ultrasound Cyclo Plasty in Eyes with Glaucoma. J. Vis. Exp. (131), e56192, doi:10.3791/56192 (2018).