青光眼 程序员

The number of patients with glaucoma worldwide more than 100 million (!) People. Nine out of ten blind people live in developing countries, and two thirds of them could be cured, they begin to be treated on time.

全球青光眼患者人数超过1亿(！)人。 十个盲人中有九个生活在发展中国家，其中三分之二可以治愈，并开始按时接受治疗。

Glaucoma is the second cause of blindness after cataract — up to 20% of all cases of the disease end with it. Some people do not know about the disease. Glaucoma is often detected at stage 2–3 or at the last, 4th stage, when it is often impossible to help a person. In Russia, glaucoma has recently become the first cause of irreversible blindness, overtaking injury and vascular eye disease.

青光眼是白内障之后第二个失明的原因-多达20％的该病病例都以其结束。 有些人不了解这种疾病。 青光眼通常在第2–3阶段或最后第4阶段被发现，这时通常无法帮助一个人。 在俄罗斯，青光眼最近已成为导致不可逆性失明，过度伤害和血管性眼病的首要原因。

Despite a serious breakthrough in the understanding of many of the problems of glaucoma over the past few years, it must be admitted that so far no effective methods have been proposed to prevent the disease, its early (fairly cheap method!) Identification and treatment methods that are widely available.

尽管在过去几年中在对青光眼许多问题的理解上取得了重大突破，但必须承认，到目前为止，尚未提出任何有效的方法来预防这种疾病，包括其早期(相当便宜的方法！)鉴定和治疗方法。广泛可用。

The trouble is that the prevention of this disease, we have long ceased. Previously, after forty, all Soviet people were sure to measure eye pressure once a year. In clinics there were professional examination rooms, people with elevated intraocular pressure were referred to an ophthalmologist. And so revealed about half of patients with glaucoma. Now there is nothing like this. Saving patients was the work of the patients themselves (that is, drowning people).

麻烦在于预防这种疾病，我们早已停止。 此前，四十岁以后，所有苏联人都确保每年测量一次眼压。 在诊所里有专业的检查室，眼内压升高的人被转诊给眼科医生。 因此揭示出约一半的青光眼患者。 现在没有像这样的东西了。 挽救患者是患者自身(即溺水者)的工作。

Since the treatment of glaucoma is just as dangerous as caving — you climb into the dark, and when and what falls on your head, science is unknown. But if you don’t fall, you will drown or suffocate yourself — there are options. When you guess where you are, it will be too late. Let me start with a number of rules described below.

由于治疗青光眼和探洞一样危险-您爬上黑暗，何时何地跌落在您的头上，科学是未知的。 但是，如果您不跌倒，就会淹死或窒息而死-有很多选择。 当您猜测自己的位置时，将为时已晚。 让我从下面描述的许多规则开始。

规则编号1 (Rule number 1)

If you have been diagnosed with glaucoma, this disease will accompany you throughout your life. This means that some part of the optic nerve has suffered. Therefore, one cannot say — “I have glaucoma removed” even after surgery. Living with glaucoma is not a sentence, but we must not forget about it.

如果您被诊断患有青光眼，这种疾病将伴随您一生。 这意味着视神经的某些部位受到了损害。 因此，即使在手术后，也不能说“我已切除青光眼”。 与青光眼一起生活不是一句话，但我们一定不要忘记它。

规则编号2 (Rule number 2)

This imposes a number of lifelong limitations and requires the regular use of drops — about them below. If you are respectful of your illness, the rate of its progression will slow down significantly.

这强加了许多终生限制，并且需要定期使用滴剂-以下是关于它们的信息。 如果您尊重自己的疾病，其发展速度将大大减慢。

规则编号3 (Rule number 3)

Regular lifetime visits to an ophthalmologist are needed to monitor the level of intraocular pressure. Ideally, monthly. Once every 6 months you need to do research to assess the visual fields and tomograms of the optic nerves of both eyes. This is a dynamic control.

需要定期拜访眼科医生以监测眼内压的水平。 理想情况下，每月一次。 您需要每6个月进行一次研究，以评估两只眼睛的视神经的视野和X线断层图。 这是一个动态控件。

Believe me, those patients who did not observe appointments lost sight, refused surgical treatment, disappeared for months and years, and then lamented that vision was irretrievably lost.

相信我，那些没有遵守约定的患者失去了视力，拒绝了手术治疗，消失了几个月甚至几年，然后为无法挽回的视力而感叹。

规则编号4 (Rule number 4)

If nothing hurts, do not think that there is no disease and all the dangers are exaggerated. A feature of glaucoma is the absence of symptoms in the early and advanced stages of the disease. The patient himself does not know about the disease until he begins to lose his sight.

如果没有伤害，不要以为没有疾病，所有的危险都被夸大了。 青光眼的特征是在疾病的早期和晚期不出现症状。 患者自己直到开始失明才知道这种疾病。

In order to notice the disease in time, preventive examination by an ophthalmologist is necessary. You need to pass it once a year, and after 50 years — twice a year.

为了及时发现疾病，必须由眼科医生进行预防性检查。 您需要每年通过一次，然后在50年后通过-每年两次。

规则编号5 (Rule number 5)

Do not look for a “wonderful” pill, “magic” drops or devices that “heal all ailments”, which are so actively offered on the pages of newspapers, on radio and television, on the Internet, telling tips on how to cure glaucoma with folk remedies. This way you will lose that valuable time for treatment and it will be impossible to catch up.

不要在报纸，广播电视，互联网上积极地提供“神奇的”药丸，“魔术”滴剂或“治愈所有疾病”的设备，告诉他们如何治疗青光眼用民间疗法。 这样，您将失去宝贵的治疗时间，将无法追上。

Use evidence-based medicine methods!

使用循证医学方法！

目前青光眼有什么治疗方法？ (What is the treatment for glaucoma currently?)

All types of treatment for glaucoma are aimed at normalizing intraocular pressure, improving nutrition in the tissues of the eye and in the optic nerve, as well as stabilizing visual functions.

青光眼的所有类型的治疗均旨在使眼内压正常化，改善眼组织和视神经的营养以及稳定视觉功能。

保守治疗青光眼 (Conservative treatment of glaucoma)

That is, the instillation of various types of drops in a certain mode, and for each eye, it is selected separately.

即，以某种模式滴注各种类型的滴剂，并且对于每只眼睛，分别地选择滴剂。

This therapy is most common in the early stages of glaucoma treatment. It can also be an addition to other types of treatment — laser or surgical.

这种疗法在青光眼治疗的早期最为普遍。 它也可以是其他类型的治疗(激光或外科手术)的补充。

Some medicinal substances are aimed at reducing the production of intraocular fluid. Others, with the help of special mechanisms, are aimed at improving the outflow of intraocular fluid and thereby lowering the intraocular pressure. Also, there are combined drugs that combine both directions.

一些药用物质旨在减少眼内液的产生。 其他的，借助于特殊的机制，旨在改善眼内液的流出，从而降低眼内压。 另外，还有结合了两个方向的组合药物。

青光眼滴是否无害？ (Are the drops of glaucoma harmless?)

Modern drops of glaucoma are in most cases effective, but not always harmless.

现代青光眼药水在大多数情况下是有效的，但并不总是无害的。

Drops contain the active substance in the form of a solution, as well as a preservative, for example, benzalkonium hydrochloride. It has a negative effect on the eye surface. With prolonged use (we are talking about years), especially if the doctor does not change the drug, and the patient for a long time uses the same medicine, dry eye syndrome may develop (redness, pain, dryness).

滴剂含有溶液形式的活性物质，以及防腐剂，例如盐酸苯扎氯铵。 它对眼睛表面有负面影响。 如果长时间使用(我们正在谈论几年)，尤其是如果医生不更换药物，并且患者长时间使用相同的药物，则可能会发展为干眼症(发红，疼痛，干燥)。

Allergic reactions and intolerance of drugs of the general and local character are possible.

一般和局部药物的过敏React和不耐受是可能的。

In addition, reactions of the body as a whole are possible, for example, interruptions in heart rhythm, lowering of blood pressure, sleep disturbance and dizziness, etc.

另外，身体整体上可能发生React，例如心律不齐，血压降低，睡眠障碍和头晕等。

A competent doctor from a huge arsenal of drops must choose a suitable one or find a replacement. If this does not work, surgical assistance is needed.

庞大的滴剂库中的合格医生必须选择合适的滴剂或找到替代品。 如果这不起作用，则需要手术帮助。

Drug treatment of glaucoma is prescribed by an ophthalmologist only after a complete ophthalmologic examination is entirely individual — how it is written here.

仅在全面的眼科检查完全由个人进行之后，眼科医生才开具青光眼药物治疗处方。

It is very dangerous to self-treat glaucoma — do not use or cancel antiglaucoma drugs yourself, do not violate the mode and frequency of instillation. With these actions, you can cause irreparable harm to your eyes and lose your sight.

自我治疗型青光眼非常危险-不要自己使用或取消抗青光眼药物，不要违反滴注的方式和频率。 通过这些操作，您可能对眼睛造成无法弥补的伤害并失去视力。

And, here's another, in my (and not only) opinion — taufon and emoxipin, so loved by all — are useless with this diagnosis. Glaucoma and cataracts are not treated. The lens and the optic nerve do not reach. «Holy water» and more efficiently.

而且，在我(且不仅如此)看来，这是所有人都喜爱的taufon和emoxipin，对这种诊断毫无用处。 青光眼和白内障不予治疗。 晶状体和视神经未触及。 «圣水»，效率更高。

激光治疗青光眼 (Laser treatment for glaucoma)

1. Patients love the word «laser.» So, only with angle-closure glaucoma, it is 100% effective. In cases of closed and narrow angles, a procedure such as laser iridectomy is the guarantor of prevention of an angle-closure glaucoma attack.

1.患者喜欢“激光”一词。 因此，仅对于闭角型青光眼，它是100％有效的。 在闭合和窄角的情况下，诸如虹膜虹膜切除术之类的手术是预防闭角型青光眼发作的保证。

In the case of angle-closure glaucoma (we wrote about it here ), the angle of the anterior chamber, in which the main outflow collector of the Schlemm's canal passes, is blocked by the iris root. By the way, this condition can be periodic, for example, it can manifest itself only when the pupil is dilated (at night, under stress, etc.).

在闭角型青光眼的情况下(我们在此处进行了介绍 )，虹膜根部阻塞了前房角，Schlemm管的主要流出收集器通过该前房角。 顺便说一句，这种情况可能是周期性的，例如，只有在瞳Kong散大时(夜间，压力等)它才能表现出来。

Predisposing factors — farsightedness (“short eye”) + “thick” lens (thickens with age) + front attachment of the lens + small front camera

诱发因素-远视(“短眼”)+“厚”镜头(随年龄增长的厚度)+镜头的前部附件+小型前置摄像头

Then this is what happens:

然后会发生以下情况：

The fluid accumulates in the back of the chamber, the iris overlaps the outflow channel, the pressure rises, the person experiences pain in the eye, the eye becomes red and there may be a loss of vision if you do not unlock the outflow.

液体积聚在腔室的后部，虹膜与流出通道重叠，压力升高，人会感到眼部疼痛，眼睛变红，如果不打开流出Kong可能会导致视力下降。

In this case, a hole is made in the iris using a perforator laser — peripheral laser iridectomy (iridotomy). It is also proposed to perform in the case when the angle of the front camera has not yet closed, but there is such a risk. Narrow angles are determined by inspection with a special goniscopic lens.

在这种情况下，使用穿Kong激光-虹膜周边虹膜切除术(虹膜切开术)在虹膜上打一个洞。 还建议在前摄像机的角度尚未闭合的情况下执行，但是存在这种风险。 狭窄的角度是通过使用特殊的检眼镜检查确定的。

So schematically looks laser iridectomy and the eye after it under a microscope因此，在显微镜下示意性地看到激光虹膜切除术和眼睛

And here is a video of the procedure:

这是该过程的视频：

If the laser fails to perform the opening, surgical iridectomy is performed under operating conditions.

如果激光无法打开，则在手术条件下进行手术虹膜切除术。

Laser iridectomy is performed using laser systems with different wavelengths: using a single-pulse solid-state neodymium YAG laser or a gas argon laser.

激光虹膜切除术是使用不同波长的激光系统执行的：使用单脉冲固态钕YAG激光或氩气激光。

2. Now about laser treatment for open-angle glaucoma. And I remind you that 80% of all cases it is she who is open-angle glaucoma. It's all not so simple. The varieties of laser surgery in the treatment of open-angle glaucoma are laser trabeculoplasty or trabeculo-puncture. The method involves applying point burn applications on a specific part of the trabeculae (the network through which the outflow is taking place).

2.现在谈谈开角型青光眼的激光治疗。 而且我提醒您，在所有情况下，有80％的患者是开角型青光眼。 这不是那么简单。 用于治疗开角型青光眼的激光手术的种类是激光小梁成形术或小梁穿刺术。 该方法涉及在小梁的特定部分(通过其发生流出的网络)上应用点刻录应用程序。

It is assumed that the pigment that litters the trabeculae is “knocked out”, the fibers shrink and increase the spacing for outflow — they achieve a “popcorn effect”. For this, argon and neodymium laser trabeculoplasty (LTP) (514/532 nm) and diode infrared or micropulse LTP (810 nm) are used.

假定乱丢了小梁的色素被“剔除”，纤维收缩并增加了流出的空间-它们实现了“爆米花效应”。 为此，使用氩和钕激光小梁成形术(LTP)(514/532 nm)和二极管红外或微脉冲LTP(810 nm)。

In fact, such a procedure in itself can further increase the intraocular pressure, if the effect is, then it is very short-lived and unstable. As an independent procedure, it is dangerous, since after it the patients consider themselves to be a “cured” laser and often stop dropping drops and stop visits to the ophthalmologist. And glaucoma is quietly progressing!

实际上，这样的过程本身可以进一步增加眼内压，如果效果良好，那么它是短暂的且不稳定的。 作为独立的程序，这很危险，因为在此之后，患者会认为自己是“固化”激光，并且通常会停止滴药并停止拜访眼科医生。 青光眼正在悄然发展！

Laser procedures such as descemetonogonopuncture (BPH)With the help of these lasers, we often use in addition to microsurgical non-penetrating deep sclerectomy (NSEG), which will be discussed further. Then the shots are applied on the Descemet membrane, and not on the channel — it turns into a «sieve» and further enhances the outflow.

诸如去盲肠吻合术(BPH)之类的激光程序在这些激光的帮助下，除了显微外科非穿透性深层巩膜切除术(NSEG)之外，我们还经常使用，我们将对此进行进一步讨论。 然后将弹丸涂在Descemet膜上，而不是在通道上-它变成“筛子”并进一步增强流出。

3. And finally, the laser for cyclophotocoagulation. In this case, it doesn't matter what was the cause.

3.最后，使用激光进行循环光凝。 在这种情况下，原因无关紧要。

Used in the advanced end stage of the disease. When the eye does not see or hardly sees, it begins to hurt and bother. On the surface of the eyeball or from inside it (using an endoscope combined with a laser) coagulates are applied at a distance of 1.5 — 3 mm from the limbus in the projection area of ​​the processes of the ciliary body, a rather painful procedure.

用于疾病的晚期阶段。 当眼睛看不到或几乎看不见时，它开始受伤并困扰。 在眼球表面或其内部(使用内窥镜结合激光)在距睫状体突起区域的角膜缘1.5至3 mm处施加凝结物，这相当痛苦程序。

Outdoor cyclophotocoagulation (DPC)户外光凝(DPC)

Schematic representation of endoscopic cyclophotocoagulation.内窥镜循环光凝的示意图。

As a result of coagulation of the secreting ciliary epithelium, which produces intraocular fluid, intraocular pressure decreases. You can use a diode laser (810 nm) and neodymium laser (1064 nm).

由于分泌性睫状上皮的凝结而产生眼内液，眼内压降低。 您可以使用二极管激光器(810 nm)和钕激光器(1064 nm)。

Therefore, the conclusion is that not all lasers are equally useful; a laser can eliminate the cause of glaucoma only with angle-closure glaucoma. A modern ophthalmologic clinic should have at least three types of laser systems for the treatment of various glaucoma variants.

因此，得出的结论是，并非所有激光器都同样有用。 激光只能用闭角型青光眼才能消除青光眼的原因。 现代化的眼科诊所应至少具有三种用于治疗各种青光眼变体的激光系统。

青光眼的外科治疗 (Surgical treatment of glaucoma)

Surgical treatment of glaucoma is aimed at creating an alternative system of intraocular fluid outflow, or at normalizing the circulation of intraocular fluid or reducing its production. This allows you to save the patient from drops or reduce dependence on them. The question of the surgical treatment of glaucoma is decided on the basis of the data of the dynamics of glaucoma strictly individually and depends on the form and its stage, the level of intraocular pressure increase, the outflow coefficient, the state of the anterior chamber angle, the visual field, and the general somatic state of the patient.

青光眼的外科治疗的目的是创造一种替代的眼内液流出系统，或使眼内液循环正常化或减少其产生。 这使您可以避免患者掉落或减少对其的依赖性。 青光眼的手术治疗问题是根据青光眼的动力学数据严格确定的，取决于其形式和阶段，眼内压升高的水平，流出系数，前房角的状态，视野和患者的总体躯体状态。

抗青光眼手术的类型 (Types of antiglaucoma operations)

1. 1. Non-penetrating (non-fistulatizing) antiglaucoma operations. For example, non-penetrating deep sclerectomy (NSEG);

1. 1.非穿透性(非瘘管化)抗青光眼手术。 例如，非穿透性深层巩膜切除术(NSEG)；

In the upper part of the limbus, under the upper eyelid, a pocket of about 4 × 5 mm is formed in the middle layers of the sclera, part of the Schlemm's canal with its inner wall is exposed and removed, and the area of ​​the Descemet membrane adjacent to the limbus is capable of filtering intraocular fluid. To extend the “service life” of this operation, drainage is placed in the pocket (it can be from different materials, for example, collagen) — this prevents adhesion of the pocket walls and scarring in the area of ​​operation.

在角膜缘的上部，上眼睑下方，巩膜的中层形成一个约4×5毫米的袋，施莱姆管的一部分及其内壁暴露并去除，并且角膜缘附近的Descemet膜能够过滤眼内液。 为了延长该手术的``使用寿命''，将引流管放置在口袋中(它可以用其他材料制成，例如胶原蛋白)-这样可以防止口袋壁粘连和在手术区域形成疤痕。

Usually this type of surgery is the primary choice for open-angle glaucoma, because:

通常，这种手术是开角型青光眼的首选，因为：

1. It is as safe as possible, since there are no pressure drops — the eye cavity does not open and the pressure decreases smoothly.由于没有压力下降，因此尽可能安全-眼腔不会张开并且压力会平稳下降。
2. It can be very convenient to combine, if necessary, to simultaneously perform antiglaucoma surgery and cataract surgery如果需要，可以同时进行抗青光眼手术和白内障手术相结合，非常方便
3. There are many drains that enhance and prolong the result of the operation.有许多排水管可以增强和延长手术效果。
4. When properly performed by the surgeon, the risks of potential complications are reduced to an unlikely minimum.如果由外科医生正确执行，则潜在并发症的风险会降低到不可能的最低水平。
5. It is performed on an outpatient basis and the rehabilitation period is 1-2 days.它是在门诊进行的，康复期为1-2天。

Outpatient microsurgery of glaucoma青光眼的门诊显微手术

2. 2. Penetrating (fistulizing) antiglaucoma operations. For example, trabeculectomy;

2. 2.穿透(瘘道化)抗青光眼手术。 例如，小梁切除术；

In this case, a pocket is also formed in the middle layers of the sclera, part of the Schlemm's canal is removed, the eye is opened and the hole in the iris is surgically performed (the iris coloboma).

在这种情况下，巩膜的中间层也形成了一个口袋，切除了施莱姆管的一部分，张开了眼睛，并通过手术进行了虹膜中的Kong(虹膜大眼)。

The difference with the non-penetrating operation is in the opening of the eyeball — in the case of penetrating surgery, the eye is opened, in the case of non-penetrating surgery, a thin semi-permeable Descemet membrane remains intact, due to which the eye is sealed.

与非穿透性手术的区别在于眼球张开-在穿透性手术中，眼睛张开；在非穿透性手术中，半透性Descemet薄膜保持完整，因此眼睛被密封。

It is used in cases of more developed glaucoma and the need for a second operation. An older type of surgery, with various types of drainage that prevent scarring.

它用于青光眼较发达和需要再次手术的情况。 一种较旧的手术，具有各种类型的引流术，可防止瘢痕形成。

The patient's eye after surgery.手术后病人的眼睛。

Penetrating operations are more dangerous, as they can cause postoperative hypotension (long-term persistent pressure reduction), intraocular inflammation and hemorrhage, the appearance of cataracts, but have a longer service life.

穿透性手术更为危险，因为它们可引起术后低血压(长期持续降低压力)，眼内炎症和出血，白内障的出现，但使用寿命更长。

排水类型 (Types of drainage)

There are a great variety of drainage types — they differ in the type of material: hydrogel, collagen, metal and plastic.

引流类型多种多样-物质类型不同：水凝胶，胶原蛋白，金属和塑料。

The shape can be rectangular, oval, square and triangular.

形状可以是矩形，椭圆形，正方形和三角形。

They can be solid or porous, be a tube or a “nail.”

它们可以是固体或多Kong的，可以是管子或“指甲”。

There are so-called valve drains (Ahmed or Malteno) — this is a system of tubes with a plastic “pocket” that provide communication between the anterior chamber of the eye and the space between the eye shells. outflow. Inside the tubes are valves that are able to regulate the flow of intraocular fluid.

有所谓的阀门排水管(艾哈迈德(Ahmed)或马尔特诺(Malteno))-这是一个带有塑料“口袋”的管道系统，可在眼睛的前房和眼壳之间的空间之间提供连通。 外流。 管内是能够调节眼内液流量的阀。

Which is better? There is no ideal, everything is very individual. Everything as always depends on the experience and common sense of the surgeon.

哪个更好？ 没有理想，一切都是非常个人的。 一切都取决于外科医生的经验和常识。

Ahmed’s valve looks like this schematically:

艾哈迈德的阀门示意图如下：

And so — «live»:

等等-«直播»：

«Nail» -mini shunt, made of steel:

«钉子»-钢制迷你分流器：

Drainage of gold is rather expensive and very fragile:

黄金的消耗相当昂贵且非常脆弱：

3. Operations that normalize the circulation of aqueous humor. For example, iridectomy (with closed anterior chamber angle).

3.使房水循环正常化的操作。 例如，虹膜切除术(前房角闭合)。

In case the angle of the anterior chamber is blocked by the iris root, by opening the anterior chamber of the eye we can make a hole in the iris and restore the flow of fluid from the posterior chamber to the anterior chamber of the eye. Microsurgical techniques have made iridectomy less traumatic and practically safe operation.

如果前房的角度被虹膜根部阻塞，则通过打开眼睛的前房，我们可以在虹膜上打个洞，并恢复从后房到眼睛前房的液流。 显微外科技术已使虹膜切除术的创伤小且实用安全。

These operations include iridocycloretraction and others. This type of operation is less predictable in terms of efficiency, is associated with complications such as hemorrhages into the eye cavity, the appearance and rapid maturation of cataracts, and chronic inflammatory process.

这些操作包括虹膜回缩等。 这种手术在效率方面难以预测，并伴有并发症，例如眼腔出血，白内障的出现和Swift成熟以及慢性炎症过程。

4. Operations that reduce the production of aqueous humor. For example, cyclic cryoagulation.

4.减少房水产生的操作。 例如，循环冷冻凝结。

Cyclotriocoagulation is carried out at the terminal stage of glaucoma, as well as in the case of ineffectiveness of trabeculectomy or other similar operations. The zone that produces intraocular fluid can not only be destroyed by a laser — it can be “frozen”. During cyclocryocoagulation using a special cryoprobe on the surface of the sclera cause burns in the projection of the ciliary body, which are arranged in a circle. In the area of ​​burns of a cryoprobe, cells of the ciliary body atrophy due to the influence of low temperatures. As a result, the amount of watery moisture produced is reduced. Exposure 1-2 minutes, 6-8 objects, temperature -130 ° — 150 ° C.

在青光眼末期以及在小梁切除术或其他类似手术无效的情况下，应进行环凝凝结。 产生眼内液的区域不仅可以被激光破坏，还可以被“冻结”。 在巩膜表面使用特殊的低温探针进行环冰凝结过程中，会在睫状体的突出部分烧伤，烧伤呈圆形排列。 在低温探针的灼伤区域，由于低温的影响，睫状体细胞萎缩。 结果，减少了产生的水分。 曝光1-2分钟，6-8个物体，温度-130°-150°C。

In short, a burn or frostbite helps to reduce pressure as an attempt to save the eye as an organ that, unfortunately, does not see.

简而言之，烧伤或冻伤有助于减轻压力，试图将眼睛保存为不幸的是看不到的器官。

5.

5，

根管成形术-Schlemm根管的塑料。 (Canaloplasty — plastic of the Schlemm’s canal.)

The canal of Schlemm (named after the German anatomist Friedrich Schlemm in the 9th-9th century) is the main transport collector draining aqueous humor (speed of about 2-3 microliters per minute) from the anterior chamber of the eye through numerous grids veins of the skull.

Schlemm运河(以9至9世纪德国解剖学家Friedrich Schlemm的名字命名)是主要的运输收集器，它通过眼球的前房从眼前房排出大量房水(速度约为每分钟2-3微升)。颅骨。

This is a vessel that goes around the junction of the cornea and the iris in the thickness of the sclera in the corner of the anterior chamber.

这是一个围绕前房角处巩膜厚度的角膜和虹膜交界处的血管。

The channel in its structure resembles a lymphatic vessel. The inner part of the canal, which comes into close contact with the watery moisture, is covered with a microporous (trabecular) network. This site has the greatest resistance to the outflow of aqueous humor. If the canal trunk or its mesh structure is blocked, glaucoma will develop.

该通道的结构类似于淋巴管。 与含水水分紧密接触的运河内部被微Kong(小梁)网络覆盖。 该部位对房水流出的阻力最大。 如果运河干线或其网状结构被阻塞，则会发生青光眼。

It occurs in atherosclerosis, diabetes, injury or infection of the eye.

它发生在动脉粥样硬化，糖尿病，眼睛受伤或感染中。

This is how Schlemm's channel looks in full face and profile:

这是Schlemm频道的正面和侧面外观：

ОThe operations on the canal include expanding it with various probes and cans, holding special threads “in a circle”, dissection (ab interno trabeculectomy) and, finally, simply filling it with viscous fluids (for example, vysokanalostomy).

О在运河上的手术包括用各种探针和罐头将其扩张，将特殊的螺纹“围成一圈”，解剖(椎间小梁切除术)，最后，简单地用粘性流体(例如，vysokanalostomy)进行填充。

It looks like canaloplasty thread:

看起来像管成形术线：

However, such operations at best give a very short-lived effect due to scarring and recurrent blockage. But scientific research in this direction is constantly being conducted.

但是，由于结疤和反复阻塞，这种操作充其量只能带来非常短暂的效果。 但是，一直在朝着这个方向进行科学研究。

青光眼何时需要手术？ (When does glaucoma need surgery?)

Surgical treatment is an alternative to drug therapy in the initial stage and the only possible way to preserve vision and stabilize the disease in the advanced and advanced stages. Usually, a surgical operation for glaucoma is prescribed with a decrease or absence of the effectiveness of treatment with drugs and the loss of the effect of laser surgery for glaucoma. The period of rehabilitation after operations for glaucoma is usually minimal, there are some small limitations in the postoperative period, but the patient can start work after a few days.

在初始阶段，外科手术治疗是药物治疗的替代方法，并且是在晚期和晚期保持视力并稳定疾病的唯一可能方法。 通常，针对青光眼的外科手术被开处方以降低或不存在药物治疗的有效性以及激光治疗青光眼的效果的丧失。 青光眼手术后的康复期通常最短，术后期有一些小限制，但是患者可以在几天后开始工作。

什么是急性青光眼？ (What is acute glaucoma?)

This is a very dangerous critical condition resulting from a sharp increase in intraocular pressure.

由于眼内压的急剧增加，这是非常危险的危急状况。

An acute attack of glaucoma usually begins suddenly. Usually, with the appearance of pain in the eyeball, and the corresponding half of the head, especially often in the occipital region, it may be accompanied by nausea, often vomiting and general weakness. An acute attack of glaucoma can be confused with a migraine, hypertensive crisis, and even food poisoning; pains can spread to the area of ​​the heart and abdomen that are similar to those in cardiovascular diseases.

青光眼的急性发作通常突然开始。 通常，眼球和相应的半个头部出现疼痛，尤其是在枕骨部位，通常伴有恶心，呕吐和全身无力。 青光眼的急性发作可以与偏头痛，高血压危机甚至食物中毒相混淆； 疼痛可能会扩散到与心血管疾病相似的心脏和腹部区域。

An acute attack of glaucoma appears for no apparent reason against the background of complete health — suddenly there are pains in the eye and in the head, the eye becomes red and watery, the vision decreases, there may appear “rainbow rings” around the sources of light and fogging. The intraocular pressure may increase to 60–80 mm Hg. Art., stops almost or completely outflow of intraocular fluid from the eye. To the touch such an eye becomes as dense as a stone.

在完全健康的情况下，没有明显的原因出现青光眼的急性发作-突然在眼睛和头部出现疼痛，眼睛变红变水，视力下降，放射源周围可能出现“彩虹环”和雾。 眼内压可能增至60–80 mm Hg。 Art。，几乎或完全阻止眼内液从眼睛流出。 这样的眼睛摸起来像石头一样浓密。

Errors in the diagnosis are expensive, as the patient begins to be treated for another condition, and the necessary emergency care in case of an acute attack does not have glaucoma. If, within 1-2 days after the onset of an attack, the intraocular pressure is not reduced with the help of drugs, laser or surgically, the optic nerve dies and the loss of vision becomes irreversible.

诊断错误是昂贵的，因为患者开始接受另一种疾病的治疗，并且在发生急性发作的情况下所必需的紧急护理没有青光眼。 如果在发作后的1-2天内，在药物，激光或外科手术的帮助下眼压没有降低，则视神经死亡并且视力丧失变得不可逆转。

关于该主题的其他帖子 (Other posts on the topic)

• Glaucoma — not heard of it? Meet the serial silent view killer

  青光眼-没听说吗？ 认识串行无声视图杀手

• Cataract: it is waiting for you personally (if you live, of course)

  白内障：它正在亲自等你(当然，如果你活着的话)

翻译自: https://habr.com/en/company/klinika_shilovoy/blog/510966/

青光眼 程序员