Новая хирургическая методика антиглаукомной операции с биодеградирующим дренажем для стабилизации гипотензивного эффекта

Abstract

Purpose. To develop a modification of sinus trabeculectomy (STE) using a new biodegradable drainage in glaucoma surgery for normalizing and stabilizing aqueous humor outflow along the formed pathways. Material and methods. We observed 63 patients (63 eyes) with primary open-angle glaucoma in the advanced stages with previous surgeries. The patients were divided into groups: Group 1 (main group) – 32 patients who underwent the proposed modification of STE using a new biodegradable drainage (absorbable suture material Vicryl); Group 2 (control) – 31 patients with standard STE and implantation of ‘Xenoplast’ drainage The maximum duration of patients’ follow-up was 24 months. Results. The total number of intra- and early postoperative complications in the main group was less (25%) than in the control group (41.9%). This was especially true of a ciliochoroidal detachment, which was recorded much less frequently after STE with biodegradable drainage than after a standard operation with Xenoplast drainage implant (3.1% vs. 9.7%). 2 years after surgery in the main group, complete IOP compensation was observed in 84.4% of cases, partial – in 12.5% of cases. The unsuccessful outcome was observed in 3.1% of cases. In the control group, the corresponding results were: 70.9% and 16.1% with hypertensive failure equal to 12.9%. Conclusion. The STE modification was developed using a new biodegradable drainage (absorbable suture material Vicryl) to form a stable pathway of the aqueous humor outflow and prolong the hypertensive effect of the operation. It was found that intra- and early postoperative complications after the modified version of STE were less common than in the control group (especially ciliochoroidal detachment – 3.1 fold lower). At the same time, the hypertensive results of the proposed operation without additional drug load in patients with advanced and far-advanced stages of POAG with previous glaucoma surgeries were higher (84,4%) in the long-term follow-up than the efficacy of traditional STE with Xenoplast drainage (70,9%). Key words: primary open-angle glaucoma, surgical treatment, modification of sinus trabeculectomy, biodegradable drainage, stability of the hypertensive effect.