Leczenie operacyjne jaskry pierwotnej otwartego kąta przywracające mechanizmy fizjologiczne – kanaloplastyka
Surgical Treatment of Primary Open Angle Glaucoma Restoring Physiological Mechanisms – Canaloplasty
Karolina Krix-Jachym, Mariusz Kosatka, Marek Rękas
Klinika Okulistyczna Wojskowego Instytutu Medycznego w Warszawie
Kierownik: dr hab. n. med. Marek Rękas, prof. ndzw. WIM
Summary: Purpose: This article presents a surgical technique called canaloplasty. The surgery is performed in order to increase the outflow of aqueous humour from the anterior chamber using a conventional outflow pathway in primary open-angle glaucoma. The efficiency of canaloplasty does not depend on subconjunctival filtration so in effect the forming of a filtering bleb is not the primary goal of the surgery. During the surgery a microcatheter is inserted into the Schlemm’s canal, which dilates its lumen mechanically on all circumference. Schlemm’s canal is filled with viscoelastic, while prolene suture placed in it is tensioning its walls. At a time such a type of surgery is much safer than trabeculectomy, the efficiency of both is comparable. The paper presents indications, contraindications to this type of surgery, as well as channelography being an illustration method of the aqueous outflow pathway. During the surgery in order to visualize Schlemm’s canal walls tension, anatomical structures of the conventional outflow pathway of the outflow as well as iridocorneal angle elements the US probe of 80 MHz frequency is used, providing the axial resolution of 25 µm.
Conclusions: Canaloplasty allows to control IOP and provides opportunities to decrease the number of antiglaucoma medications used. When compared to a traditional glaucoma surgery, canaloplasty appears to be a much safer method of the treatment. Visual methods allow to estimate the anatomy of the outflow system. Channelography performed before the surgery allows for the functional evaluation of the conventional outflow pathway whilst an intraoperative US (iUS), carried out during the surgery, provides basis for the evaluation of the dilation of Schlemm’s canal and trabecular meshwork.
Słowa kluczowe: ciśnienie wewnątrzgałkowe, operacja przeciwjaskrowa, cewnikowanie kanału Schlemma, kanalografia, kanaloplastyka, jaskra pierwotna otwartego kąta.
Keywords: intraocular pressure, glaucoma surgery, catheterization of Schlemm’s canal, channelography, canaloplasty, primary open-angle glaucoma.