Surgical natural uveoscleral outflow activation in the primary and secondary glaucoma patients treatment

Abstract

One of the leading causes of the visual acuity decrease and progressive blindness is glaucoma. Despite conservative treatment of this pathology achieved success, the results don't fully satisfy the ophthalmologists. It is necessary to invent new more effective intraocular pressure permanent compensation surgical techniques. Conventional glaucoma surgical treatment methods and their modifications don’t always improve an intraocular liquid outflow quite effectively. They do not lead to permanent everlasting intraocular pressure compensation in the remote postoperative period. In this case it is rather important to develop and introduce new surgical techniques into the clinic to activate intraocular liquid outflow additionally. It became a reason to induce our interest in a modified technique development directed to the natural uveoscleral outflow activation, allowing to reach long-lasting permanent intraocular pressure compensation in the remote period.The aim of the study: to improve glaucoma patients’ surgical treatment results by activation of the natural uveoscleral intraocular liquid outflow.Patients and methods: 86 patients’ treatment results (90 eyes, 18-89 y.o., mean age – 65,0±13,3) were analyzed. All the glaucoma patients were surgically treated by a modified technique of an intraocular liquid uveoscleral outflow activation by an angular-uveal drainage after an implantation of a collagenous drain (Patent of Ukraine № 46521 from 25.12.2009). Primary glaucoma was diagnosed in 52 (57,8 %) eyes, secondary glaucoma, namely, neovascular – in 38 (42,2 %) eyes. Primary glaucoma patients presented with an initial stage in 6 (11,4 %) eyes, developed – in 9 (17,3 %), advanced – in 15 (29,0 %) and terminal – in 22 eyes (42,3 %). In the early postoperative period and in 6, 12 and 24 months after the surgery all the patients underwent visual acuity examination, tonometry by Maklakov, biomicroscopy, ophthalmoscopy, examination of a vision field, tonography by Nesterov and comparison with preoperative results.Results. In the early and remote postoperative period (up to 24 months) all the patients had statistically significant intraocular pressure decrease. Before the surgery in primary glaucoma patients True intraocular pressure index (Р0) averaged 30,3±5,7 mm of mercury, Outflow easiness coefficient – 0,1±0,04. In 6 months after the surgery intraocular pressure remained within normal values (18,4±2,4 mm of mercury), Outflow easiness coefficient – 0,2±0,05. In 12 months intraocular pressure remained almost unchanged (Р0 index – 18,1±2,2 mm of mercury, Outflow easiness coefficient – 0,2±0,04). In 24 months intraocular pressure varied from 12 to 25 mm of mercury (on the average – 19,0±2,4 mm of mercury), Outflow easiness coefficient – 0,2±0,04. Before the surgery in secondary glaucoma patients True intraocular pressure index (Р0) averaged 32,3±6,3 mm of mercury, Outflow easiness coefficient – 0,1±0,03. In 6 months after the surgery intraocular pressure remained within normal values (18,2± 2,3 mm of mercury), Outflow easiness coefficient – 0,2±0,04. In 12 months some tendency to intraocular pressure increase was noted (Р0 index – 19,3±2,3 mm of mercury), which, however, remained within normal values, Outflow easiness coefficient – 0,2±0,03. In 24 months intraocular pressure remained almost unchanged (on the average – 19,6±2,7 mm of mercury), Outflow easiness coefficient – 0,2±0,05. These results correspond to the normal values and confirm a good hypotensive effect after the new proposed surgical technique. After the surgery visual acuity remained almost unchanged. Insignificant intraoperative bleeding from the cyclodialysis zone into the eye front camera with a consequence of postoperative hyphema was in 8 (8,9 %) eyes. The clot lysis after the treatment was within 7-10 days. Thus, in the remote period good treatment results were noted in 59 (65,6%) eyes, satisfactory – in 31 (34,4%). Unsatisfactory results were absent.Сonclusion.Our proposed technique of an angular-uveal drainage is an effective and safe glaucoma treatment surgical method.Use of the collagenous drain Xenoplast for the purpose of natural uveoscleral intraocular liquid outflow improvement leads to a long-lasting permanent normalization of an intraocular pressure in the early and remote postoperative period.Our positive glaucoma surgical treatment experience after the use of the proposed technique of a modified intraocular liquid natural uveoscleral outflow activation by the angular-uveal drainage with an implantation of a collagenous drain Xenoplast allows us to recommend it in the different stages of glaucomatous process.