Dispozitive actuale de drenaj pentru glaucom: provocări biologice și concepte de proiectare

Maria  Iacubițchii; Eugeniu Bendelic

Autori

Maria Iacubițchii Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“ https://orcid.org/0000-0001-8305-9814
Eugeniu Bendelic Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“ https://orcid.org/0000-0001-7127-9457

Cuvinte cheie:

glaucom, dispozitive de drenaj pentru chirurgiaglaucomului, fibroză, biomaterial, microșunt, chirurgieminim invazivă

Rezumat

Tratamentul glaucomului are drept scop menținerea funcției vizuale și a calității vieții pacienților, prin prevenirea progresiei neuropatiei optice glaucomatoase și minimizarea efectelor adverse asociate. Acest lucru este realizat prin menținerea unui nivel adecvat al presiunii intraoculare, stabilizarea stratului de fibre nervoase retiniene și prevenirea degradării câmpului vizual. Opțiunile terapeutice disponibile pentru pacienții cu glaucom cu unghi deschis includ: medicație, trabeculoplastie laser și chirurgia incizională a glaucomului. O componentă esențială a tratamentului chirurgical al glaucomului o reprezintă utilizarea dispozitivelor de drenaj. Microșunturile subconjunctivale, dispozitivele de restaurare a canalului lui Schlemm, sistemele de drenaj supracoroidale și implanturile convenționale pe bază de placă au fost toate dezvoltate ca urmare a progreselor majore înregistrate în proiectarea implanturilor. A fost efectuată o revizuire sistematică a literaturii de specialitate privind cercetările publicate între 2015 și 2025. Analiza arată că, deși diferite tipuri de implanturi utilizează căi diferite de drenaj al umorii apoase, factorul cheie care influențează eficacitatea pe termen lung este în continuare de natură biologică. În clasificarea conceptuală a fost inclus și șuntul antiglaucomatos cu supapă dezvoltat la Catedra de oftalmologie a USMF „Nicolae Testemitanu”, care poate fi considerat un dispozitiv de drenaj cu reglare parțială a fluxului la nivelul implantului prin intermediul unui mecanism integrat de supapă. Șuntul propus reprezintă o încercare conceptuală de a transfera parțial reglarea rezistenței de la încapsularea biologică la controlul fluxului la nivelul implantului. Deși această metodă pare promițătoare din punct de vedere teoretic, este nevoie de mai multe studii experimentale și clinice pentru a stabili dacă este sigură și eficientă pe termen lung.

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