Офтальмохирургия. 2019; : 67-72
Современный взгляд на циклодеструктивные операции при глаукоме
https://doi.org/10.25276/0235-4160-2019-4-67-72Аннотация
Основная цель лечения глаукомы – снижение ВГД до ≪целевого≫ уровня. К патогенетически обоснованным способам лечения различных видов глаукомы, в первую очередь ее рефрактерных форм, относятся вмешательства на цилиарном теле (циклодеструктивные операции, ЦДО), цель которых – подавление избыточного образования внутриглазной жидкости (ВГЖ). Ранее была широко распространена диодлазерная циклофотокоагуляция (ДЛЦФК), применяемая в основном при терминальной глаукоме. Технологические инновации привели к разработке перспективных, более безопасных и менее разрушительных методов циклодеструктивных антиглаукомных операций, таких как микроимпульсная диодная циклофотокоагуляция, эндоскопическая циклофотокоагуляция и ультразвуковая циклодеструкция. При микроимпульсной циклофотокоагуляции воздействие лазерной энергии происходит короткими импульсами с интервалами покоя, что значительно уменьшает поглощение энергии окружающими тканями и их сопутствующее повреждение. При эндоскопической циклофотокоагуляции напрямую коагулируется эпителий цилиарных отростков, что позволяет дозировать лазерную энергию под визуальным контролем. Ультразвуковая циклодеструкция вызывает коагуляционный некроз цилиарных отростков с очень незначительным побочным повреждением окружающих тканей. Возникает новый сдвиг парадигмы с выбором этих хирургических методик при лечении рефрактерной глаукомы. Данный обзор представляет собой анализ современной литературы, отражающий эффективность и безопасность циклодеструктивных антиглаукомных операций при сохранных зрительных функциях.
Список литературы
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Fyodorov Journal of Ophthalmic Surgery. 2019; : 67-72
A modern view of cyclodestructive surgery for glaucoma
https://doi.org/10.25276/0235-4160-2019-4-67-72Abstract
The main purpose of glaucoma treatment is to reduce the intraocular pressure (IOP) to a target level. One of the pathogenetically justified method of treatment for various types of glaucoma, first of all its refractory forms, is the surgery on the ciliary body. A purpose of such manipulations is to suppress excessive formation of aqueous humor. Previously, diode laser cyclophotocoagulation was widely used, which is mainly applied in terminal glaucoma. Technological innovations have led to the development of perspective, more safe, and less destructive methods of cyclodestructive anti-glaucomatous operations, such as micro-pulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation, and ultrasound cyclodestruction. During micro-pulse cyclophotocoagulation, the effect of laser energy occurs by short pulses at rest intervals, which significantly reduces the absorption of energy by surrounding tissues and their associated damage. With endoscopic cyclophotocoagulation, the epithelium of the ciliary processes is directly coagulated, which makes it possible to dose laser energy under visual control. Ultrasonic cyclodestruction causes a coagulation necrosis of the ciliary processes with a very insignificant collateral damage of surrounding tissues. Today these surgical techniques are becoming more relevant in the treatment of refractory glaucoma in order to preserve visual functions. This review is an analysis of modern literature, reflecting the efficacy and safety of cyclodestructive operations with sufficiently high visual functions.
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