国际权威解读|青光眼最新微创手术系列之InnFocus 微型引流阀

各位医学同道，由英国伦敦Moorfield眼科医院青光眼科学科带头人、国际青光眼协会主席、英国眼科杂志主编Keith Barton教授带领编写的系列微创青光眼手术介绍文章以患者教育为目的，内容浅显易懂。MedEther Education小编团队特此推出母语朗读和双语对照文字，希望有助于大家了解行业动态和学习医学英语。

基斯·巴顿（Keith Barton ）

基斯·巴顿教授是医学博士、英国皇家眼科医师学院院士、爱丁堡皇家外科医师学院院士、英国皇家医师学院院士、英国皇家医学会高级会员、国际青光眼协会主席、英国眼科杂志（BJO）主编。他是欧美最大规模、有215年历史的眼专科医院英国伦敦摩菲眼科医院(Moorfields Eye Hospital)主任医师及青光眼科学科带头人。同时是英国青光眼阀及其他微创房水引流装置植入术手术量最高的眼科专家。

其他共同作者简介:

内森·克尔（Nathan Kerr）

医学博士、澳大利亚和新西兰皇家眼科医师学院院士，是澳大利亚唯一曾接受微创青光眼手术专科医师培训的专家，擅长白内障和其他各类眼科疾病的诊疗。

需要了解更多关于青光眼微创手术的咨询，请访问migs.org。

What is an InnFocus MicroShunt?
什么是InnFocus 微型引流阀?
 
The InnFocus MicroShunt is an 8 millimetre long tube that is inserted into the eye to help lower eye pressure and reduce the need for medications. InnFocus 微型引流阀是一个长约 8 mm的管道，将其植入眼内有助于降低眼压和减少患者对药物治疗的需求。
 
It is made entirely of synthetic and biocompatible material called SIBS.
这种设备完全具有生物相容性的合成材料SIBS制成。
 
The MicroShunt won’t be rejected by the body and will not disappear or disintegrate with time.
这种微型引流阀不会被机体排斥，也不会随时间而消融或降解。 

As it is not metallic, it will not set off airport scanners and is safe if you need to have an MRI or CT scan.
由于制造材料并非非金属材质，微型引流阀不会触发机场扫描仪，患者也可安全接受核磁共振或CT扫描。

Who is suitable for an InnFocus MicroShunt?
InnFocus 微型引流阀适用于哪些患者 ？ 
 
The Innfocus MicroShunt is suitable for patients with uncontrolled eye pressure, as its pressure lowering effect is superior to implants that target the normal drainage channels (iStent, Hydrus or CyPass).
Innfocus 微型引流阀适用于眼压控制不良的患者，因为相比于针对正常引流通道的植入物（iStent，Hydrus或CyPass），其降眼压效力更强。
 
Innfocus MicroShunt might be as effective as trabeculectomy and it is therefore potentially suitable for moderate-to-advanced glaucoma.[1]  
Innfocus 微型引流阀可能与小梁切除术一样有效，因此它可能适用于中晚期青光眼患者。[1]
 
This is currently under investigation in a large international trial, and is not yet commercially available.  
目前Innfocus 微型引流阀正处于大型国际临床试验的研究验证阶段，尚未在市场上销售。

How does it work?
Innfocus 微型引流阀的工作原理是什么？ 
 
Glaucoma is most commonly associated with a buildup of fluid pressure inside the eye.
青光眼是最常见的与眼内流体压力累积增高相关的疾病。 
 
This buildup of fluid pressure is caused by partial blockage of the natural drainage channel of the eye.
这种流体压力的累积增高由眼睛的天然排水通道部分阻塞造成。
 
This pressure can damage the optic nerve which carries images from the eye to the brain affecting your vision.  
这种压力会损伤负责将眼睛获取的图像信息传入大脑的视神经，对视功能造成影响。
 
This fluid produced inside your eye is called aqueous humour, which is not your tear.  眼内产生的这种液体称为房水，是一种不同于眼泪的液体。 
 
Like trabeculectomy surgery, the MicroShunt drains fluid from inside the eye to outside, under a thin skin-like membrane covering the white of the eye called conjunctiva. The fluid is drained and pooled under conjunctiva forming what is called a bleb.
类似于小梁切除术，微型引流阀将液体从眼内引流到眼外，聚集到眼睛白色部分表面称为结膜的表皮样薄膜下，形成称为滤过泡的结构。
 
Unlike iStent, Hydrus or Cypass, which enhance the normal drainage of the fluid, MicroShunt and XEN implants are more similar to trabeculectomy and traditional aqueous implants (Ahmed or Baervledt) which create a new drainage pathway for aqueous humour. The latter is more effective at lower eye pressure.  
有别于增强液体正常排出通路的iStent、Hydrus 或 Cypass，微型引流阀和XEN等植入物的作用更类似于小梁切除术和传统的房水引流阀植入术（Ahmed或Baervledt引流阀）。这类手术的工作原理是建立一条新的房水引流通路。后者的降眼压效果更强。
 
However, you may not require very low eye pressure if you only have mild glaucoma.
如果青光眼程度很轻，患者则可能不需要把眼压降得很低。 
 
The MicroShunt can only be seen inside the eye under very high magnification.
植入眼内的微型引流阀只在非常高的放大倍率下才能看到。


What are the benefits?
Innfocus 微型引流阀能给患者带来什么益处？ 
The Innfocus MicroShunt will lower your eye pressure and prevent further damage to the optic nerve caused by eye pressure.
Innfocus 微型引流阀可以降低患者的眼压，并防止由高眼压引起的视神经的进一步损伤。
 
Innfocus MicroShunt could be as effective as trabeculectomy.
Innfocus 微型引流阀可以同小梁切除术一样有效。 
 
However, this hypothesis is still currently under formal investigation.
但上述假设目前正在研究验证中。
 
Compared to trabeculectomy, Innfocus MicroShunt has the advantage that the procedure is shorter, less invasive, and requires fewer post-operative visits.
与小梁切除术相比，innfocus 微型引流阀植入术具有手术时间短，创伤小，术后所需随访少等优点。 
 
The InnFocus MicroShunt will not cure your glaucoma, reverse any damage already caused by glaucoma, or bring back any lost vision.
InnFocus 微型引流阀并不能完全治愈青光眼，也不能逆转已经发生的青光眼损害或挽回已丧失的视力。


What does the operation involve?
手术过程是怎样的？
 
The operation is usually performed under a local anaesthetic, meaning that you are awake but your eye is numb so you will not feel anything.
这项手术通常使用局部麻醉，意味着手术过程中患者意识是清醒的但眼睛在麻醉状态下不会有任何感觉。
 
Your eye will be numbed with eye drops and then a small injection will be given around your eye.
眼部麻醉的方式是先使用滴眼液，然后在眼周注射少量药物。
 
The injection may cause a pressure sensation and brief discomfort. You will have the option of requesting light sedation.
患者可以选择使用轻度镇静剂。
 
The local anaesthetic takes several hours to wear off and may affect your vision during this time.
局部麻醉需要数小时才能失效。在这段时间内，患者的视力可能会受到影响。
 
Similar to trabeculectomy, a medication called mitomycin C will be applied to reduce scarring. It is designed to enhance the long term success of the surgery.
类似于小梁切除术，手术中将会使用丝裂霉素C以减少瘢痕形成。目的是提高术后的长期成功率。
 
The thin skin like membrane covering the white of your eye (conjunctiva) will be opened and the InnFocus MicroShunt is inserted inside your eye. The conjunctiva will be closed with one or two stitches (in contrast, 4-6 stitches will be required for trabeculectomy).
术中会切开覆盖患者眼睛白色部分的表皮样薄膜（结膜），随后将InnFocus 微型引流阀植入患者的眼内。随后用1~2针缝线闭合结膜（相比之下，小梁切除术则需要缝合4~6针）。 
 
The entire surgery takes about 20 minutes.
整个手术过程大约需要20分钟。 
 
Compared to trabeculectomy, MicroShunt requires less stitches.
与小梁切除术相比，微型引流阀所需要的缝合针数更少。
 
These stitches will be removed later in clinics or dissolved by themselves.
对这些缝线可进行拆除或待其自行溶解吸收。 


How soon will I recover?
术后多快能康复？
Following surgery your eye may be slightly blood shot and swollen for a few days. Your vision may also be blurry for 1 – 2 weeks after the procedure.
术后几日内患者的眼睛可能会出现轻微充血及肿胀。术后1~2周内可能出现视力模糊。
 
You may read and watch television; these activities will not harm your eye.
患者可以阅读和看电视，这些活动不会对手术眼造成损害。
 
You will generally have no sensation from the presence of the bleb.
患者通常不会感觉到滤过泡的存在。 
 
You will be given new anti-inflammatory and antibiotic eye drops to prevent inflammation and infection.
为了防止炎症和感染，患者需要使用未曾开封的抗炎和抗生素滴眼液。
 
The anti-inflammatory drops will normally need to be continued for 3 months.
抗炎滴眼液通常需要持续用药3个月。
 
The MicroShunt will begin to work straight away to lower your eye pressure and you can stop taking ALL your glaucoma drops in the operated eye.
手术后，微型引流阀会立即起效以降低患者的眼压，患者可以在手术眼上停用所有抗青光眼滴眼液。 
 
Any drops you use in your other eye must be continued as normal.
而患者未经手术的对侧眼正在使用的任何滴眼液则必须继续正常使用。 
 
As with all eye surgeries, you should avoid strenuous activity for the first month including swimming, tennis, jogging, and contact sports.
跟所有眼科手术一样，患者要在术后一个月避免剧烈运动，包括游泳、网球、慢跑和接触性运动。
 
Most people take 1 – 2 weeks off work after surgery, however the length of time will depend on the nature of your work.
大多数人在术后请假休息1~2周，具体时间长短取决于患者的工作性质。
 
It is safe to fly after surgery, however you will need to be seen few times by your surgeon in the first two months.
手术后可以安全乘坐飞机，但在术后前两个月，患者需要找手术医生复诊几次。

 What are the risks?
这种手术有什么风险？
It is normal for there to be a small amount of bleeding inside the eye during the operation but this resolves within a few days. If this happens, your vision could be blurred for one to two weeks.
手术中眼内少量出血是正常的，但几天内即可被吸收。如果出现这类情况，患者在术后的1~2周内可能会感到视物模糊。
 
Like all glaucoma surgery, the eye pressure lowering effect of MicroShunt may wear off with time.
像所有的青光眼手术一样，微型引流阀的降眼压效果可能会随着时间延长而逐渐减弱。
 
This is most due to scarring around the MicroShunt.
这主要是由于微型引流阀周围疤痕组织的形成所致。 
 
If this happens, you will need to restart your glaucoma medications or have further procedures to control your eye pressure, which would usually be an aqueous shunt (Baerveldt or Ahmed implant).
如果发生这种情况，患者将需要重新启用青光眼治疗药物或接受进一步手术来控制眼压，此时通常做的是房水引流阀植入术（植入Baerveldt或Ahmed引流阀）。
 
Like trabeculectomy or XEN implants which all create blebs, any bleb related risk such as life-long risk of infection is potentially present in MicroShunt surgery.
类似于小梁切除术或XEN植入术，这些手术均会产生滤过泡，因此任何与滤过泡有关的风险都有可能并发于微型引流阀植入术，如终生都可能存在的感染风险。 


Are there any alternatives?
有什么替代疗法？
The closest alternatives to the MicroShunt will be a traditional trabeculectomy or aqueous shunt implant (Baerveldt or Ahmed).
与微型引流阀最接近的替代方案是传统的小梁切除术或房水引流阀植入术（植入Baerveldt或Ahmed）。
 
At this stage, we do not have long term data on MicroShunt as we do with trabeculectomy.
在现阶段，关于微型引流阀，我们还没能收集到像小梁切除术一样的长期数据。 

基斯·巴顿教授是医学博士、英国皇家眼科医师学院院士、爱丁堡皇家外科医师学院院士、英国皇家医师学院院士、英国皇家医学会高级会员、国际青光眼协会主席、英国眼科杂志（BJO）主编。他是欧美最大规模、有215年历史的眼专科医院英国伦敦摩菲眼科医院(Moorfields Eye Hospital)主任医师及青光眼科学科带头人。同时是英国青光眼阀及其他微创房水引流装置植入术手术量最高的眼科专家。

References and Disclaimer
参考文献和免责声明
[1] Batlle, J.F., et al., Three-Year Follow-up of a Novel Aqueous Humor 微型引流阀. J Glaucoma, 2016. 25(2): p. e58-65.
 
本文仅作为参考信息，不能用作疾病的诊疗方案。
This leaflet is for information only and should not be used for the diagnosis or treatment of medical conditions. 

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