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( 三 ) Murray|组织|诊疗|患者|调节|an

多年来，众多研究人员探索了许多不同的概念，对各种微创青光眼手术有很大的兴趣。但在大多数情况下，术后有一个眼压下降的底限，术后眼压在14mmHg到15mmHg之间。研究人员希望将眼内压降低到外静脉压，但目前的手术还不能做到这一点。因此，如果能直接将外静脉压作为目标，将有希望以一种新颖的方式来降低眼压。 Johnstone教授认为，本次会议中最有趣的事情之一是由梅奥诊所开发的药物：钾离子通道剂。该制剂的目标是让巩膜外静脉压力降低，促使远端小梁网的房水流出。这种专门针对房水远端流出系统的新型药物将是一个令人兴奋的新选择。
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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.
总的来说，随着青光眼领域技术的发展，手术方式和治疗药物的不断创新，将不断为临床治疗青光眼提供新的选择，让患者获得更好的视觉质量和手术预后。

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参考文献：
【1】Dvorak-Theobald G, Kirk HQ. Aqueous pathways in some cases of glaucoma. Am J Ophthalmol. 1956;41:11-21.
【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】【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.
（来源：《国际眼科时讯》编辑部）
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