Novel Glaucoma Procedures A Report by the American Academy of Ophthalmology

被引:169
作者
Francis, Brian A. [1 ]
Singh, Kuldev [2 ]
Lin, Shan C. [3 ]
Hodapp, Elizabeth [4 ]
Jampel, Henry D. [5 ]
Samples, John R. [6 ,7 ]
Smith, Scott D. [8 ]
机构
[1] Univ So Calif, Keck Sch Med, Doheny Eye Inst, Los Angeles, CA 90033 USA
[2] Stanford Univ, Dept Ophthalmol, Stanford, CA 94305 USA
[3] Univ Calif San Francisco, Dept Ophthalmol, San Francisco, CA USA
[4] Bascom Palmer Eye Inst, Miami, FL 33136 USA
[5] Johns Hopkins Univ, Wilmer Eye Inst, Glaucoma Div, Baltimore, MD 21218 USA
[6] Oregon Hlth & Sci Univ, Dept Ophthalmol, Portland, OR 97201 USA
[7] Rocky Vista Univ, Dept Surg, Parker, CO USA
[8] Columbia Univ, Edward S Harkness Eye Inst, New York, NY USA
关键词
OPEN-ANGLE GLAUCOMA; MICRO-BYPASS STENT; EXCIMER-LASER TRABECULOTOMY; EX-PRESS; CATARACT-SURGERY; CIRCUMFERENTIAL VISCODILATION; FLEXIBLE MICROCATHETER; SCLERAL FLAP; TRABECULECTOMY; CANALOPLASTY;
D O I
10.1016/j.ophtha.2011.03.028
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Objective: To review the published literature and summarize clinically relevant information about novel, or emerging, surgical techniques for the treatment of open-angle glaucoma and to describe the devices and procedures in proper context of the appropriate patient population, theoretic effects, advantages, and disadvantages. Design: Devices and procedures that have US Food and Drug Administration clearance or are currently in phase III clinical trials in the United States are included: the Fugo blade (Medisurg Ltd., Norristown, PA), Ex-PRESS mini glaucoma shunt (Alcon, Inc., Hunenberg, Switzerland), SOLX Gold Shunt (SOLX Ltd., Boston, MA), excimer laser trabeculotomy (AIDA, Glautec AG, Nurnberg, Germany), canaloplasty (iScience Interventional Corp., Menlo Park, CA), trabeculotomy by internal approach (Trabectome, NeoMedix, Inc., Tustin, CA), and trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills, CA). Methods: Literature searches of the PubMed and the Cochrane Library databases were conducted up to October 2009 with no date or language restrictions. Main Outcome Measures: These searches retrieved 192 citations, of which 23 were deemed topically relevant and rated for quality of evidence by the panel methodologist. All studies but one, which was rated as level II evidence, were rated as level III evidence. Results: All of the devices studied showed a statistically significant reduction in intraocular pressure and, in some cases, glaucoma medication use. The success and failure definitions varied among studies, as did the calculated rates. Various types and rates of complications were reported depending on the surgical technique. On the basis of the review of the literature and mechanism of action, the authors also summarized theoretic advantages and disadvantages of each surgery. Conclusions: The novel glaucoma surgeries studied all show some promise as alternative treatments to lower intraocular pressure in the treatment of open-angle glaucoma. It is not possible to conclude whether these novel procedures are superior, equal to, or inferior to surgery such as trabeculectomy or to one another. The studies provide the basis for future comparative or randomized trials of existing glaucoma surgical techniques and other novel procedures.
引用
收藏
页码:1466 / 1480
页数:15
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