THE ROLE OF ULTRASOUND BIOMICROSCOPY IN DIAGNOSTICS OF POST-UVEAL GLAUCOMA AND THE CHOICE OF THE TREATMENT SURGERY FOR ITS CORRECTION IN THE CHILDREN

Abstract

Introduction. At present, trabeculectomy is the method of choice for the treatment of uveitic glaucoma with the pre- and trabecular retention of the outflow. However, the effectiveness of such intervention decreases over time due to the scarring of the newly formed outflow pathways. Ultrasound biomicroscopy is the method allowing for the objective evaluation of the state of the anterior segment of the eye. Aim. The objective of the present study was to estimate the condition of the filtration zone after trabeculectomy in the children presenting with uveitic glaucoma with the use of ultrasound biomicroscopy for the elucidation of the parameters characterizing the compensation of the processes underlying the development of glaucoma and the signs of enhancement of the proliferative changes responsible for the elevation of intraocular pressure (IOP). Material and methods. A total of 32 children at the age from 6 to17 years presenting with uveitic glaucoma were examined with the use of ultrasound biomicroscopy during the period from 1 month to 7 years (mean 23.5 ± 2.6 months)after the trabeculectomy. Results. It was shown that the maximum height, area, volume, and frequency of detection of the microcavities in the filtration bleb as well as the area and volume of the intrascleral cavity could be observed in the cases of IOP compensation in the absence of medication therapy (28 eyes). These parameters were lower in the children with compensated glaucoma given the antihypertensive treatment and fell down to the minimal values in the children with uncompensated IOP (2 eyes). The study has demonstrated the association between the drug-free compensation of glaucoma and the height of the filtration bleb in excess of 0.9 mm and its volume over 14 cub. m. The absence of IOP compensation was associated with a more than 30% decrease in the height, area, and volume of the filtration bleb and with a more than 10% increase of filtration bleb as well as with the decrease and/or disappearance of the microcavities. These findings give evidence that the above characteristics can be used for the comprehensive evaluation of the quality of compensation of post-uveal glaucoma and the choice of the optimal surgical strategy for the treatment of this condition. Conclusion. The present study has demonstrated the relationship between the success of compensation of post-uveal glaucoma following trabeculectomy and the parameters of bth the filtration bleb and the intrascleral cavity as determined by means of ultrasound biomicroscopy. The expediency of the application of the ultrasound biomicroscopic studies of the filtration zone within one month after trabeculectomy is substantiated. These studies should be continued during the follow-up of the patients showing the tendency toward the further elevation of the intraocular pressure and the decrease of the filtration bleb. The examination should be repeated once every year in the case od persistent compensation of uveitic glaucoma.