Anti-glaucoma Surgery Research Articles

Multiple cytokine analysis of aqueous humor in uveitis with or without secondary glaucoma

To assess the level of both pro-inflammatory and anti-inflammatory cytokines in the aqueous humor (AH) of patients suffering from uveitis, with or without coexisting glaucoma, and compare them with patients diagnosed with primary open-angle glaucoma (POAG) and those with age-related cataract (ARC). By using Luminex xMAP® multiplex assays analyses, we assessed levels of 11 cytokines and chemokines, and compared them across groups, including uveitis-secondary glaucoma (USG) (n = 16), uveitis without glaucoma (UwoG), (n = 16), POAG (n = 16), and ARC (n = 16) to explore the correlation between these cytokines and the presence of uveitis, as well as intraocular pressure (IOP). Pro-inflammatory factors MCP-1, MIP-1β, IL-6, IL-8, and transforming growth factors TGF-β1 and TGF-β2 were significantly elevated in the AH of USG eyes. In the case of enhanced anti-inflammatory in the perioperative period, the pro-inflammatory factors remained notably elevated in the USG group compared to the UwoG group (P < 0.01). The levels of IL-6, IL-8, and MCP-1 in the AH of the USG group and POAG group had the same trend, which markedly surpassed those of the ARC group (P < 0.01). Significantly increased levels of MCP-1, MIP-1β, IL-6, IL-8, TGF-β1, and TGF-β2 were found in the AH of USG patients, implying a potential role for these mediators in the progression of glaucomatous manifestations within patients with uveitis. Besides the analysis revealed no discernible statistical disparity in cytokine concentrations within the AH of USG eyes whether the preoperative baseline IOP was greater than 30 mmHg or not, indicating that the safety of antiglaucoma surgery in USG patients even with baseline high IOP.

Focusing on issues about phacoemulsification lens extraction combined with goniosynechialysis

Angle closure is a basic pathological process in primary angle-closure glaucoma. Unlike filtration anti-glaucoma surgery, goniosynechialysis is a treatment for the cause of primary angle-closure glaucoma by reconstructing the physiological aqueous outflow pathway. In the past 10 years, phacoemulsification lens extraction with posterior chamber intraocular lens implantation in combination with goniosynechialysis for the treatment of primary angle-closure glaucoma has become a hot topic of clinical research and discussion. This article points out the issues that need to be paid attention to in the clinical practice of the combined surgery, including the relationship between phacoemulsification surgery and goniosynechialysis, the effectiveness and influencing factors of the combined surgery, and how to avoid the postoperative re-adhesion of the angle, in order to provide reference and guidance for better goniosynechialysis.

IL-22/IL-22RA1 Promotes Human Tenon's Capsule Fibroblasts Proliferation and Regulates Fibrosis Through STAT3 Signaling Pathway.

Purpose: Although it is now understood that most antiglaucoma surgeries fail because of scarring of the filtering tract, the underlying mechanism remains to be elucidated. The present study investigated the mechanism by which the interleukin (IL)-22/IL-22 receptor alpha 1 (IL-22RA1) signaling pathway regulates scar formation in glaucoma patients. Method: A total of 31 glaucoma patients who underwent trabeculectomy surgery with uncontrollable intraocular pressure because of scarring and 19 strabismus patients as the control patient group were included in the present study. ELISA was performed to measure the content of IL-22 in peripheral blood. Serum from patients was used to incubate human Tenon's capsule fibroblasts (HTFs) cells and IL-22 antibody rescued the effect of IL-22 on the biological functions. qPCR and Western blot were performed to determine IL-22RA1 mRNA and protein expression levels. Flow cytometry was performed to assess the cell cycle distribution and the Cell Counting Kit-8 assay was used to analyze cell proliferation. Results: The ELISA assay revealed that the serum IL-22 level of glaucoma patients was significantly higher than the healthy group (29.80 ± 5.1 ng/µL vs. 5.21 ± 0.9 ng/µL). After incubation with patient serum, the proliferation and activation of human Tenon fibroblasts (HTFs) were promoted. IL-22 mediated the biological function of HTFs via directly binding IL-22RA1. Moreover, transfection of the siR-IL-22RA1 or IL-22RA1 gene resulted in significant antifibrosis or profibrosis in HTFs. When a signal transducer and activator of transcription (STAT) 3 inhibitor (BAY) was introduced to the IL-22RA1 overexpression group, IL-22-induced proliferation was reduced in HTFs. Additionally, glaucoma patients had increased levels of IL-22 expression following surgery. Conclusions: The IL-22/IL-22RA1/STAT3 signaling pathway promoted fibroblast cell proliferation and alpha-smooth muscle actin, potentially regulating fibrosis in glaucoma filtration tracts. Our results provide hitherto undocumented insights into the pathophysiology of postoperative scarring.

Subtotal Serous Retinal Detachment after Non­-Penetrating Glaucoma Surgery. Clinical Case

Purpose: to provide a clinical case of serous retinal detachment after non­penetrating antiglaucoma surgery. A patient with hypertension and type II diabetes mellitus underwent a non­penetrating deep sclerectomy in our clinic against the background of uncompensated glaucoma. Subtotal serous retinal detachment was found in the early postoperative period. Against the background of steroid therapy, the detachment resolved within 2 weeks. We believe that the cause of serous detachment is a significant gradient in the decrease in intraocular pressure against the background of uncompensated glaucoma as a result of surgery against the background of uncompensated glaucoma and endothelial dysfunction due to common diseases. Patients with comorbidities and initially severe condition require more thorough preoperative preparation, monitoring and correction of treatment in the postoperative period.

Minimally invasive bleb surgery versus minimally invasive glaucoma surgery: a 12-month retrospective study

This study aimed to compare the IOP-lowering effectiveness and safety of standalone Preserflo MicroShunt and iStent 1st generation implantation combined with phacoemulsification in Caucasian patients with a 12-month follow-up period. This retrospective study analyzed the medical histories of patients undergoing antiglaucoma surgery at the Department of Ophthalmology, Medical University of Bialystok, between January 2019 and January 2022. The main outcome measures were success rates (complete: proportion of eyes with IOP < 18 mmHg (criterion A) and < 15 mmHg (criterion B) or 20% reduction in IOP without any glaucoma medication; qualified: proportion of eyes achieving IOPs < 18 mmHg and < 15 mmHg or 20% reduction in IOP from baseline with or without medications), mean reduction (%) in IOP, medication burden, number of complications and additional interventions. In both groups, a significant decrease in IOP and medication burden were observed at 6 and 12 months when compared with baseline. At 12 months, qualified surgical success in criterion A was recorded in 67.4% and 85.7% of patients in the Preserfo and iStent groups, respectively (p = 0.045). Complete surgical success in criterion B at 12 months accounted to 61.4% of patients from Prserflo group and 32.7% patients in iStent group (p = 0.04). Surgical failure at 12 months was documented in 30.2% and 6.3% of patients, respectively (p = 0.003). There was a significant difference between groups in %IOP reduction after 12 months. Greater reduction was observed in Preserflo group, MD = − 8.41 CI95 [− 15.88; − 0.95], p = 0.028, (− 33.49% ± 21.59 vs − 25.07% ± 14.15 in iStent group). Both procedures effectively reduced IOP and postoperative use of antiglaucoma medications in glaucoma patients.

Некоторые факторы риска воспаления переднего отрезка глаза после хирургии катаракты у пациентов с глаукомой (серия клинических случаев)

Purpose. The study purpose was to identify risk factors that increase anterior segment inflammation after cataract surgery in patients with glaucoma. Material and method. We present 3 clinical cases in which anterior segment inflammation was observed after phacoemulsification in patients with combined cataract and glaucoma (with failure of the ligamentous apparatus of the lens, a history of anti-glaucoma surgery and the presence of a complete complicated cataract against the background of a narrow pupil). Results. In the first clinical case, descemetite was biomicroscopically observed on the next postoperative day; the intraocular fluid’s opalescence of the anterior eye chamber. This condition was the result of excessive manipulation during surgery (use of iris retractors and intracapsular ring). The vision on the first day was 0.4 does not correct (n/c), after 7 days it was 0.6 n/c. In the second clinical case, excessive contact with the iris (rupture of synechiae and action of instruments dilating the pupil) resulted in postoperative descemetis, dispersion of iris pigment in the anterior chamber moisture, residual viscoelastic on the endothelium. Vision on the first day after surgery was 0.2 n/c, on the 7th – 0.4 n/c. In the third clinical case, the descemetal folds were a consequence of increased ultrasound activity in a mature cataract as well as of manipulations that dilated the pupil. The day after surgery, visual acuity was 0.5 n/c. Conclusion. These clinical cases demonstrate risk factors of increased anterior segment inflammatory response after phacoemulsification for patients with combined cataract and glaucoma. They are: lens subluxation, previous trabeculectomy, complete complicated cataract and narrow rigid pupil. Key words: cataract, glaucoma, phacoemulsification, intraocular lens, cataract extraction, inflammation

Topographical features of the formation of outflow tracts with the use of spongy allo-drainages in glaucoma

PURPOSE. Improving the results of the operation and achieving its reliability in secondary glaucoma, including refractory glaucoma, can be done using a non-biodestructible allograft drainage with spongy structure fabricated by Alloplant® technology.METHODS. Experimental and morphological studies conducted in the Russian Eye and Plastic Surgery Center showed that the allogeneic spongy biomaterial used for anti-glaucoma sponge drainage surgery is gradually replaced by loose tissue with a porous structure, similar to trabecular, forming a new drainage system. During the operation, the proximal part of the drainage is inserted through the excised drainage zone in the anterior chamber angle (ACA). The distal part is tucked into the suprachoroidal space through a linear incision in the scleral bed.RESULTS. The newly created topography of the ACA after sponge drainage operation with the use of allogeneic biomaterial features not only the expansion of the ACA profile, but also the replacement of the excised part of the drainage zone with biomaterial after sinus trabeculectomy (STE) and elimination of retention of the intraocular fluid (IOF) outflow. Ultrasound biomicroscopy (UBM) performed at various times after antiglaucoma surgery showed that the microtubule system preserved. Optical coherence tomography (OCT) of the ACA demonstrates the location of the drainage in the long-term follow-up.CONCLUSION. Antiglaucoma operation with the use of allogeneic biomaterial with spongy structure promotes the formation of trabecula-like tissue in the ACA, eliminates retention of IOF outflow, and reduces the risk of scleroscleral and sclero-conjunctival adhesions.

Подходы к комбинированной хирургии катаракты и глаукомы в условиях слабости связочного аппарата хрусталика

Purpose. To demonstrate the effectiveness of single-step phacoemulsification of cataracts and antiglaucoma surgery in conditions of weakness of the zonular apparatus. Methods. Patient N., 67 years old, came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) with complaints of decreased vision, increased intraocular pressure (IOP), and narrowing of the fields of view of the right eye. The diagnoses: OD Primary open-angle glaucoma 3v, Subluxation of the lens grade 1 OS Primary open-angle glaucoma 1a, OU Complicated cataract, Pseudoexfoliation syndrome. Carried out: autorefractokeratometry, visual acuity testing, computerized perimetry, biomicroscopy, gonioscopy, pneumotonometry, tonometry according to Maklakov, optical biometry. Considering the weakness of the lens zonules, the method of fixation of the intraocular lens (IOL) by optic capture technique was used. Results. Examination and evaluation one week post-operation: Visus 0.6 unc, IOP (pneumotonometry) 11 mmHg without hypotensive therapy; biomicroscopy: a calm eye with a well-expressed filtration bleb at the 12 o’clock position, well-adapted sutures, a transparent cornea of average depth, clear aqueous humor, moderate iris atrophy, round 3 mm pupil with pseudophakia at the pupil’s edge, IOL located in the capsular bag with haptics in the iridociliary groove, stable positioning. Fundus examination shows a pale optic nerve head, excavated with 0.8 cup-to-disc ratio, well-defined borders, narrowed vessels. Macular region appears normal. Conclusion. Combined cataract and glaucoma surgery in a patient with subluxated crystalline lens using the «optic capture» technique and Non-penetrating Glaucoma Surgery allowed preserving the correct and stable position of the IOL with normalization of intraocular pressure without the need for hypotensive therapy during a 1-year follow-up period. Key words: one-stage surgery, primary angle-closure glaucoma complicated by cataract, «optic capture»

Modern trends in the treatment of glaucoma

In nearly all Russian regions, glaucoma ranks first among the causes of disability due to ophthalmic pathology, which is in line with global trends of glaucoma incidence growth and its leading position among the causes of irreversible blindness. Treatment of glaucoma is aimed at lowering intraocular pressure (IOP). This review presents the main current trends in the treatment of glaucoma: drug therapy, laser surgery, fistulizing, drainage and non-penetrating surgery, as well as the latest micro-invasive glaucoma surgery (MIGS).Currently, the pharmaceutical market offers many antihypertensive drops. Fixed-dose combinations of drugs have been proposed to increase treatment adherence, and effective drug delivery methods are being developed, which lower IOP with minimal side effects. Further development of laser surgery makes it both a method of choice for the initial treatment (selective laser trabeculoplasty) and expands its capabilities for various stages of glaucoma (micropulse cyclophotocoagulation). All this significantly reduces the frequency of classical macroinvasive antiglaucoma operations. The previously existing gap between conservative medical therapy and antiglaucoma surgery is filled by the newest MIHG procedures. In recent years, at all stages of primary open-angle glaucoma therapy, the emergence of new pharmaceuticals, methods and implants has been noted. These constitute the purpose of this publication.

Glaucoma drainage device implantation and cyclophotocoagulation in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty.

To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6-21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.

Powikłania po trabekulektomii, aktualne strategie działania – przegląd piśmiennictwa

Glaucoma is the first cause of blindness in Europe and over the world. The purposes of its treatment are lowering intraocular pressure. For patients who have visual potential, conventional glaucoma surgery such as trabeculectomy is frequently performed. The most common failures of it are associated with functioning of the filtering bleb, which causes inappropriate filtration and ultimately hypotony or increased intraocular pressure. Prevention or good treatment of complications after trabeculectomy is necessary to achieve long-term success of anti-glaucoma surgery.

Dynamics of intraocular pressure in patients with refractory glaucoma after transscleral cyclophotocoagulation in micropulse mode

A retrospective analysis of IOP values was carried out in 38 patients (38 eyes) with refractory glaucoma stage III–IV after transscleral micropulse cyclophotocoagulation (mCPC) using the Cyclo G6 IRIDEX device on the next day after the procedure, after 1 month, 6, 12 and 24 months after surgery. The dynamics of IOP in the postoperative period largely depends on the initial values of the clinical parameter and does not depend on the patient’s age (p = 0.32), glaucoma stage (p = 0.46), history of antiglaucoma surgery (p = 0.34), the number of used drugs (p = 0.72). After mCPC, patients with lower baseline IOP values have a higher decrease in the indicator (-36 %) and a gradual increase by the follow-up period of 12–24 months compared with patients with high baseline IOP values.

New concept of etiopathogenesis and treatment of primary open-angle glaucoma

Primary open-angle glaucoma (POAG) is one of the main causes of irreversible blindness. There is no single theory of POAG development. The trigger of the disease is unknown. Treatment is ineffective. The author's concept: the trigger of the glaucomatous process is a genetically programmed small distance between the ciliary body and the lens equator (less than the age-related norm) in the presbyopic period of life. This causes weakness of accommodation and triggers further pathological changes in the eye. For proof of concept, large-scale studies of the anterior segment of the eye (ultrasound biomicroscopy) should be performed in presbyopes with ophthalmic hypertension, with and without POAG, with measurement of the distance "ciliary body - lens equator". Objective acomodometry is also necessary to determine the volume of accommodation in the above patients. In case of confirmation of the author's concept, a 3-component phased treatment of POAG is proposed: 1. Surgical expansion of the ciliary body ring (scleral thinning) - non-penetrating supraciliary sclerectomy or application of antimetabolites to the supraciliary sclera; 2. Phaco emulsification of the lens with implantation of an IOL model that maximizes the volume of pseudo - accommodation; 3. antiglaucomatous microinvasive surgery.

Application of artificial intelligence in glaucoma. Part 2. Neural networks and machine learning in the monitoring and treatment of glaucoma

The second part of the literature review on the application of artificial intelligence (AI) methods for screening, diagnosing, monitoring, and treating glaucoma provides information on how AI methods enhance the effectiveness of glaucoma monitoring and treatment, presents technologies that use machine learning, including neural networks, to predict disease progression and determine the need for anti-glaucoma surgery. The article also discusses the methods of personalized treatment based on projection machine learning methods and outlines the problems and prospects of using AI in solving tasks related to screening, diagnosing, and treating glaucoma.

Three-component tear substitute as preoperative support in glaucoma surgery

This study investigates the effect of preoperative preparation with the three-component tear substitute Stillavit on the outcomes of glaucoma surgery in patients on long-term topical glaucoma therapy. The study included 63 patients (63 eyes) with glaucoma, among them 30 (30 eyes) were women and 33 (33 eyes) were men. Group 1 consisted of 33 patients (33 eyes) receiving long-term topical antihypertensive therapy with preservatives and tear substitute Stillavit 3 times a day for 1 month as preoperative preparation. Group 2 included 30 patients (30 eyes) receiving similar antihypertensive therapy who were not prescribed preoperative medications. All patients underwent a comprehensive ophthalmological examination and computer tomography of the filtering blebs (FB) on Visante system (Carl Zeiss Meditec, Germany) before surgery, as well as 1 week, 1, 3, and 6 months after surgery. Mean intraocular pressure (IOP) elevation at 6 months postoperatively was significantly higher in the group that did not undergo preoperative preparation with a tear substitute, compared to the group of patients who received the tear substitute Stillavit preoperatively. According to anterior segment optical coherence tomography, a greater number of favorable diffuse FB were noted in the group that received the tear substitute Stillavit in preparation for surgery - 87.9%, while in group 2 (without preparation) - 66.7%. Odds ratio calculation between the two groups revealed that preoperative preparation with the tear substitute Stillavit reduced the odds of IOP elevation to 20 mm Hg or higher at 3 months postoperatively by more than 10 times. The use of tear substitute Stillavit in preparation for anti-glaucoma surgery reduces the chances of IOP elevation in the early postoperative period by more than 10 times, which may indicate a reduction in the rate of FB scarring due to the beneficial effect of the drug's components on the precorneal tear film.

Possibilities of Preservative-Free Therapy for Primary Open-Angle Glaucoma

Purpose: To compare the effectiveness of trabeculectomy and evaluate the change of the state of the tissues of the anterior segment of the eye in patients with long-term use of preservative and non-preserved hypotensive therapy before surgery. Patients and Methods. The study was conducted in a group of 30 patients (30 eyes) aged from 58 to 77 years with uncompensated primary openangle glaucoma, who were admitted to the glaucoma surgery. The patients were divided into 2 groups depending on the hypotensive regimen used before surgery: group I - patients who used preservative-containing local hypotensive drugs; Group II - patients who used Traviolan© and other non-preservative hypotensive drugs before antiglaucoma surgery. At the initial examination, the collection and analysis of patient complaints, visometry, tonometry, and biomicroscopy of the structures of the anterior segment of the eye were performed. Patients complaints were assessed on the OSDI test questionnaire. The study of total tear production was investigated using the Schirmer test. The tear film break time study investigated the Norn test. Observation and re-examinations were performed a week, 1 month and 3 months after trabeculectomy. Results. A week after glaucoma surgery, there was a short-term deterioration in the parameters by which dry eye disease (DED) was assessed: in group I, OSDI was 11.8 ± 3.3, Schirmer and Norn tests — 5.3 ± 1.3 mm and 4.3 ± 1.0 sec, respectively. In group II OSDI was 10.7 ± 3.5, Schirmer and Norn tests were 8.2 ± 2.2 mm and 4.7 ± 1.3 sec, respectively. After 1 and 3 months, the DED indicators improved, more pronounced in group I: after 1 and 3 months, OSDI was 12.9 ± 3.7 and 12.9 ± 4.2, respectively; Schirmer’s test — respectively, 7.4 ± 1.9 and 7.0 ± 1.8 mm; Norn’s test — 5.1 ± 0.8 and 5.2 ± 0.9 sec. In group II, 1 and 3 months after trabeculectomy, OSDI was 12.4 ± 3.0 and 12.4 ± 2.4. Schirmer’s test was 9.9 ± 2.1 and 9.5 ± 1.7 mm, Norn’s test was 5.5 ± 1.2 and 5.5 ± 1.3 sec, respectively. At all follow-up periods, except for week 1, there was a significant intergroup difference between the studied parameters of dry eye disease (p &lt; 0.05). Conclusion. Long-term use of preservative-containing hypotensive therapy contributes to the development of chronic toxic-allergic conjunctivitis, which affects the long-term prognosis of trabeculectomy and the quality of life associated with DED. One of the ways to minimize such negative effects is the use of preservative-free drugs in the selection of glaucoma therapy. The use of a preservative-free form of travoprost is justified due to its high selectivity for FP-prostanoid receptors, which ensures high efficiency and less side effects. The improvement in DED parameters associated with cancel of therapy after surgery is more pronounced in the group of patients who initially took preservative-free drugs.

The Effect of Glaucoma Treatment on Aniridia-Associated Keratopathy (AAK) - A Report from the Homburg Register for Congenital Aniridia.

Congenital aniridia is a severe malformation of almost all eye segments. Aniridia-associated keratopathy (AAK) and secondary glaucoma, which occur in more than 50% of affected individuals, are typically progressive and pose a high risk of blindness for patients with congenital aniridia. Our aim was to investigate the effect of glaucoma treatment on AAK in patients of the Homburg Aniridia Center. Our retrospective monocentric study included patients who underwent a comprehensive ophthalmological examination at the Homburg Aniridia Center between June 2003 and January 2022. There were 556 eyes of 286 subjects (20.1 ± 20.1 years; 45.5% males) included. In 307 (55.2%) eyes of 163 subjects (27.5 ± 16.3 years; 43.1% males), glaucoma was present at the time of examination. The mean intraocular pressure in the glaucoma group was 19.0 mmHg (± 8.0), while in the non-glaucoma group, it was 14.1 mmHg (± 3.6) (p < 0.001). In the glaucoma group, 68 patients used antiglaucomatous topical monotherapy, 51 patients used 2 agents, 41 patients used 3agents, 7 patients used quadruple therapy, and 140 did not use topical therapy (e.g., after pressure-lowering surgery, pain-free end-stage glaucoma, or incompliance). Patients were classified according to the following stages of AAK: Stage 0 (96 eyes [17.2%], no keratopathy), Stage 1 (178 eyes [32.0%]), Stage 2 (107 eyes [19.2%]), Stage 3 (67 eyes [12.0%]), Stage 4 (62 eyes [11.1%]), Stage 5 (45 eyes [8.0%]). The mean stage of AAK was 1.4 (1.2 - 1.5) in the group without eye drops, 1.9 (1.5 - 2.2) in the group with monotherapy, 1.8 (1.5 - 2.1) in the group with 2 drugs, 1.9(1.5 - 2.2) in the group with 3 drugs, 3.4 (2.3 - 4.6) in the group with 4 drugs, and 3.3 (3.1 - 3.6) after antiglaucomatous surgery. The stage of AAK was significantly positively correlated with the number of pressure-lowering eye drops (p < 0.05) and prior pressure-lowering surgery (p < 0.05). Prostaglandin analogues were not correlated with a higher AAK stage compared to the other drug groups. At the Homburg Aniridia Center, patients using topical antiglaucomatous quadruple therapy or who had previously undergone antiglaucomatous surgery had by far the highest AAK stage. The different drug groups had no influence on the AAK stage.

Сравнительный анализ динамики внутриглазного давления и центральной толщины роговицы после факоэмульсификации катаракты с имплантацией интраокулярной линзы в зависимости от наличия первичной открытоугольной глаукомы

A prospective open study of 64 eyes (64 patients) was conducted, the parameters of IOP and central corneal thickness (CCT) in the early postoperative period were studied in patients with primary-open-angle glaucoma (POAG) and without glaucoma. The terms of normalization of these parameters are determined, as well as possible influencing factors on changes in IOP and CCT indicators. In patients with POAG after phaco an increase in hypotensive drops was required in 50 % of cases, in 19 % of patients with an average IOP after surgery up to 28.8 ± 5.2 mm Hg (p&lt;0.01), there was a need for antiglaucoma operation (AGO) in the early postoperative period due to persistent IOP decompensation. Basically, these were patients who received 2 or 3 hypotensive drugs before phaco, had 3rd degree lens density, stage 3 glaucoma and a longer operation time. In patients without POAG an increase of IOP level is possible at day 1 after phaco to an average of 22.4±5.6 mm Hg (p=0.03), but to a lesser extent than in patients with POAG (p&lt;0.05). This group consisted exclusively of patients with 2nd and 3rd degree of lens density and longer operation time. In patients with POAG at the day after phaco CCT index significantly increases to an average of 617.9 ±88.6 microns (p&lt;0.001), approaching the norm at day 14. In patients without glaucoma the level of CCT at the day after surgery also equally significantly increases to an average of 624±106.3 microns, approaching the baseline level by day 14. Key words: early postoperative period; open-angle glaucoma; cataract; intraocular pressure; central corneal thickness.

Features of the reparative process after antiglaucoma surgery

Excessive fibrosis and scarring of newly created aqueous humor outflow pathways, mainly at the level of the intrascleral canal and filtering bleb, is a significant disadvantage of the so-called bleb-dependent antiglaucoma surgery. Taking into account the fact that aqueous humor, which flows evenly through the non-healing fistula under the hermetically sutured conjunctiva, is the forming substrate for the newly created outflow pathways, its composition also plays an important role in the body's response to surgical trauma. A large number of publications reliably demonstrate an increase in the concentration of various biologically active molecules in the aqueous humor of the anterior chamber of glaucoma patients. These are transforming growth factor β (TGF-β), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), interleukins IL-6 and IL-8, etc., which concentration in cases of unsuccessful outcome of trabeculectomy was significantly increased compared to patients who underwent successful surgeries. In addition, it has been established that an imbalance of various matrix metalloproteinase pools, fibroblast activation, wound infiltration by neutrophils and macrophages, which in turn express a significant amount of pro-inflammatory cytokines and growth factors, contribute to the prolongation of inflammation and fibrosis. An important condition for the removal of aqueous humor from the filtering bleb area is the postoperative activation of conjunctival lymphatic angiogenesis, which suppression may be associated with prolonged inflammation or the active use of cytostatics. This literature review presents the complexities of the pathophysiological mechanisms of postoperative healing and the formation of newly created aqueous humor outflow pathways after antiglaucoma operations. At the same time, the question remains open about the effect of initial changes not only on the tissues of the ocular surface, but also in the aqueous humor of the anterior chamber, as well as the general condition of patients on the outcome of the operation.The purpose of this review is to present modern literature data on the pathophysiological mechanisms of the wound healing process and the features of postoperative healing regulation after antiglaucoma surgery.

Detección y caracterización de defectos del campo visual mediante perimetría Octopus en glaucoma congénito primario

PurposeTo detect and characterise visual field (VF) defects using static Octopus perimetry in patients with primary congenital glaucoma (PCG) and to determine VF quality and time duration. Material and methodsEighty-eight eyes of 70 patients diagnosed with PCG were included. Assessments were performed using an Octopus 900 and each eye was assessed with the tendency-oriented perimetry (G-TOP) algorithm. Quantitative VF data were collected: quality data (false positive and negative response, and time duration) and results of mean deviation (MD) and square root of loss variance (sLV). Qualitative data were collected: the presence of diffuse and localized defects, the affected hemifield and grade of defects using the Aulhorn and Karmeyer classification. Correlations between perimetric results and clinical variables were analysed. ResultsMedian age was 11 (8-17) years. 65.9% (58/88) of PCG eyes showed VF defects. Diffuse defects were observed in 10/58 eyes (16.94%) (mean MD=23.92 [SD: 2.52]) dB) and localized defects in 48/58 eyes (82.75%). The most frequent defect was spot-like/stroke-like/incipient paracentral scotoma (n=15), nasal step (n=8), adding arcuate defect (n=2), half ring-shaped (n=13) and concentric defect with a central island (n=9). And the most frequent affected visual hemifield was inferior hemifield. Mean test duration was 2min 12s (SD: 21.6s). MD and sLV values were correlated with best corrected visual acuity (BCVA), cup to disc ratio and number of antiglaucoma surgeries (all P<.001). ConclusionA high number of diffuse and localized defects were identified using Octopus perimetry in PCG patients. The most frequent defect was paracentral scotoma and inferior hemifield was the most affected.