Publication: Resultado a medio plazo del implante supracoroideo gold glaucoma micro shunt en pacientes con glaucoma refractario
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2017-03-02
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Universidad Complutense de Madrid
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Abstract
INTRODUCCIÓN: El glaucoma es una neuropatía óptica, primaria o secundaria, en la que se produce una pérdida de campo visual que lleva a un deterioro de la visión. Uno de los principales factores de riesgo es el aumento de la presión intraocular (PIO).Actualmente la base del tratamiento del glaucoma es la reducción de la PIO. El más prevalente es el glaucoma primario de ángulo abierto y constituye una de las principales causas de ceguera en el mundo. Glaucoma refractario es aquel glaucoma que no es adecuadamente controlado con tratamiento médico, láser, quirúrgico convencional ni con la combinación de estos. Clásicamente el glaucoma refractario se ha intentado tratar con antimetabolitos como coadyuvante de las cirugías filtrantes o mediante dispositivos de drenaje clásicos.Actualmente existen otras opciones de tratamiento como el microstent trabecular iStent, el implante Ex-Press, o el Trabectome entre otros. El espacio supracoroideo se ha postulado como un área de drenaje de humor acuoso alternativa al espacio subconjuntival y se ha comprobado que es una vía eficaz de disminuir la PIO en pacientes con glaucoma. Ha sido ensayado previamente en cirugías como la ciclodiálisis ab-interno y ab-externo y con algunos dispositivos de drenaje.La fluorofotometría (FFM) del segmento anterior permite, mediante mediciones seriadas de la concentración de fluoresceína en la cámara anterior, conocer la tasa de recambio (producción y eliminación) del humor acuoso. JUSTIFICACIÓN: El Gold Glaucoma Shunt (GGS) se plantea como una alternativa terapéutica en pacientes con glaucoma refractario. Busca la disminución de la PIO favoreciendo la vía de drenaje supracoroidea y presenta la ventaja adicional de preservar la conjuntiva y el espacio subconjuntival. HIPÓTESIS DE TRABAJO: Nuestra hipótesis de trabajo es que el GGS podría ser eficaz en pacientes con glaucoma refractario. El descenso de PIO se conseguiría mediante el drenaje controlado de humor acuoso al espacio supracoroideo y dicho drenaje se confirmaría mediante FFM. Dada la vía de abordaje quirúrgica no se produciría un daño endotelial importante ni inflamación notable mantenida en la cámara anterior gracias a su composición de oro purificado inerte al 99,95%. No serían previsibles complicaciones importantes...
INTRODUCTION: Glaucoma is an either primary or secondary optic neuropathy where a loss of visual fi eld happens that leads to vision impairment. One of the main risk factors is the increase of intraocular pressure (IOP). Nowadays the base of glaucoma treatment is IOP reduction.The most prevalent glaucoma is primary open angle glaucoma and it is one of the leading causes of blindness in the world. Refractory glaucomas are those glaucomas which are not adequately controlled by means of medical treatment, laser or conventional surgery or the combination of these.The treatment of refractory glaucoma has consisted traditionally of antimetabolites and filtering surgery or classical glaucoma drainage devices. Currently other surgical options are being explored, such as the Trabecular Bypass iStent, Ex-Press Glaucoma Filtration Device or Trabectome among others. Suprachoroidal space has been thought to be an aqueous humor drainage area alternative to subconjunctival space. It has been proved to be an effective way of decreasing IOP in patients with glaucoma by means of ab-interno and ab-externo cyclodialysis and some drainage devices. Anterior segment fl uorophotometry (FFM), by means of sequencial anterior chamber fl uorescence measurements, allows us to know the aqueous humor production and elimination rate. JUSTIFICATION: Gold Glaucoma Shunt (GGS) is proposed as an alternative way to treat refractory glaucoma. Its aim is to decrease IOP by increasing the suprachoroidal aqueous drainage route, and has the additional advantage of preserving the conjunctiva and subconjunctival space and it has te additional advantage. WORKING HYPOTHESIS: Our working hypothesis is that GGS could be effective in patients with refractory glaucoma.The decrease in IOP would be achieved by controlled aqueous humor filtration into the suprachoroidal space, and this filtration would be confirmed by FFM. Given the surgical procedure there would not be severe endothelial damage or persistent anterior chamber inflammation thanks to its 99,95% purified gold composition. Severe complications would not be expected...
INTRODUCTION: Glaucoma is an either primary or secondary optic neuropathy where a loss of visual fi eld happens that leads to vision impairment. One of the main risk factors is the increase of intraocular pressure (IOP). Nowadays the base of glaucoma treatment is IOP reduction.The most prevalent glaucoma is primary open angle glaucoma and it is one of the leading causes of blindness in the world. Refractory glaucomas are those glaucomas which are not adequately controlled by means of medical treatment, laser or conventional surgery or the combination of these.The treatment of refractory glaucoma has consisted traditionally of antimetabolites and filtering surgery or classical glaucoma drainage devices. Currently other surgical options are being explored, such as the Trabecular Bypass iStent, Ex-Press Glaucoma Filtration Device or Trabectome among others. Suprachoroidal space has been thought to be an aqueous humor drainage area alternative to subconjunctival space. It has been proved to be an effective way of decreasing IOP in patients with glaucoma by means of ab-interno and ab-externo cyclodialysis and some drainage devices. Anterior segment fl uorophotometry (FFM), by means of sequencial anterior chamber fl uorescence measurements, allows us to know the aqueous humor production and elimination rate. JUSTIFICATION: Gold Glaucoma Shunt (GGS) is proposed as an alternative way to treat refractory glaucoma. Its aim is to decrease IOP by increasing the suprachoroidal aqueous drainage route, and has the additional advantage of preserving the conjunctiva and subconjunctival space and it has te additional advantage. WORKING HYPOTHESIS: Our working hypothesis is that GGS could be effective in patients with refractory glaucoma.The decrease in IOP would be achieved by controlled aqueous humor filtration into the suprachoroidal space, and this filtration would be confirmed by FFM. Given the surgical procedure there would not be severe endothelial damage or persistent anterior chamber inflammation thanks to its 99,95% purified gold composition. Severe complications would not be expected...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Oftalmología y Otorrinolaringología, leída el 04/02/2016