Antiglaucomatous Operation Research Articles

Комбинированное оперативное вмешательство при врожденных глаукомах у детей с сочетанной патологией хрусталика

In recent years, the percentage of early manifestations of congenital glaucoma in children with anomalies of the anterior segment of the eye has increased. The tactics of surgical treatment of this form of glaucoma, especially with combined pathology of the lens, is an urgent problem in pediatric ophthalmic surgery. Purpose. To determine the optimal tactics and analyze the results of surgical treatment of congenital glaucoma in eyes with anomalies of the anterior segment of the eye, combined with abnormalities of the lens development. Material and methods. For 2018–2023 we operated on 27 people (43 eyes) with congenital glaucoma in eyes with concomitant congenital lens pathology. All children underwent combined surgical interventions (vitreal and anthralaucomatous surgery) in one or more stages. Results. As a result of surgical treatment, a positive effect on IOP compensation was achieved in 88,4 % of cases (38 eyes). Conclusions. In case of pathology of the anterior segment of the eye in combination with pathology of the lens, surgical intervention is necessary in the early stages of identifying Intraocular pressure decompensation. Сombined operations are effective: vitreal surgery (reconstructive surgery on the anterior segment) and antiglaucomatous operations of the fistulizing type. Keywords: congenital glaucoma, congenital lens pathology, combined operations

Опыт повышения доступности высокотехнологичной офтальмологической помощи в Смоленской области посредством организации лечебно-диагностического отделения федеральной клиники

P u r p o s e – to analyze the development of the availability of ophthalmological care in the Smolensk region after the organization of the work of the Smolensk medical diagnostic department. M a t e r i a l s a n d m e t h o d s . The analysis was carried out on the basis of data from the medical records of patients insured in the Smolensk region and received medical care at the Smolensk medical diagnostic department, as well as directly at the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. R e s u l t s . During the period of 2016–2021 activity of the Smolensk medical diagnostic department, diagnostic studies were carried out in 43274 patients, of which 2457 were children from 3 years old, the volume of ophthalmological care to residents of the Smolensk region was increased and expanded: 25972 surgical and laser interventions were performed in a one-day day hospital, of which 10692 were interventions in the treatment of cataracts, 8675 laser interventions were performed, 2689 interventions for various vitreoretinal pathologies, 2043 refractive and 694 anti-glaucomatous operations, 457 scleroplasty, 232 operations for strabismus, 246 oculoplastic operations, 132 implantations of corneal segments and 112 keratoplastics. C o n c l u s i o n . For residents of the Smolensk region, the staging period between the initial appointment with an ophthalmologist and the period of hospitalization has been reduced, which makes it possible to minimize the waiting time for the necessary treatment.

Ahmed valve implantation results in children with uveitic glaucoma

The purposeis to evaluate the effectiveness and safety of Ahmed valve implantation in children with refractory postuveitic glaucoma (PUG).Material and methods. Ahmed valve was implanted to 10 children aged 7 to 17 years (10 eyes) with open-angle or mixed PUG uncompensated even by a maximum antihypertensive mode. Previously, all patients had undergone an average of 2.1 ± 0.9 surgeries aimed at normalizing the intraocular pressure (IOP) (predominantly, sinus trabeculectomy). 6 eyes were pseudophakic, 2 phakic, 2 aphakic. Ahmed valves were implanted according to the generally accepted technique. At the time of surgery IOP was 30.50 ± 4.35 mm Hg on average. The follow-up postsurgical period ranged from 3.9 to 23.6 months (averagely, 14.1 ± 6.5).Results.A stable hypotensive effect of the intervention was achieved in 90 % of cases, of which 3 patients had no hypotensives while 6 patients received hypotensive drugs even though their quantity was significantly smaller than before surgery (1.7 ± 1.49, p=0.028). At the end of the follow-up the average IOP was 18.1 ± 5.34 mm Hg, (significantly lower than before surgery, p = 0.008). During surgery, 1 patient experienced bleeding from the vessels of the anterior chamber angle after paracentesis, which was stopped by tamponade with sterile air. In other cases, the surgery as well as the immediate and distant postoperative period showed no complications.Conclusion.Ahmed valve implantation is an effective and safe method of the surgical treatment of refractory PUG in children and can be recommended in cases when previous antiglaucomatous operations proved ineffective, including patients with pseudophakia and aphakia.

Morphological features of immune inflammation in patients with persistent post-traumatic uveitis

Purpose : to study the morphology of immune inflammation in patients with long-term posttraumatic uveitis. Material and methods . 54 patients who had one of their eyes removed after trauma and/or the results of surgical intervention were examined, followed by morphological examination of the removed eyes. The eyes were divided into three groups based on the type of trauma. Group I consisted of 20 eyes removed in the outcome of contusion injury. Group II was formed from 16 eyes removed as the outcome of a penetrating wound. Group III included 18 removed eyes after penetrating surgical interventions performed for retinal detachment and/or antiglaucomatous operations. Results . Morphological signs of immune inflammation were found in at least half of the cases in each of the studied groups. In group I (patients with concussion injury outcome) the incidence was the highest and amounted to 65 %, whilst in group II and III the signs were revealed in 56.3 %, and 50 %, respectively. In group III, all cases with immune post-traumatic inflammation referred to patients who underwent vitreoretinal interventions with the introduction of silicone oil into the vitreal cavity. Conclusions . According to comprehensive clinical and morphological study of 54 enucleated eyes, morphopathogenesis of immune inflammation with characteristic lymphoid infiltration and formation of lymphoid nodules was revealed in 57.4 % of cases. In patients with morphologically detected immune uveitis in history, exacerbation of post-traumatic inflammatory process was found to be related to acute respiratory viral diseases in 45.1 % of cases, which cannot exclude a possible role of the infectious factor in the development of an inflammatory reaction with signs of immune-based uveitis.

Surgical treatment of congenital glaucoma in children using Glautex drainage

Clinical studies were conducted in the ophthalmological department of Tashkent Pediatric Medical Institute clinic. The study included 47 patients (50 eyes) with congenital glaucoma. All children had undergone anti-glaucomatous surgery previously. Patients were divided into 2 groups. Patients of group 1 underwent a fistulizing antiglaucomatous operation using autoscleral drainage, and group 2 - sinus trabeculectomy with the use of Glautex biodegradable drainage. Analysis of the obtained data showed that IOP in patients of group 1 averaged 14.8±0.08 mm Hg on day 7 (at discharge), 21.3±0.07 mm Hg after 1 month, 22.7±0.07 mm Hg after 3 months, and 22.9±0.01 mm Hg after 6 months. IOP of group 2 patients amounted to 17.8±0.03 mm Hg at discharge, 18.3±0.07 mm Hg after 1 month, 18.8±0.08 mm Hg after 3 months, and 19.1±0.07 mm Hg after 6 months. In patients of group 1, the true P0 level decreased by 41% and amounted to 13.5 mm Hg, while in patients of group 2 it decreased by 52.7% and averaged 11.2 mm Hg. Sinus trabeculectomy using Glautex drainage can help achieve a long hypotensive effect, avoid repeated surgical interventions, prevent severe postoperative hypotension and thereby reduce the risk of postoperative complications.

Современный взгляд на циклодеструктивные операции при глаукоме

The main purpose of glaucoma treatment is to reduce the intraocular pressure (IOP) to a target level. One of the pathogenetically justified method of treatment for various types of glaucoma, first of all its refractory forms, is the surgery on the ciliary body. A purpose of such manipulations is to suppress excessive formation of aqueous humor. Previously, diode laser cyclophotocoagulation was widely used, which is mainly applied in terminal glaucoma. Technological innovations have led to the development of perspective, more safe, and less destructive methods of cyclodestructive anti-glaucomatous operations, such as micro-pulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation, and ultrasound cyclodestruction. During micro-pulse cyclophotocoagulation, the effect of laser energy occurs by short pulses at rest intervals, which significantly reduces the absorption of energy by surrounding tissues and their associated damage. With endoscopic cyclophotocoagulation, the epithelium of the ciliary processes is directly coagulated, which makes it possible to dose laser energy under visual control. Ultrasonic cyclodestruction causes a coagulation necrosis of the ciliary processes with a very insignificant collateral damage of surrounding tissues. Today these surgical techniques are becoming more relevant in the treatment of refractory glaucoma in order to preserve visual functions. This review is an analysis of modern literature, reflecting the efficacy and safety of cyclodestructive operations with sufficiently high visual functions.

Оценка гемостатического эффекта 1% раствора неполной серебряной соли полиакриловой кислоты при проведении антиглаукоматозных операций у пациентов с первичной открытоугольной глаукомой и сахарным диабетом 2 типа

Оценка гемостатического эффекта 1% раствора неполной серебряной соли полиакриловой кислоты при проведении антиглаукоматозных операций у пациентов с первичной открытоугольной глаукомой и сахарным диабетом 2 типа

Eye hydrodynamics in children subject to total intravenous anesthesia

Purpose: to study eye hydrodynamics in children subjected to total intravenous anesthesia during ophthalmic operations. Materials and methods. 50 children (100 eyes) aged 15 days to 14 years were examined. 21 children showed impaired hydrodynamics while the remaining 29 had no hydrodynamic disorders. All patients received combined endotracheal anesthesia for ophthalmic operations.Results. The patients with undisturbed hydrodynamics showed a significant increase in true intraocular pressure (Po) (by 3.8 ± 0.12 mm Hg) after an injection of anesthesia with ketamine, due to a significant increase in aqueous humor production. Children with disturbed hydrodynamics, who received an antihypertensive ophthalmic drug (arutimol 0.25–0.5 %), after an injection of anesthesia with fentanyl, showed a significant Po decrease (by 3.9 ± 0.12 mm Hg) due to a significant increase of outflow facility rate (C) and a decrease in aqueous humour volume (F). The patients who received no antihypertensive therapy showed a significant decrease in Po (by 2.08 ± 0.7 mm Hg) due to a significant increase in C. In contrast, the decrease in F proved to be insignificant.Conclusion. For an objective assessment of tonographic parameters in children with impaired eye hydrodynamics who received antihypertensive therapy (arutimol 0.25–0.5 %) and anesthesized with fentanyl, we recommend that the Po indices be adjusted upwards by 3.9 ± 0.12 mm Hg, without arutimol by 2.08 ± 0.7 mm Hg, which will help in choosing the type and volume of antiglaucomatous operations. It is also necessary to take into account the increase in Po under the action of ketamine (by 3.8 ± 0.12 mm Hg) in children with undisturbed eye hydrodynamics to prevent possible intra- and postoperative complications.

ОКТ-ангиография в оценке функциональных исходов антиглаукомных операций у больных гипертензивной глаукомой

ОКТ-ангиография в оценке функциональных исходов антиглаукомных операций у больных гипертензивной глаукомой

TECHNICAL POSSIBILITIES FOR MINIMIZING THE TRAUMATIC IMPACT OF PHACOEMULSIFICATION OF AGE-RELATED CATARACT ON THE EYES WITH PRIMARY OPEN-ANGLE GLAUCOMA WITH TARGET INTRAOCULAR PRESSURE

Frequency of recurrences of increase of intraocular pressure (IOP) in postoperative period of phacoemulsification (PE) using our own surgical techniques at combination of primary open-angle glaucoma (POAG) and age-related cataracts was studied. The clinical material consisted of 83 patients (83 eyes) with developed or far-advanced stages of glaucoma, a rigid pupil, a dense nucleus, a lens subluxation of the 1st degree, which had antiglaucomatous operations. The use of our own methods of performing some stages of PE helped to reduced intraoperative trauma and frequency of recurrence of increase of IOP in period of observation to 3 years.

Результаты новой антиглаукомной операции непроникающего типа у больных вторичной глаукомой (клинические случаи)

Результаты новой антиглаукомной операции непроникающего типа у больных вторичной глаукомой (клинические случаи)

Notfallkeratoplastik mit porcinen Xenotransplantaten bei nekrotisierender Keratitis

Background The great shortage of donor material in Ukraine makes it necessary to find additional sources of transplant material. A possible suitable material are the porcine corneas, as they are similar in structure and biomechanical parameters to the human cornea. The purpose of our study was to analyze the results of therapeutic keratoplasty (KP) with keratoxenotransplants from cryolyophilized porcine corneas in patients with severe necrotizing keratitis. Methods A retrospective analysis of 32 xenotransplantations patients with severe necrotizing keratitis (17 lamellar, 6stepped perforating, 4 perforating, 5 "biological coverage" according to Puchkovskaya) was completed. Results All eyes could be preserved, but the graft was rejected in all eyes. A semitransparent xenograft (XG) was achieved in 9 patients (33.3%). The best results were obtained after lamellar XKP with an XT diameter of 3.5 - 6.5 mm. Lamellar XTs with larger diameters (7.0 - 10.0 mm) were opaque. Postoperatively, the intensity of the inflammatory response after stepped XKP was slightly lower than that of the classical perforating XKP. A new KP with human corneas had to be performed in 5 patients, in one case combined with an antiglaucomatous operation and in another case with cataract extraction. Antiglaucomatous surgery had to be performed in 5 patients (15.6%). Conclusion In the absence of human donor corneas, a porcine keratoxenoimplant can be used as temporary therapeutic keratoplasty in case of emergency stop the inflammation process and to save the eye. In cases of keratoxenoimplant, a poor visual outcome is expected.

A Method for Preventing Scarring from Surgical Treatment of Glaucoma

Актуальность Улучшение технических аспектов выполнения хирургических вмешательств при глаукоме позволило до-биться снижения внутриглазного давления в раннем послеоперационном периоде, а также уменьшения частоты развитияпослеоперационных осложнений. Актуальным является вопрос избыточного рубцевания в области оперативного вме-шательства, в результате которого снижается гипотензивный эффект операции, а в отдаленном послеоперационномпериоде, в некоторых случаях, сводит на нет результаты операции.Цель исследования Разработать способ повышения эффективность антиглаукоматозной операции, при которой для про-филактики рубцевания используют синтетический материал Gore-tex.Материалы и методы Эксперимент проведен на 30 животных, которые были разделены на две группы, контрольную - 15животных, оперированных по стандартной методике глубокой склерэктомии по С. Н. Федеорову (ГСЭ), и опытную - 15животных, которым при выполнении ГСЭ под поверхностный склеральный лоскут укладывалась полоска, выкроенная измембраны Gore-tex.Результаты и их обсуждение Исследование результатов имплантации синтетического материала Gore-tex при про-ведении ГСЭ выявило снижение частоты рецидива подъёма внутриглазного давления (ВГД) в позднем послеоперационномпериоде, уменьшение процессов рубцевания. Морфологические исследования показали, что в контрольной группе через 6месяцев в зоне оперативного вмешательства определялось разрастание грубой соединительной ткани с незначительнымколичеством фибробластов и новообразованных сосудов. Уровень внутриглазного давления (ВГД) в контрольной группеживотных через 6 месяцев составил 11.0 мм рт. ст, т. е. вернулся к дооперационному уровню, тогда как в опытной группечерез 6 месяцев после хирургического вмешательства имплант окружен тонкой фиброзной капсулы, вокруг имплантаиме-ется полость до 20 мкм, заполненная жидкостью, которая сообщается с супрахориоидальным и субтеноновым простран-ством. Отмечались дополнительные полости между отдельными волокнами коллагена, также заполненные жидкостью.Уровень ВГД через 6 месяцев после проведения оперативного вмешательства по предлагаемой методике составил 9,0 ммрт ст, что коррелировало с морфологическими изменениями в зоне вмешательства.Заключение Полученные результаты свидетельствуют о том, что использование мембраны Gore-tex снижает процессырубцевания в зоне оперативного вмешательства и способствует повышению гипотензивного эффекта существующегохирургического лечения.Ключевые слова глаукома, профилактика рубцевания, хирургическое лечение.

PRIMARY OPEN-ANGLE GLAUCOMA IN ONCOLOGIC PATIENTS

Актуальность. Снижение зрительных функций при глаукоме неблагоприятно сказывается на качестве жизни онкологических больных. Но и сама злокачественная опухоль, как и методы ее лечения, могут вызывать прогрессирование глаукомы.

Phakomatosis Pigmentovascularis Associated With Sturge–Weber Syndrome, Ota Nevus, and Congenital Glaucoma

Phakomatosis pigmentovascularis (PPV) is a rare congenital malformation syndrome that is characterized by a combination of capillary abnormalities and dermal melanocytosis.We describe 3 cases of PPV combined with bilateral Sturge–Weber syndrome (SWS), Ota nevus, and congenital glaucoma.Case 1 was a 2-year-old boy. Facial port-wine stains distributed along the 3 branches of his trigeminal nerves, which suggested the existence of SWS. Gray-blue patches were spread over the frontal and temporal areas of bilateral face, waist, buttocks, and thigh. Bilateral triangular alopecia was found on the temporal scalp. The diagnosis of Ota nevus was made by the bilateral scleral malanocystosis. Increased intraocular pressure, enlarged cornea, and pathologic optic disc cupping supported the diagnoses of infantile bilateral glaucoma. Case 2 was a 4-year-old boy. Port-wine stains were found on the face along the 3 branches of the trigeminal nerve and distributed along the trunk, arms, and legs. Mongolian spots spread over his frontal and temporal areas of the bilateral face, waist, buttocks, thigh, abdomen, and back. Infantile glaucoma was found in both eyes. Ota nevus were found in the both eyes. Optic coherent tomography (OCT) scans revealed increased thickness of choroid. Case 3 was a 5-year-old boy. Besides Ota nevus and infantile glaucoma in both eyes, color Doppler ultrasonography showed choroidal hemagioma. OCT scan showed increased choroidal thickness. The bilateral triangular alopecia on the child's temporal scalp was similar to that of Case 1. Cases 1 and 2 presented with port-wine stain patches that were consistent with the characteristic manifestation of PPV type IIb. However, the CMTC of Case 3 met the diagnostic criteria for PPV type Vb.Case 1 was treated with trabeculotomies in both eyes. For Cases 2 and 3, surgical interventions were not considered due to the high risks of antiglaucomatous operation complications. We prescribed them antiglaucoma indications.The simultaneously coexistence of PPV with SWS, Ota nevus, and congenital glaucoma is rare. In the clinic, additional detailed examinations and tests of PPV patients to exclude other ocular abnormalities or extraocular involvements are necessary.

Modified by air plasma polymer tack membranes as drainage material for antiglaucomatous operations

The morphological and clinical studies of poly(ethylene terephthalate) track membranes modified by air plasma as drainage materials for antiglaucomatous operations were performed. It was demonstrated their compatibility with eye tissues. Moreover, it was shown that a new drainage has a good lasting hypotensive effect and can be used as operation for refractory glaucoma surgery.

ROLE OF MATRIX METALLOPROTEINASES IN THE PATHOGENESIS OF PRIMARY OPEN-ANGLE GLAUCOMA

Matrix metalloproteinases (MMPs) - a family of enzymes, which convert extracellular matrix. Proved the role of MMPs in apoptosis of retinal ganglion cells, tissues remodulition the optic nerve and the change in the form of lattice plate with POAG. MMPs are involved in violations of blood aqueous barrier and the regulation of intraocular fluid. Many papers have focused on the role of these enzymes in the filter pad with scarring antiglaucomatous operations. The study of MMPs offers the prospect of early diagnosis and targeted therapy of POAG pathogenesis.

Explantodrainage with nanostructured surface for refractory glaucoma surgery

This article presents the results of experimental research of nanostructured track membranes implantation as drainage for refractory glaucoma surgery. For nanostructuring of the membrane surface was applied a treatment by air plasma. Tissues reaction of rabbit’s eyes to drainage implantation was studied in the experiment in vivo . The histological research data demonstrate that the reaction of the inflammatory cells to drainage was minimal. After antiglaucomatous operation filtering blebs were split and plane and in all the cases resulted in a stable hypotensive effect.

Use of polymer track membranes with nanostructured surface as drainage in antiglaucomatous operations

The morphological and clinical studies of poly(ethylene terephthalate) track membranes with a nanostructured surface as drainage materials for antiglaucomatous operations were performed. For nanostructuring of the membrane surface a treatment by plasma of non-polymerizing gasses was applied. It was demonstrated that a new drainage has compatibility with eye tissues and a good lasting hypotensive effect and can be used as operation for refractory glaucoma surgery.

Dependence of the effectiveness of antiglaucomatous operations on the method of forming the conjunctival flap

The influence of two methods of forming a conjunctival flap on the hypotensive efficiency of operations and the outflow of intraocular fluid in the long-term follow-up was studied. Operated on 2 groups of patients - 150 people (150 eyes). In group 1 (76 patients), operations were performed with an incision of the conjunctiva at the site of its attachment along the limbus for 5 - 6 mm, followed by its separation by 3 - 4 mm upward.