and|AGS2022创新奖获得者Murray A. Johnstone教授专访：青光眼诊疗技术的创新与变革( 二 ) Murray|组织|诊疗|患者|调节|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.
在青光眼研究和临床工作中，不断寻找创新灵感
Johnstone教授感慨，他在哈佛医学院做眼科住院医师时，很幸运能和Martin Grant教授一起工作。 Martin Grant教授是世界房水外流方面的权威，是一位非常棒的导师——经常提出新的问题让学生思考，并试图让学生始终保持好奇心。 Martin Grant教授非常重视经验观察，他曾提出：在科学中，所有的想法都是暂时的，不应该假设任何事情都已经确定了，需要不断地重新审视旧的概念，重新评估现有的工作，并在获得新信息时改变想法。作为一名临床医生， Johnstone教授多年来一直服务于青光眼患者，在此过程中他逐渐意识到，临床工作中需要一个更基本的概念来描述房水流出系统是如何工作的。这也是Johnstone教授多年来从事研究工作的主要动力。
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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.
青光眼治疗的未来之路：微创手术和针对房水远端流出系统的新型药物
Johnstone教授指出，微创青光眼手术有很多不同的类型，他的兴趣是Schlemm管和远端流出通道的微创青光眼手术，包括Schelmm管的减压和弹性扩张等微创青光眼靶向手术及房角到Schelemm管的分流手术（如Glaukos装置或小梁切除术等）。此外，各种GATT步骤将套管穿在管道周围，然后将套管拉入房角。 Johnstone教授表示，对流出系统的损害较小并改善了房水泵的功能的手术，具有巨大的发展潜力。