PRESERFLOTM Microshunt Implantation and Multiple Non-penetrating Deep Sclerectomy in Primary Open-angle Glaucoma Surgery

To compare the intraocular pressure lowering effect and the frequency of post-operative complications in two of the most used filtration surgery techniques: trabeculectomy and non-penetrating deep sclerectomy (NPDS) without collagen implants. Thirty-four eyes of 17 patients with medically uncontrolled symmetrical primary open-angle glaucoma were included in the study. One randomly selected eye per patient had either trabeculectomy or NPDS without collagen implants as the first surgical procedure. The other eye underwent the second filtration surgery technique less than 6 weeks later. Post-operatively, the intraocular pressure (IOP) diurnal curves were determined at 1, 2, 3, 6, 12 and 18 months. The intergroup differences in IOP lowering effect were determined in an analysis of covariance (ANCOVA), with pre-operative IOP as a changing covariate. Kaplan-Meier survival curves were drawn for IOP, and intercurve analysis was performed. Comparisons of the number of post-operative antiglaucomatous medications, as well as of the complication rate, were done by 2 x 2 frequency tables. A p value of less than 0.05 was considered statistically significant. There were statistically significant differences in post-operative IOP level between the two groups at 1, 2, 3, 6, 12 and 18 months, with a lower level in the trabeculectomy group. Using the Kaplan Meier cumulative survival curve, the trabeculectomy patients had a better complete success rate than the NPDS patients at 18 months post-operatively. There were statistically significantly fewer complications in the NPDS group. Trabeculectomy lowers the IOP more than the NPDS technique. However, the complication rate seems to be lower in NPDS.

ЦЕЛЬ. Анализ средне- и долгосрочных результатов имплантации мини-шунта Ex-PRESS в лечении глаукомы. МЕТОДЫ. Непроникающая глубокая склерэктомия с имплантацией мини-шунта Ex-PRESS R-50 проведена на 198 глазах 177 пациентов с неконтролируемой и/или рефрактерной к медикаментозной терапии глаукомой в период с 2011 по 2014 гг. Критерии исключения пациентов: наличие неоваскулярной, закрытоугольной или врожденной глаукомы, предшествующие офтальмологические оперативные вмешательства в течение последних 6 месяцев, необходимость одномоментной комбинированной хирургии катаракты и глаукомы. В исследование включен 161 пациент (176 глаз). В анамнезе у 126 (77,6%) пациентов отмечено проведение других антиглаукомных хирургических вмешательств, у 108 (67%) пациентов была выполнена факоэмульсификация катаракты с имплантацией ИОЛ, 43 (26,7%) пациентам проведена витрэктомия, при этом все хирургические вмешательства были выполнены в сроки более 6 месяцев перед настоящим исследованием. Стандартное плановое офтальмологическое обследование всем пациентам выполняли до хирургического вмешательства и в сроки 1 день, 7 дней, 1, 2, 3, 6, 12, 18, 24 и 36 месяцев после имплантации дренажа. У части пациентов осмотры проводили также в 48 (n=44; 27,3%) и 60 (n=21; 13%) месяцев после операции. Дополнительно проведено разделение пациентов на группу 1 («факичная» глаукома; n=53; 32,9%) и группу 2 (артифакичная глаукома; n=108; 78,3%). РЕЗУЛЬТАТЫ. Средний период наблюдения составил 43,7±2,9 месяцев. Средний возраст пациентов на момент хирургического вмешательства 72,4±9,6 лет, из них 63 (39,1%) мужчин и 98 (60,9%) женщин. Отмечено снижение внутриглазного давления (ВГД) по сравнению с дооперационными значениями 32,3±8,7 до 6,2±7,7 мм рт.ст. через 1 неделю, 11,9±5,8 мм рт.ст. через 1 месяц, 12,5±4,0 ‒ через 2 месяца, 12,7±4,8 ‒ через 3 месяца, 12,1±4,5 ‒ через 6 месяцев, 11,7±4,2 ‒ через 12 месяцев, 12,9±5,1 мм рт.ст. через 18 месяцев после хирургического вмешательства. В срок наблюдения 24 месяца отмечено снижение ВГД до 15,3±6,6 мм рт.ст., а в сроки наблюдения 36 месяцев – до 17,5±6,8 мм рт.ст. (45,8%). У 44 (27,3%) пациентов через 48 месяцев отмечено превышение уровня границы «успеха» - 22,4±8,0 мм рт.ст. В срок 60 месяцев после операции при анализе динамики ВГД у 21 (13%) пациента средний его уровень составил 26,1±8,2 мм рт.ст. У пациентов отмечено статистически незначимое изменение МКОЗ с 0,61±0,25 в предоперационном периоде до 0,57±0,31 во время последнего осмотра (p>0,1). Показано значимое снижение количества принимаемых антиглаукомных препаратов, при этом в срок наблюдения 24 месяца после хирургического вмешательства оно составило 0,55±1,1 против 2,7±0,9 в дооперационном периоде (p=0,002), а в срок наблюдения 36 месяцев – 0,89±1,2 (p=0,01). Во всех исследуемых случаях в послеоперационном периоде (10-14 дней) проводили ежедневный массаж фильтрационной зоны. У 94 (58,4%) пациентов выполнено ИАГ-лазерное воздействие на шунт в различные послеоперационные сроки. Из осложнений наиболее часто отмечали транзиторную гипотонию в раннем послеоперационном периоде, симптом Зейделя, а также инкапсулирование фильтрационной подушки, которое требовало дополнительного амбулаторного вмешательства. В максимальный срок наблюдения 36 месяцев несколько лучшие результаты получены во 2-й группе (среднее ВГД 15,9±4,2 против 17,3±4,4 мм рт.ст. в группе 1, p>0,1). Аналогичные отличия получены и для количества антиглаукомных препаратов (0,81±0,9 в группе 2 против 0,97±1,1 в группе 1, p>0,1). Несколько большие различия получены для максимально корригированной остроты зрения в отдаленном периоде наблюдения (0,62±0,26 во 2-й группе против 0,38±0,21 в 1-й группе, 0,05

PURPOSE. Analysis of the results of surgical treatment of glaucoma by non-penetrating deep sclerectomy (NPDS) combined with suprachoroidal implantation of collagen drainage.METHODS. This open prospective study included a total of 98 patients (104 eyes), 45 men and 53 women with primary open-angle glaucoma who were examined and operated on. All patients underwent non-penetrating deep sclerectomy with implantation of the "Xenoplast" drainage. Group I (n=72) consisted of patients without suprachoroidal drainage, and Group II (n=32) — patients who were implanted the drainage. Group I included 15 cases (20.8%) with stage I glaucoma, 17 (23.6%) — stage II, 38 (52.8%) — stage III and 2 (2.8%) — stage IV. Group II patients had stage I glaucoma in 8 cases (25%), stage II in 5 (15.6%), stage III in 17 (53.1%) and stage IV in 2 cases (6.3%). The mean age of study patients was 68.2±7.4 years.RESULTS. All early postoperative complications were transient. There were no significant differences in the frequency of complications between the two groups (p>0.05). In group I patients, Descemet’s goniopuncture was performed significantly more frequently than in group II (p<0.05). No complications were detected in the late postoperative period. Pronounced hypotensive effect wasobserved in both groups on the first day after the operation, IOP in group I was slightly lower and amounted to 15.5±2.3 mm Hg in comparison with 17.3±2.5 mm Hg in group II (p>0.05). Further, after 7 days and 1 month, we observed a slight increase of IOP in group I up to 17.2±2.0 mm Hg, while in Group II it remained practically unchanged. After 1 and 2 years of observation, a respective increase of the mean IOP to 18.5±2.8 and 17.8±2.6 mm Hg was registered in group I. Group II, on the contrary, showed a decrease in IOP in these periods to 16.8±1.9 and 16.2±1.8 mm Hg, respectively (differences between the groups were not statistically significant, p>0.05). In group I, the mean number of instillations used to achieve target IOP was 0.89±0.27; in group II it was 0.83±0.26 (p>0.05). The rate of achieving "complete" success after 6 months and 2 years of observation in groups I and II did not differ significantly and was 94.4% and 90.6%, 65.3% and 59.4%, respectively (p>0.05).CONCLUSION. This paper presents a comparative analysis of the results of non-penetrating deep sclerectomy and collagen drainage implantation depending on the involvement of the suprachoroidal space in the operation with 24 months follow-up. Both groups were comparable in the majority of studied parameters, except for the frequency of laser Descemet’s goniopuncture in the postoperative period (it was significantly lower in the group with suprachoroidal drainage). The proposed technique is effective and safe in the treatment of primary open-angle glaucoma.

The surgery of Schlemm's canal is related to microinvasive surgery for primary open-angle glaucoma, which is why this area in ophthalmology is rapidly advancing and is a priority. The goal is to develop a technique for canal dilation performed during non-penetrating deep sclerectomy, as well as to assess its impact on the condition of Schlemm's canal and the hydrodynamic parameters of the eye. Materials and methods: This paper presents an analysis of the results of non-penetrating surgery with Schlemm's canal dilation in 30 patients (30 eyes) with advanced primary open-angle glaucoma (main group) compared to standard technology for minimally invasive non-penetrating surgery (30 patients, 30 eyes). All patients underwent ophthalmoscopy, biomicroscopy, keratorefractometry, computer perimetry, tonometry, tonography, gonioscopy, pachymetry, optical coherence tomography of the optic nerve head and anterior segment with measurement of the longitudinal and transverse axis diameters, as well as the area of sagittal scanning of Schlemm's canal. Results and discussion: The hypotensive effect after surgery was more pronounced in the main group of patients at 45.3 %, compared to 39.3 % in the control group (p 0.05). The hypotensive effect in the main group was due to a significantly greater outflow of intraocular fluid. The difference between the mean values of the outflow facility coefficient of intraocular fluid in the main group, (0.3 ± 0.05) mm³/mm Hg × min, and the control group, (0.24 ± 0.04) mm³/mm Hg × min, was statistically significant (p 0.001). Six months after surgery, the average area of Schlemm's canal was 41.7 % larger than that of the control group patients. The difference between the mean values of the area of Schlemm's canal in the main group, (1996.7 ± 232.4) µm², and the control group (1163.4 ± 226.9) µm², was statistically significant (p 0.001). Conclusion: Canal dilation during non-penetrating glaucoma surgery allows for the safe elimination of Schlemm's canal collapse, significantly expanding its lumen, normalizing intraocular hydrodynamics, and contributing to the stabilization of visual functions.

Glaucoma filtration surgeries remain the cornerstone of management for patients with primary open-angle glaucoma (POAG) who exhibit inadequate intraocular pressure (IOP) control despite maximal medical therapy. Among the commonly performed procedures, sub-scleral trabeculectomy (SST) and non-penetrating deep sclerectomy (NPDS) are widely utilized for their proven efficacy in lowering IOP. However, beyond IOP reduction, these surgical interventions may induce structural and biomechanical alterations in the cornea due to scleral flap creation, tissue manipulation, suturing techniques, and postoperative wound healing responses. Such changes can influence corneal curvature and induce surgically related astigmatism, thereby affecting visual quality and refractive stability in the postoperative period. Despite the clinical importance of these refractive alterations, the magnitude and pattern of corneal topographic changes following different glaucoma surgical techniques remain incompletely understood. A clearer understanding of these changes is essential to optimize surgical planning, improve postoperative visual outcomes, and provide accurate patient counseling : The present study aimed to evaluate and compare corneal topographic changes following sub-scleral trabeculectomy (SST) and non-penetrating deep sclerectomy (NPDS) in patients diagnosed with primary open-angle glaucoma (POAG). Specifically, the study sought to quantify surgically induced alterations in keratometric parameters and corneal astigmatism using computerized corneal topography, and to determine whether one surgical technique results in greater refractive impact than the other.This prospective comparative study enrolled 30 eyes of 30 patients diagnosed with primary open-angle glaucoma. Participants were equally allocated into two groups according to the surgical technique performed. Group A comprised patients who underwent sub-scleral trabeculectomy (SST) with intraoperative application of Mitomycin C (MMC) at a concentration of 0.2 mg/ml for 2 minutes. Group B included patients who underwent non-penetrating deep sclerectomy (NPDS), also with intraoperative application of MMC at a concentration of 0.2 mg/ml for 2 minutes. All patients underwent a comprehensive preoperative ophthalmic evaluation, including measurement of best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure assessment, gonioscopy, and fundus examination. Computerized corneal topography was performed preoperatively and repeated at 3 months postoperatively to assess corneal curvature changes. The primary outcome measures included changes in keratometric parameters: flat keratometry (K1), steep keratometry (K2), average keratometry (Avg K), corneal astigmatism (magnitude and axis), and apical keratometry front (AKf). Surgically induced changes were calculated by subtracting preoperative values from postoperative measurements. The collected data were statistically analyzed to compare topographic changes between the two surgical groups. The study was conducted at the Ophthalmology Department of Mother Theresa University Hospital Center between April 2025 and November 2025. A highly statistically significant increase (p < 0.001) was observed in keratometric changes in Group A (SST) compared with Group B (NPDS). Specifically, the mean change in flat keratometry (ΔK1) was 0.47 ± 0.09 D in Group A versus 0.22 ± 0.09 D in Group B. Similarly, the mean change in steep keratometry (ΔK2) was 0.86 ± 0.18 D in Group A compared to 0.46 ± 0.08 D in Group B. Surgically induced corneal astigmatism was also significantly greater in Group A (1.32 ± 0.13 D) than in Group B (0.69 ± 0.10 D). In contrast, no statistically significant differences were detected between the two groups with respect to changes in average keratometry (ΔAvg K) or apical keratometry front (ΔAKf), indicating comparable overall corneal curvature stability in these parameters. Glaucoma filtration surgery is associated with measurable corneal topographic alterations that may influence postoperative refractive outcomes. Surgically induced astigmatism appears to contribute to reduced unaided visual acuity during the early postoperative period. Sub-scleral trabeculectomy demonstrated a significantly greater impact on corneal astigmatism compared to non-penetrating deep sclerectomy. These findings suggest that NPDS may offer a relative refractive advantage in terms of minimizing surgically induced astigmatism.

PURPOSE. To determine the role of extracellular matrix (ECM), transforming growth factor β (TGF-β) and matrix metalloproteinase 9 (MMP-9) in the mechanisms of filtering bleb formation after non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).METHODS. The study consisted of prospective examination of 65 patients with POAG operated by the NPDS method. Three groups were formed: group 1 — optimal hypotensive effect of NPDS (21 patients); group 2 — relative hypotensive effect (23 people); group 3 — absence of hypotensive effect (21 patients). During the postoperative period, the condition of the intraocular fluid outflow pathways was evaluated with ultra biomicroscopy, optical coherence tomography, level of intraocular pressure, as well as the concentrations of TGF-β and MMR-9 in the tear and aqueous humor.RESULTS. The anterior chamber aqueous humor was found to contain TGF-β in all patients with glaucoma. Group 1 was noted to have minimal initial TGF-β concentrations in the tear and aqueous humor, high MMR-9 level in the pre- and postoperative period. Sparse extracellular matrix was the substrate for the filtering blebs. Group 2 was revealed to have elevated initial concentrations of TGF-β in the tear and aqueous humor, extremely high level of MMP-9 in the aqueous humor, accumulation of MMP-9 in the tear after 2 weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early period, loci of rigid ECM were visualized in the filtering blebs, but functional outflow pathways were successfully formed by month two after additional therapy. Group 3 was established to have maximum TGF-β concentrations and low MMP-9 concentrations in the anterior chamber aqueous humor, a decrease in tear MMP-9 after two weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early postoperative period, the filtering blebs were based on rigid ECM, by month two there was scar deformation of the outflow pathways.CONCLUSION. The important conditions for the formation of functional filtering blebs after NPDS are the structural organization of temporary ECM of the filtering blebs in the early postoperative period and the timely degradation of ECM components with predominant concentration of MMR-9 over TGF-β.

Purpose. The purpose of this study is to evaluate the effectiveness of various treatment methods for early stage POAG. Material and methods. The study included 298 patients (298 eyes) with the initial stage of POAG, who were treated in the glaucoma department at the Federal State Institution National Medical Research Center MNTK Eye Microsurgery named after. acad. S.N. Fedorov of the Russian Ministry of Health from 2020 to 2022. The patients were divided into 3 groups. Patients of group 1 (101 patients – 101 eyes) were administered local antihypertensive therapy with prostaglandin analogues, patients of group 2 (99 patients – 99 eyes) underwent selective laser trabeculoplasty (SLT), patients of group 3 (98 patients – 98 eyes) – non-penetrating deep sclerectomy (NPDS). The follow-up period was 3 years. Results. The effectiveness of prostaglandin monotherapy was 66.3%, while by 3 years of follow-up, SLT was performed in 22 cases (21.8%), and NPDS was required in 12 cases (11.9%). The effectiveness of SLT in the second group was 73.7%, in 34 cases (34.3%) SLT had to be repeated and in 15 cases (15.2%) of them a subsequent NPDS was performed, 11 cases (11.1%) required intensification of antihypertensive regimens. The efficacy of two-stage treatment in group 3 (NPDS + descemetogoniopuncture (DGP)) was 85.7%, with DGP performed in 42 cases (42.8%), antihypertensive regimens intensified in 14 cases (14.3%). Conclusion. The effectiveness of prostaglandins was 66.3% at baseline, SLT – 73.7%, NPDS – 85.7% Key words: primary open-angle glaucoma, treatment at the initial stage, antihypertensive therapy, selective laser trabeculoplasty, non-penetrating deep sclerectomy

Today the mechanisms of pathological scarring and inconsistency of the intraocular fluid outflow pathways after nonpenetrating deep sclerectomy (NPDS), reducing its effectiveness, have not yet been determined. There is no systematic information about the regulatory role of cytokine TGF-β and MMP-9 in the mechanisms of formation of the newly created intraocular fluid outflow pathways.Aim: to assess changes in the clinical and immunological status of patients with open-angle glaucoma after NPDS in the early postoperative period.Methods. A prospective examination of 26 patients with open-angle glaucoma before and in 1 month after NPDS with determination of concentration of TGF-β and MMP-9 in tear humor. One month after NPDS, all patients were divided into two groups depending on the effect of the operation achieved according to the developed criteria.Results. Before the operation, tears TGF-β values in group 1 exceeded baseline values of group 2 by 1.4 times, the initial content of MMP-9 in tears in both groups was comparable. After the operation, in group 1, a moderate increase in the concentration of tears TGF-β by 1.3 times and a significant increase in the concentration of tears MMP-9 in 4.6 times compared with baseline values were revealed. In patients of group 2, after NPDS, there was a significant increase in the concentration of tears TGF-β, on average, 2.4 times relative to preoperative values, the content of MMP-9 did not significantly change.Conclusion. 1 month after NPDS, an imbalance in the concentration of TGF-β and MMP-9 in tears was detected in patients of the two groups that have fundamental clinical differences in the hypotensive effect and the formation of postoperative intraocular fluid outflow pathways.

The aim. To assess the dynamics of cytokine content in tear fluid of primary openangle glaucoma (POAG) patients at various terms after non-penetrating deep sclerectomy (NPDS) in relation to the functional state of the outflow tracts.Material and methods. We carried out prospective examination of 65 patients with advanced stage of primary open-angle glaucoma after NPDS. Depending on the course of the postoperative period and the conditions for achieving the hypotensive effect of NPDS, all patients were divided into three groups: group 1 – with the optimal hypotensive effect; group 2 – with the conditional hypotensive effect; group 3 – with no hypotensive effect after NPDS. The intraocular pressure and the concentration of TGF-β, MMP-9, IL-6, IL-8, VEGF-A (121 and 165) in the tear fluid were studied using ELISA method in pre- and postoperative period. We studied the outflow tracts using optical coherence tomography and carried out ultrastructural analysis of filtering blebs tissue.Results. In group 1, the minimum initial concentrations of IL-6, IL-8 and TGF-β in the tear fluid and their moderate increase in the postoperative period; high concentrations of MMP-9 at all stages and an increase in VEGF-A by 2 months after NPDS were registered. In group 2, there was a high level of VEGF-A in the tear fluid before and 2 months after NPDS, an increase in TGF-β, IL-6 and IL-8 in the tear fluid in the early period with their suppression in the late period, as well as an increase in MMP-9 in the early postoperative period. Group 3 had maximum concentrations of TGF-β and IL-8 in the tear fluid initially and in the early postoperative period, suppression of MMP-9 in the tear fluid 2 weeks after and of VEGF-A 2 months after NPDS.Conclusion. Initially high concentrations of IL-6, IL-8, and TGF-β in the tear fluid and the suppression of MMP-9 and VEGF-A in the postoperative period contribute to the surgical failure of the NPDS.

Purpose: comparative study of trabeculectomy results with various models of domestic “Glautex” drainage in the surgical treatment of primary open angle glaucoma (POAG). Patients and methods. The results of surgical treatment of 98 (105 eyes) patients with POAG aged 50–83 years who underwent trabeculectomy with various Glautex drainage models were analyzed. There were 43 men (43.9 %) and 55 (56.1 %) women. The second (II) stage of POAG was diagnosed in 49 eyes (46.7 %), the third (III) stage in 56 (53.3 %). All patients were divided into 3 groups. The first (main) group consisted of 34 (37 eyes) patients who underwent trabeculectomy in combination with the implantation of Glautex DDA drainage model. The second (main) group included 29 (30 eyes) patients with trabeculectomy and implantation of the SDA model of this drainage. The third group was the control group and consisted of 35 (38 eyes) patients with the classical method of surgery without using any drainage. Results. There was a significant 71.7 % decrease in IOP compared with baseline data in the 1st patients group after antiglaucomatous surgery, 72 and 74 % decrease was in the 2nd and 3rd groups respectively (p < 0.05). An increase in IOP was noted predominantly in the control and in the second study group within 1 month of follow-up. Normalization of ophthalmotonous pressure was achieved by using needling in 13.3 % (4/30) patients in the second group, in 7.9 % (6/38) cases in the control group. The absolute hypotensive effect in the 1st group was noted in 75.7 % of cases; the relative hypotensive effect was in 8.1 %; total failure was in 16.2 %. In the 2nd group the absolute hypotensive effect of the surgery was in 73.3 % of 30 cases, the relative was in 6.7 %, total failure was in 20 %. In the control group (38 eyes), absolute success was in 63.1 %, the relative hypotensive effect was in 13.2 %, and the total failure was in 23.7 %. Conclusion. Trabeculectomy with Glautex drainage and with various models in case of primary open-angle glaucoma provided a sufficiently high relative hypotensive effect in 82 % of cases in a year after the surgery. The achieved surgery outcomes with this drainage in the studied periods did not depend on applied model: DDA or SDA (83.8 and 80 % respectively), but was higher than the classical trabeculectomy (76.3 %). However, in case of the SDA model, needling was required in 13.3 % of cases in the early postoperative period.

PURPOSE. To evaluate the potential impact of herpesvirus infection (carriage) on early postoperative outcomes of antiglaucoma surgeries.MATERIAL AND METHODS. The study included 95 patients with stage I, II and III primary open-angle glaucoma (POAG), with indications for surgical treatment. The patients were divided into the main group (group 1, 31 patient) and the control group (group 2, 64 patients). The groups were formed on the basis of information obtained from the anamnesis about a transferred herpes simplex virus of any localization (as a rule, it was labial, oral-facial herpes and its skin manifestation). The indication for surgical treatment was the absence of persistent normalization of intraocular pressure and a decrease in visual functions. Depending on the clinical situation, patients underwent one of the two types of surgical interventions: trabeculectomy and non-penetrating deep sclerectomy. Analysis of postoperative complications was performed on day 7 after surgery.RESULTS. The most frequent complications in the early postoperative period were ciliochoroidal detachment, hyphema, increased intraocular pressure, shallow anterior chamber syndrome, excessive vascularization in the surgery site, clinical signs of conjunctival-scleral and sclerascleral scarring. On day 7 after antiglaucoma surgery, the IOP level was 9.1±0.8 mm Hg on average in the groups. IOP was 1–2 mm Hg higher in case of non-penetrating surgery. In the same patients, normalization of IOP by the same date was obtained in 63.15% of cases, which required goniopuncture; needling was indicated and performed in 84.2% of patients. Ciliochoroidal detachment was diagnosed in both groups with the same frequency: 9.7 and 9.4%, respectively. Presence of minor hyphema was observed only after trabeculectomy, in 16.1 and 10.9% of cases, respectively.CONCLUSION. Results of this study, firstly, do not indicate that HSV activates in response to surgical intervention; secondly, in patients who had been infected with it previously, only a tendency for the number of most common intra- and postoperative complications to increase was noted. The obtained results are insufficient for an unambiguous answer to the question posed in this study, which indicates the need for further research.

Purpose : To analyze the efficacy of novel technique of primary open-angle glaucoma (POAG) and complicated cataract surgery that combines phacoemulsification and modified stainless steel Glaucoma Filtration Device implantation. Methods : 100 patients (120 eyes) with POAG and complicated cataract aged 52‑89 years were included in the study. All patients were divided into 3 groups. In group I, phacoemulsification with non-penetrating deep sclerectomy (NPDS) and collagen drainage device implantation by Malygin B. A. was performed. In group II, phacoemulsification with Glaucoma Filtration Device implantation using standard technique was performed. In group III, phacoemulsification with Glaucoma Filtration Device implantation using improved technique was performed. Results: Following phacoemulsification with NPDS, IOP was decreased by 38 % in a month and by 21 % in a year while visual acuity improved 3,8 times in a year. Following phacoemulsification with Glaucoma Filtration Device implantation using standard technique, IOP was decreased by 41 % in a month and by 39 % in a year while visual acuity improved 4,3 times in a year. Following phacoemulsification with Glaucoma Filtration Device implantation using modified technique, IOP was decreased by 43 % in a month and remains stable in a year while visual acuity improved almost 5 times in a year. Conclusion: Phacoemulsification with Glaucoma Filtration Device implantation using modified technique provides adequate IOP reduction and highest possible functional results in early and late post-op period.

Purpose of the study was to analyze and compare the outcomes of implantation of polymer micro shunt «Reper-NN» manufactured in Russia and «Ex-PRESS» shunt in surgical treatment of open-angle glaucoma. Material and methods. The results of treating 74 patients with open-angle glaucoma were analyzed. All patients were divided into 2 groups: group I consisted of 48 patients underwent micro shunt «Ex-PRESS» implantation, group II with 26 patients underwent Russian polymer micro shunt implantation. The control criteria in the early and remote postoperative period were: Maklakov tonometry, visual acuity, computer perimetry. Results and discussion. The significant reduction in intraocular pressure compared with the preoperative level has been achieved in the early and remote period as a result of implanting both shunts. The implantation simplicity and design features of polymer micro shunt «Reper-NN» provided with the relatively similar to «Ex-PRESS» shunt risks of complications such as postoperative hypotonia and ciliochoroidal detachment. Thus, the first experience of using Russian manufactured polymer shunt showed the sufficient efficacy and safety in primary open-angle glaucoma surgery and allowed recommending its further application in clinical practice.

PURPOSE. To compare the hypotensive effectiveness of Glauteks and HealaFlow drainage implants in non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).METHODS. The study included 56 patients (56 eyes), of them 19 had moderate POAG and 37 had advanced POAG. The intraocular pressure (IOP) level was 27.8±3.6 mm Hg on the hypotensive regimen. Glauteks drainage impalnt was used in the first group (27 eyes), HealaFlow drainage implant — in the second group (29 eyes).RESULTS. On the 1st day after surgery the IOP was 13.3±1.8 mm Hg in the 1st group, and 13.6±1.7 mm Hg in the 2nd group. After 3 months, the average IOP level was 15.6±1.4 mm Hg in the 1st group, and 15.9±1.6 mm Hg in the 2nd group. All patients underwent a planned Descemet's goniopuncture at 3 months. After one year, the IOP level in the 1st group amounted to 17.3±1.7 mm Hg (IOP normalization achieved in 96% of eyes), with 67% of the eyes not requiring hypotensive therapy. In the 2nd group — 18.0±1.8 mm Hg (IOP normalization achieved in 93% of eyes), with 62% of the eyes not requiring hypotensive therapy. After two years, 25 patients of the 1st group had normalized IOP and was 18.2±1.5 mm Hg, of them 30% did not use hypotensive therapy. In the 2nd group, 27 eyes had IOP of 18.3±1.7 mm Hg, of which 28% did not require hypotensive therapy. Over the 2 years of follow-up, reoperations were required in 11% of eyes in the 1st group and in 14% of eyes in the 2nd group.CONCLUSION. The use of biodegradable Glautex and HealaFlow drainage devices in NPDS allowed achieving persistent normalization of IOP in the vast majority of patients with POAG — 89% and 86%, respectively — within 2 years of follow-up.

Purpose The aim of this study was to compare the changes in subfoveal choroidal thickness (SFCT) following trabeculectomy and nonpenetrating deep sclerectomy (NPDS) in cases with primary open-angle glaucoma (POAG). Patients and methods This is a prospective interventional comparative randomized study that was carried out on 42 eyes of 32 patients with chronic POAG who were divided into two groups: group A included 22 eyes that underwent trabeculectomy, and group B included 20 eyes that underwent NPDS. SFCT was measured preoperatively and was repeated on the third day and at 1 month postoperatively using spectral domain optical coherence tomography. Results In group A, there was a statistically significant increase in the SFCT on the third postoperative day and after 1 month, with a mean value of 42.86±38.08 and 28.5±27.91 μm, respectively, when compared with the preoperative SFCT (P<0.05). In group B, the increase in SFCT was statistically significant on the third postoperative day, with a mean value of 38.45±24.33 μm when compared with the preoperative SFCT (P=0.0001). However, after 1 month, the increase in SFCT became nonsignificant, with a mean value of 13.25±6.55 μm when compared with the preoperative SFCT (P=0.19). There was a positive correlation between the amplitude of intraocular pressure reduction and the change in the SFCT in both groups. Conclusion Both trabeculectomy and NPDS caused a significant increase in SFCT in the early postoperative period, which might be related to postoperative hypotony maculopathy. SFCT went back near to normal values after NPDS earlier than after trabeculectomy in cases with POAG.