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Antonio M. Fea, 1 Andrea Gilardi, 1 Davide Bovone, 1 Michele Reibaldi, 1 Alessandro Rossi, 1 Earl R. Craven21 Diploma yeScientific Ophthalmological University of Turin, Turin, Italy;2 Johns Hopkins University, Baltimore, Maryland, USA Elmer Eye Institute Glaucoma Center of Excellence Munyori anoenderana: Antonio M. Fea, +39 3495601674, email [email protected] Abstract: PRESERFLO™ MicroShunt mudziyo mutsva wekuvhiya glaucoma zvishoma (MIGS) ) yakasimwa ab externo, iyo aqueous kuseka inodirwa munzvimbo yepasi conjunctival.Yakagadzirwa seyakachengeteka uye isingadhure kurapwa kwevarwere vane mishonga isingadzoreki yekutanga yakavhurika angle glaucoma (POAG).Maitiro echinyakare ekuisirwa kweMicroShunt anosanganisira matanho akakosha akasiyana, anosanganisira kugadzira homwe diki ine 1mm blade, kuisa 25G (25G) tsono kuburikidza nehomwe yescleral mukamuri yepamberi (AC), uyezve yakatetepa-yakavakirwa 23-geji ( 23G ) Iyo cannula inobvisa stent.Nekudaro, kuiswa kwetsono muhomwe ye scleral kunogadzira nzira isiriyo, zvichiita kuti zviome kupinza mudziyo.Chinangwa chechinyorwa chino ndechekukurudzira nzira yakareruka yekusima.Nzira yedu inoratidza kugadzira scleral tunnel uchishandisa 25G tsono zvakananga uye kushandisa iyi 25G tsono mumakumbo kuti iite zvishoma sclera mu AC.Iyo MicroShunt yakabva yaunganidzwa pane 23G cannula yaive yakanamatira sirinji ye1ml.Mudziyo wacho unogona kuzokwizwa nejekiseni.Nokudaro, kubuda kunze kunogona kusimbiswa pakarepo nekucherechedza madonhwe emvura achiyerera kubva kunze kwekuvhura kwe stent.Iyi nzira itsva inogona kunge iine mabhenefiti akasiyana-siyana akadai sekutonga kurinani kwenzvimbo yekupinda, kudzivirira ndima dzenhema, kuderedzwa kana kubviswa kwenjodzi yekubuda kunze kweaqueous kuseka, kukwidziridzwa kwegwara rakafanana kune iris ndege, uye kukurumidza kukuru.Mazwi akakosha: MIGS, open-angle glaucoma, Preserflo, MicroShunt, glaucoma kuvhiya, subconjunctival filtration.
Mumakore mashoma apfuura, kuvhiyiwa kushoma kana kushoma (MIGS) kwakabuda mumunda wekuvhiya glaucoma.1-5 Iyi michina yeMIGS yakagadziridzwa kuitira kurapwa kwevarwere vasina kutarisirwa nemishonga vane primary open-angle glaucoma (POAG) yekuvandudza kuchengeteka nekuchengetedza kushanda kwekudzikisa intraocular pressure (IOP).1-5 MIGS zvishandiso zvinogona kukamurwa kuita: trabecular, suprachoroidal, uye subconjunctival.1,3 Subconjunctival outflow inotevedzera nzira ye trabeculectomy.Kuenzaniswa netrabeculectomy, inopa yakaderera postoperative intraocular pressure, ichipa maitiro akajairwa uye kuchengetedzwa kwakanyanya.1-5 Yese ma subconjunctival madivayiri akavakirwa pane tubule implantation.Iyo lumen zviyero zvezvishandiso izvi zvakayereswa uchishandisa iyo Hagen-Poiseuille laminar flow equation.1 Kazhinji, lumen inosarudzwa kudzivirira kusingaperi hypotension uye yakakura zvakakwana kudzivirira kuvhara.
Kunyangwe paine gakava pamusoro pekutarisa MicroShunt seMIGS, nezvinangwa zvegwaro iri, izwi rekuti MIGS richashandiswa kwariri.The Preservlo TM MicroShunt implant ichangobva kuiswa.6 Iyo shunt ine polystyrene block, isobutylene block, styrene polymer yaimboshandiswa secoronary stent nekuti inokonzera kuzvimba kushoma uye encapsulation.7,8 Mudziyo wacho wakareba 8.5 mm uye une lumen ye70 µm yekudzora kuyerera nekuchengetedza IOP iri pamusoro pe5 mmHg.(neavhareji yekugadzirwa kwemvura).8 Kureba kwechigadzirwa kunobvumira kubuda kukuru kwemashure ekubuda kwemvura, saka nzvimbo yakakura yemashure incision inokurudzirwa.
Kazhinji, iyo oblique quadrant ndiyo inosarudzika saiti yekuisirwa sezvo ichidzivirira kupinda kune yepamusoro rectus muscle.Mitomycin-C (MMC) kutariswa uye nguva yekuratidzwa zvakasiyana zvichienderana nenjodzi kana ruzivo rwekuvhiya.9-16
Iyi pfupiso yepfupi inoitirwa kudonongodza zvimwe zvigadziriso kune maitiro ekukurumidza uye nyore MicroShunt kuisirwa.
Ongororo yezvinyorwa zvekurapa yakabvumidzwa neEthics Committee yeYunivhesiti yeTurin.Nekuda kwekuti uku kwaive kudzokororwa kwakadzokororwa kwemarekodhi ezvokurapa, komiti yezvetsika yakabvisa zvaidiwa kuti iwane mvumo yakanyorwa ine ruzivo rwekutora chikamu muchidzidzo.Zvisinei, vatori vechikamu vose vakapa mvumo yakanyorwa yakanyorwa vasati vavhiyiwa.
Kuti uve nechokwadi chekuvanzika kwemurwere, ruzivo rwavo haruna kuzivikanwa kuburikidza nekushandiswa kweakasarudzika zviziviso.Chirongwa chekudzidza chakatevera mitemo yeDeclaration yeHelsinki uye Mirayiridzo yeGood Clinical Practice / International Coordinating Committee.
Chidzidzo chezvino chaisanganisira varwere vePOAG vakatevedzana ≥18 yemakore uye varwere vakabatwa nezvinodhaka vane preoperative IOP ≥23 mmHg avo vakazvimiririra MicroShunt implantation.
PRESERFLO TM MicroShunt (Santen ex Innfocus, Miami, FL, USA) inowanikwa mune isina kuvharwa packaging kit ine 3 mm scleral marker, 1 mm triangular blade, 3 LASIK Shields TM (EYETEC, Antwerp, Belgium), chiratidzo uye saizi 2. tsono (25G).
Usati washandisa MicroShunt, mugadziri anokurudzira kuzadzazve ne 23G cannula, iyo isingabatanidzwi mukiti.
Kunyange zvazvo iri kuwedzera kuti glaucoma vanovhiya vanoziva maitiro ekutanga ekudyara, mamwe ematanho anogona kuve akaoma.Kunyanya, apo tsono ye25G inotsvedza, muromo wayo unogona kugadzira nzira isina kururama / isina kururama mune imwe ndege kana kupinda mukamuri yepamberi pasina kusvika kumusoro kwe scleral tunnel.Izvo zvakaoma chaizvo kudzora nzira ye 25G tsono nokuti nzvimbo mukati me scleral tunnel ndeyechokwadi, kana kuti inenge yakaonda zvikuru (ona Fig. 1).
Mufananidzo 1. Mhedziso yematanho makuru ehunyanzvi hutsva hwekuvhiya.(A) Iyo tsono yakagadzirirwa kupinda mukati me sclera 3 mm kubva kumucheto.(B) Kana tsono yasvika panhengo, inosundirwa pasi.(C) Tsono inopinda mukamuri yepamberi.(D) Mushure mekugadzira tunnel ine blade ye triangular, nzira yetsono inoshandiswa kupinda mukamuri yepamberi haigoni kutevera mugero, ichigadzira nzira yenhema.
Mune zvimwe zviitiko, dambudziko iri rinogona kuita kuti kuisa microshunt mukamuri yepamberi (AC) kunetse nekuti muromo wayo wakavharirwa mugero.Mukuwedzera, kunyengedza uku kunogona kuoma zvakanyanya mumaziso ane abnormal limbal anatomy.
Zvakare, kana kuedza kwechipiri kuchiri kutadza, chiremba anovhiya anogona kumanikidzwa kudyara mudziyo mune imwe nzira inobatsira.Iyi saiti inonyanya kukonzeresa kunotevera mavanga nekuda kwekuvapo kweiyo yepamusoro rectus abdominis.
Kuti udzivise dambudziko iri, imwe sarudzo ndeye kubaya AK nemuromo wemicroknife inoshandiswa kugadzira scleral homwe.Kunyange zvazvo nzira iyi ichichengetedza nguva uye ichidzivirira kusikwa kwendima dzisina kururama, zvinogona kuva zvakaoma kufungidzira kureba kweAC iri kuuya.Mukuwedzera, iyo triangular chimiro cheblade inotsanangura nzira yakakura, iyo inogadzira lateral kuyerera munguva yekutanga postoperative.Zvinoenderana nemutemo waPoiseuille, iyo lateral inoyerera zvakare inokonesa kuedza kugadzira yakapihwa kubuda kwemvura kubva ku AC, iyo inogona kubatsira mukuvandudza hypotension.
Nzira yedu yekuvhiya inopa kuvandudzwa kuviri pamusoro pemaitiro ekuvhiya echinyakare.Yekutanga ndeye kushandisa zvakananga tsono ye25G senzira.Sekuvandudzwa kwechipiri, nzira yedu inokurudzira kubatanidza 23G cannula, iyo inowanzoshandiswa kune silicone mafuta aspiration, kumucheto wekupedzisira kweMicroShunt.Saka, chiremba anovhiya anogona kutsvaira mudziyo zvakananga panguva yekuiswa kweshinda.
Kushandisa tsono ye25G kugadzira mugero kunorerutsa nzira yekuvhiya sezvo ichibvisa kudiwa kwehomwe ye scleral uye inoderedza zvakanyanya nzvimbo yescleral inobatanidzwa mukuita.Pamusoro pezvo, kuvandudzwa uku kunobatsira kuderedza kukuvadzwa kwenguva refu kune endothelial masero nekumanikidza sclera sezvainoswedera kunhengo, nekudaro ichipinda muiris mune imwe ndege yakafanana (ona Mufananidzo 1 uye vhidhiyo yekuwedzera).
Kuvandudzwa kwechipiri kunopihwa tekinoroji nyowani kushandisa 23 G cannula, yakafanana necannula inowanzoshandiswa kune silicone oiri aspiration.Iyi 23G cannula inogadzirisa iyo MicroShunt uye inoita kuti zvive nyore kutsvaira.Uye zvakare, iyo fluid inoiswa mu AC inowedzerawo kudzvanywa, ichibvumira aqueous kuseka kuyerera nepakati pekupedzisira kwechigadzirwa (ona Mufananidzo 1 uye vhidhiyo yekuwedzera).
Chiitiko chedu chekiriniki chaisanganisira maziso gumi nemashanu kubva kuvarwere gumi neshanu veOAG vakawana yakazvimirira microshunt uye vakateverwa kwemwedzi mitatu.Kunyangwe paine data pamusoro pe intraocular pressure yekudzikisa zvinodhaka uye intraocular pressure yekudzikisa zvinodhaka, chinangwa chedu chikuru chaive chekuisa pfungwa pamatambudziko ekutanga epashure.
Vose varwere vaiva Caucasian, median (interquartile range, IqR) zera raiva 76.0 (range 71.8 kusvika 84.3) makore, 6 (40.0%) vaiva vakadzi.Makiyi ehuwandu hwevanhu uye makiriniki maitiro anopfupikiswa muTafura 2.
Median (IqR) IOP yakadzikira kubva pa28.0 (27.0 kusvika 32.5) mm Hg.Art.pakutanga kwechidzidzo kusvika 11.0 (10.0 kusvika 12.0) mm Hg.Art.mushure memwedzi ye3 (Hodges-Lehman median musiyano: -18.0 mmHg, 95% nguva yekuvimba: -22.0 kusvika -14.0 mmHg, p = 0.0010) (Fig. 2).Saizvozvowo, nhamba yemishonga yeophthalmic antihypertensive yakaderera zvikuru kubva ku3.0 (2.2-3.0) zvinodhaka pakutanga kusvika ku0.0 (0.0-0.12) mishonga pamwedzi mitatu (Hodges-Lehman zvinoreva kusiyana: -2.5 mishonga) Mushonga, 95% CI: -3.0 kusvika -2.0 Mushonga, p = 0.0007).Mushure memwedzi mitatu, hapana wevarwere akatora systemic zvinodhaka kuderedza IOP.
Mufananidzo 2 Zvinoreva intraocular pressure panguva yekutevera.Mabhawa akatwasuka anomiririra interquartile range. * p <0.005 kana ichienzaniswa neyekutanga (Friedman bvunzo uye post hoc kuongororwa kwepaviri kuenzanisa kwakaitwa nenzira yeConover). * p <0.005 kana ichienzaniswa neyekutanga (Friedman bvunzo uye post hoc kuongororwa kwepaviri kuenzanisa kwakaitwa nenzira yeConover). * p <0,005 попарных сравнений были выполнены по методу. * p <0.005 kana ichienzaniswa neyakatangira (bvunzo yaFriedman uye post hoc kuongororwa kwekuenzanisa paviri kwakaitwa neConover's method). *p < 0.005 与基线相比（弗里德曼检验和成对比较的事后分析是使用Conover 方法完成的）. *p <0.005 * p <0,005 а парных сравнений были выполнены Фридмана и апостериорный анализ для парных сравнений были выполнены в польнены в песпольные выполнены песни. * p <0.005 zvichienzaniswa nekutanga (bvunzo yaFriedman uye post hoc kuongororwa kwekuenzanisa kwepaviri kwakaitwa uchishandisa nzira yaConover).
Visual acuity yakaderera zvakanyanya pazuva 1, vhiki 1, uye mwedzi 1 zvichienzaniswa nemaitiro ekutanga, asi akadzoka uye akagadzikana kubva pamwedzi 2 (Fig. 3).
Mupunga.3. Ongororo yemedian maximally corrected distance visual acuity (BCDVA) panguva yekutevera.Mabhawa akatwasuka anomiririra interquartile range. *p <0.01 kana ichienzaniswa neyekutanga (bvunzo yeFriedman uye post hoc ongororo yekuenzanisa pairi yakaitwa neConover nzira). *p <0.01 kana ichienzaniswa neyekutanga (bvunzo yeFriedman uye post hoc ongororo yekuenzanisa pairi yakaitwa neConover nzira). *p < 0,01 Притерий Фридмана и апостериорный анализ для попарных сравнений были выполнены по методу. *p <0.01 kana ichienzaniswa neyekutanga (bvunzo yaFriedman uye post hoc kuongororwa kwekuenzanisa kweviri kwakaitwa pachishandiswa nzira yaConover). *p < 0.01 与基线相比（Friedman 检验和成对比较的事后分析是使用Conover 方法完成的）. *p <0.01 *p < 0,01 Притерий Фридмана и апостериорный анализ для парных сравнений были выполнены придмана и апостериорный анализ для парных сравнений были выполнены песпорные выполнены песпорные. * p <0.01 kana ichienzaniswa neyekutanga (bvunzo yaFriedman uye post hoc kuongororwa kwekuenzanisa kwepaviri kwakaitwa uchishandisa nzira yaConover).
Nezve kuchengeteka, maziso maviri (13.3%) akagadzira hyphema (inenge 1 mm) pazuva rekutanga rekuvhiya, iro rakagadzirisa zvachose mukati mevhiki.Peripheral choroidal detachment yakaitika mumaziso matatu (20.0%), iyo yakabudirira kugadziriswa nekurapa kwekurapa mukati memwedzi mumwe.Hapana mumwe wevarwere aida kuwedzera kupindira kwekuvhiya.
Iyo data iripo parizvino inoongorora kushanda uye kuchengetedzeka kweMicroShunt inoratidza zvinovimbisa mhedzisiro, kunyangwe zvishoma.9-16 ruzivo rwekuvhiya uye mhedzisiro yekiriniki yakakosha pakuvandudza uye kurerutsa nzira yekuvhiya.
Muchinyorwa chino, isu tinovavarira kuratidza inokurumidza, inowirirana, uye nzira iri nyore yekudyara mudziyo uyu.Clinical data yenzira yacho yakagadzirirwa kutarisa matambudziko ekutanga angave akabatanidzwa nenzira, uye kwete kuongorora kushanda kwayo.
Chishandiso chine mbabvu mbiri dzeparutivi, iyo theoretical basa iri kudzivirira kuyerera kweparutivi uye kufamba kweMicroShunt.6,8 Nzira dzechinyakare dzinosanganisira kushandiswa kwekatatu blade kugadzira isina kudzika scleral pocket kumashure kune limbus uye 3 mm pedo nenhengo kuti igamuchire idzi lateral fins.Zvisinei, kureba kwayo uye chokwadi chokuti scleral pocket inotanga 3 mm kubva pamakumbo inoguma nemudziyo unobuda zvakanyanya mukamuri yepamberi.Nekuda kweizvi, isu hatiwanzo kuisirwa ribbed zvishandiso pazasi pescleral homwe kana tichishandisa classical tekinoroji kudzivirira kuwanda kwemudziyo mukamuri yepamberi.
Ne tekinoroji yedu, iyo stent yakasununguka kufamba uye kusimuka sezvo mbabvu dziri kuwanikwa pasi peTenon capsule.Nekudaro, zvinofanirwa kusimbiswa kuti hapana dislocation yakaitika mumuenzaniso wedu.
Kushandiswa kwetsono kugadzira scleral tunnel yemidziyo yakasimwa yedhiraivha hachisi chinhu chitsva.Albis-Donado et al.[17] yakashuma migumisiro yakanaka yekiriniki muvarwere vari pasi peAhmed valve implantation yeglaucoma kuburikidza netsono-yakagadzirwa scleral tunnel pasina kushandiswa kwechubhu-inovhara chigamba.
Mumaitiro edu, takashandisa 25G ine dhayamita yekunze ye0.515 mm uye kureba kwe3 kusvika 4 mm, iyo yaive yakakwana kuchengetedza mudziyo panzvimbo.Tichifunga iyo MicroShunt yekunze dhayamita ye 0.35mm, kushandisa stylus diki kunogona kukonzera kugadzikana kwakasimba uye kushoma lateral kuyerera.Needles 26 (0.466), 27G (0.413), kana kunyange 28G (0.362) inogona kushandiswa, asi isu hatina ruzivo nediki dhayamita tsono.Zvimwe zvidzidzo zvepakati uye zvenguva refu zvinodikanwa kuti uongorore sarudzo idzi.
Rimwe dambudziko ringangove nehunyanzvi uhu i scleral erosion.Nekudaro, zvinofanirwa kucherechedzwa kuti imwe nzira yakafanana kushandisa 20G18 microvitreoretinal blade kana yakakura 22-23G17 tsono yakatsanangurwa yeMolteno implants pasina kutama kana kukukurwa18 uye Ahmed ane kushoma chubhu retraction (4/186).17
Nzira yetsono ine zvakati wandei pamusoro penzira dzechinyakare dzekudyara, senge nzira inokurumidza, shanduko yakatsetseka pakati pe conjunctiva ne cornea, uye kuderera kwezviitiko zve dellen uye zvinorwadza mablister.17,18 Mukuwedzera, zvidzidzo zvose zvakaratidza kuti kusavapo kwekuora kwakabatana nekubatana kwakasimba pakati pepombi nemugero, zvichiita kuti kuve nekuderera uye kupera.17.18
Panyaya yekuchengeteka, chiyero chematambudziko epashure chinoratidzika kunge chakakwirira kudarika zvakataurwa mune zvimwe zvinyorwa, asi zvinofanira kucherechedzwa kuti takatora hanya zvikuru kuti titaure kunyange matambudziko eprosaic munyaya ino, asi hapana chimwe chezvinetso izvi chakanga chakakosha kuchipatara. .
Kunyange zvazvo kuitika kwemigwagwa yenhema kusina kutaurwa mune zvidzidzo zvekare9-16, iyi intraoperative complication inogona kuitika uye inokonzera kusikwa kweimwe lateral tunnel, kuwedzera njodzi ye hyphema uye zvichida kutora nzvimbo.chinzvimbo chisingafadzi.
Uyu mushumo mupfupi une ganhuriro dzinoverengeka dzinoda kutaurwa.Pakati peizvi, zvinonyanya kukosha ndezvishoma saizi yemuenzaniso, nguva pfupi yekutevera, uye kushaikwa kweboka rinodzora.Zvisinei, chinyorwa ichi chinotsanangura nzira inonyanya kunatsiridza kuiswa kwe microshunt ine chiyero chakafanana che intraoperative uye yepakutanga mushure mekuvhiyiwa matambudziko sekune maitiro echinyakare.9-16
Mukupedzisa, kushandiswa kwetsono kugadzira nzira ye intrascleral yakaratidza migumisiro inovimbisa muboka duku revarwere.Kushandiswa kwayo kunogona kunyanya kubatsira kana kuvapo kwemimwe michina kunoganhura nzvimbo.Kumwe kutsvagurudza kunodiwa kuona kugadzikana kwenguva refu kwehunyanzvi uhu uye zvingangobatsira zvetsono diki.
Kunyora kwekurapa uye masevhisi ekunyora zvinopihwa naAntonio Martínez (MD), Ciencia y Deporte SL, nemari isingabvumirwe kubva kuYunivhesiti yeTurin.
Vanyori vanodawo kuonga A Mazzoleni, L Guazzone, C Caiafa, E Suozzo, M Pallotta, uye M Grindi nokuda kwekubatana kwavo panguva yekudzidza.
Dr. Antonio M. Fea inyanzvi yeGlaukos, Ivantis, iSTAR, EyeD, uye mupi wezano anobhadharwa weAbbVie, kunze kwebasa rakaratidzwa.Dr. Earl R. Craven parizvino mushandi weAbbVie uye anoshuma mari yemunhu kuSanten mukuwedzera kune basa rakaunzwa.Vanyori havatauri kumwe kukakavara kwekufarira mubasa iri.
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