Non-penetrating Deep Sclerectomy Research Articles

Outcomes of Non-Penetrating versus Penetrating Deep Sclerectomy in Open-Angle Glaucoma.

In this retrospective study, Non-Penetrating-Deep-Sclerectomy and Penetrating-Deep-Sclerectomy interventions showed similar >90% complete success rates at one-year post-surgery. However, Non-Penetrating-Deep-Sclerectomy achieved a superior safety profile in terms of best-corrected visual acuity recovery and rates of post-surgical complications. Comparing the surgical outcomes of two surgical techniques: non-penetrating deep sclerectomy (NPDS) and penetrating deep sclerectomy (PDS). This was a retrospective, longitudinal, comparative study including 66 eyes from 57 patients aged 69±9 years who underwent either NPDS or PDS for medically uncontrolled open-angle glaucoma. Outcome measurements included intraocular pressure (IOP), best-corrected visual acuity (BCVA), rates of complications, post-operative corrective interventions and glaucoma medications at baseline and at all post-operative appointments up to 1 year. An exploratory mixed-effects model was used to assess the intergroup differences for IOP and BCVA. One-year post-surgery, similar significant IOP reduction from baseline were observed in NPDS (from 19,9±1.3 to 11.5±0.9mmHg, P<0.001) and PDS (from 19,5±1,1 to 10.7±0.6mmHg, P<0.001). A conservative complete success rate (defined as medicated IOP ≤16mmHg and ≥20% reduction in IOP) was of 87% for NPDS and 97% for PDS. No BCVA changes were observed between baseline and 1-year post-surgery in both groups, and glaucoma medications showed a similar 10-fold reduction in both groups (P<0.001 vs. baseline). However, a significant difference in the speed of post-operative BVCA recovery was observed between NPDS and PDS (P<0.01), NPDS showing a faster recovery. Moreover, lower numbers of post-surgical complication and post-operative interventions were observed following NPDS compared to PDS (NPDS n=30 and 34 vs. PDS n=80 and 48 (P<0.05), respectively). The present study confirmed that both NPDS and PDS are highly effective surgical interventions for the management of primary open angle glaucoma. However, NPDS had a superior safety profile, in terms of BCVA recovery, complication rates and post-operative interventions.

Профилактика роговичных осложнений послеоперационного адъювантного применения антиметаболитов после непроникающей глубокой склерэктомии

Original article Prevention of corneal complications after post-operative application of antimetabolites following nonpenetrating deep sclerectomy S.N. Svetozarskii, A.N. Andreev, A.V. Shvaikin, S.V. Scherbakova, I.G. Smetankin Volga District Medical Center under the Federal Medical and Biological Agency, Nizhny Novgorod, Russian Federation Privolzhsky Research Medical University under the Ministr y of Health of Russia, Nizhny Novgorod, Russian Federation Purpose. To evaluate the clinical and functional effectiveness of the developed method for prevention of corneal complications of nonpenetrating deep sclerectomy (NPDS) with postoperative adjuvant use of 5-fluorouracil in comparison with the control group. Material and methods. Retrospective comparative study in 2 groups included patients with open angle glaucoma who were initially underwent NPDS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period. 1st group included 101 patients (101 eyes) who underwent subconjunctival injection of 5-fluorouracil after surgery using standard technique, 2nd group included 176 patients (176 eyes) who underwent subconjunctival injection of 5-fluorouracil with prophylaxis of corneal complications. Best corrected visual acuity (BCVA), intraocular pressure (IOP), frequency of corneal complications and number of visits to the doctor during the first 4 weeks after surgery were analyzed as criteria of efficacy and safety. Results. Comparison groups did not differ in demographic characteristics and preoperative BCVA and IOP parameters. Fluorescein stained corneal epithelium defects were statistically significantly more frequently observed in 1st group (38.6%) in comparison with 2nd group (7.4%) (p&lt;0.001). Four weeks after NPDS, IOP decrease was 25.5% in 1st group and 31.5% in 2nd group (p=0.042). Mean BCVA loss was 1.9 lines in 1st group and 1.3 lines in 2nd group (p&lt;0.001). The number of follow-up visits during the first month after surgery was 0.6 less in 2nd group than in 1st group (p=0.002). Conclusion. Prevention of corneal complications simply and effectively reduces the risk of corneal epithelial defects after subconjunctival injection of 5-fluorouracil as well as markedly improves the clinical and functional results of NPDS and reduces the need for outpatient visits. Key words: antimetabolites, open-angle glaucoma, corneal erosion, toxicity, prevention of complications

Surgical Outcomes in Uveitic Glaucoma: Long-Term Evaluation of Trabeculectomy, Non-Penetrating Deep Sclerectomy, Ex-PRESS Shunt and Ahmed Glaucoma Valve. A 3-Year Follow-Up Study

ABSTRACT Purpose Uveitis can lead to secondary glaucoma, a condition with challenging management that can carry irreversible visual loss. Filtering surgery has demonstrated a higher failure rate, increased incidence of postoperative complications and reinterventions in uveitic patients. There is no consensus on the optimal surgical approach for uveitic glaucoma (UG) due to limited data comparing various intraocular pressure (IOP)-lowering surgeries. This retrospective cohort aims to assess the clinical outcomes of trabeculectomy (TBT), non-penetrating deep sclerectomy (NPDS), Ex-PRESS shunt and Ahmed glaucoma valve, providing additional insights into the long-term IOP control and safety of filtering surgeries in UG. Methods The filtering surgery was performed on 32 eyes of 27 UG patients. Complete success was defined as IOP ≤ 18 mmHg or a 30% reduction. Qualified success allowed topical hypotensive treatment. Results Complete success was 40.63% (13/32) at 12 months and 36.67% (11/30) at 36 months. Qualified success was 84.38% (27/32) at 12 months and 63.33% (19/30) at 36 months. In the survival analysis, both NPDS and Ex-PRESS demonstrated decreased failure rates compared to TBT (NPDS vs TBT: HR = 0.20, p = 0.049; Ex-PRESS vs TBT: HR = 0.28, p = 0.13). One or more reinterventions were required in 34.38% (11/32) of the eyes. NPDS had the lowest incidence of hypotony. Secondary cataract was a common complication in all groups. Conclusion Various filtering surgeries are safe and effective procedures for lowering IOP and reducing the requirement of topical antihypertensives in UG at 36 months. However, one-third of the patients will require another IOP-lowering procedure.

Non-penetrating deep sclerectomy versus combined trabeculotomy-trabeculectomy in primary congenital glaucoma.

The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy-trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma.

Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15months. The secondary outcomes included surgical success and complications. The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14mmHg in the perforation group and 35 to 12mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

Combined non‐penetrating deep sclerectomy with phacoemulsification versus non‐penetrating deep sclerectomy alone

Aims/Purpose: To compare the intraocular pressure after two surgical techniques: combined non‐penetrating deep sclerectomy with phacoemulsification (Phaco‐NPDS) and non‐penetrating deep sclerectomy (NPDS) alone.Methods: It is a retrospective study including thirty‐two patients with primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG) who were not controlled with medication. They were assigned to Phaco‐NPDS (twenty‐two eyes) or NPDS (twenty eyes). Complications in surgery were noted and also, they were followed up after the surgery and intraocular pressure (IOP) was measured at one day, a month, six months and a year after the surgery. Moreover, best corrected visual acuity (BCVA) and the number of the anti‐glaucoma medications at the end of the postoperative medication was measured.Results: Mean IOP in the Phaco‐NPDS group decreased from 24.55 ± 5.8 mmHg to 17.31 ± 2.1 mmHg and in the NPDS group from 26.05 ± 4.1 to 15.6 ± 2.3 mmHg one day after surgery. The decreases of IOP in the postoperative period were statistically significant in both groups (p &lt; 0.05). There was no significant IOP difference between Phaco‐NPDS and NPDS patients postoperatively (p &gt; 0.05). The mean number of glaucoma medications decreased from 3.31 ± 1.4 to 0.68 ± 0.2 and from 3.2 ± 1.3 to 0.3 ± 0.5 in the Phaco‐NPDS and NPDS groups, respectively. The decreases in the mean number of the anti‐glaucoma medications at the end of the postoperative, 24‐month follow‐up period were found to be statistically significant for both Phaco‐NPDS and NPDS groups (p &lt; 0.05). Mean BCVA increased significantly in both groups. However, the visual outcome was significantly better for the Phaco‐NPDS group (p &lt; 0.05).Conclusions: Phaco‐NPDS surgery achieved excellent IOP control, while also providing immediate visual recovery. The success rate was similar to that of the NPDS procedure alone. It is advisable to consider Phaco‐NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma, including PXG.

Late T‐Flux extrusion: A series of 5 cases

Aims/Purpose: To Report T‐Flux® implant (Zeiss, La Rochelle, France) extrusion, as a new complication of non‐penetrating deep sclerectomy (NPDS). Analyse the risk factors that lead to it. Describe the treatment realized, and its complications.Methods: 5 eyes of 5 patients who had undergone NPDS Surgery and presented a late T‐Flux® extrusion were included in this study. We made an epidemiological description of the cases. The treatment consisted in surgical exploration, extraction of the T‐Flux® and closure of the scleral and conjunctival defect. In 1 patient reopening of the scleral flap was needed to access and extract the implant. In the postoperative, values of intraocular pressure (IOP) and complications were evaluated.Results: Of the 5 patients, 2 were man and 3 were female, the mean age was 78 years old, the mean time from the implantation until the extrusion was 11 years and 7 months. Mitomycin C was applied intraoperative during the NPDS in all cases, the concentration used was 0.02%, and the application time 1 min. 4 of the patients were operated by the same surgeon, one of the cases was re intervened later with trabeculectomy. All cases presented a partial or total dissolution of the scleral flap. There was no significant variation on the IOP prior and after surgery, The mean IOP at the diagnosis was 14 mmHg, and the mean IOP postoperative was 13.4. One patient had post surgical seidel that resolved without the need of re intervention.Conclusions: Extrusion T‐Flux® implant is a late postoperative complication of NPDS, unknown up to date, that may occur many years after the original intervention. Treatment consists in surgical extraction and repair. In our experience this complication might be related to mitomycin C use, given that all of our eyes presented a scleral flap necrosis. There is a need of more reports on this complication, to approach its real incidence and predisposing factors.

Technical aspects and intraoperative factors influencing the efficiency of non-penetrating deep sclerectomy and implantation of PreserFlo MicroShunt

Glaucoma is a neurodegenerative disorder marked by the death of retinal ganglion cells which causes characteristic vision field loss. At the moment the only well-known risk factor for progression of the glaucoma is intraocular pressure. In this regard the lowering of intraocular pressure became the main focus of treatment.&#x0D; Different types of glaucoma surgeries have developed over the last decades. Most of them facilitate outflow of aqueous humor, few decrease the production. This article takes into account two of them: non-penetrating deep sclerectomy and implantation of PreserFlo MicroShunt.&#x0D; Deep sclerectomy is a well established non-penetrating type of glaucoma surgery. With use of adjuvant methods such as use of space-maintaining implants, use of viscoelastic agent and use of antimetabolites during procedure it allowed to achieve success rate of standard penetrating surgery with lower rate of complications.&#x0D; PreserFlo MicroShunt implantation is a promising new filtration procedure for glaucoma treatment. First published studies show promising efficacy and safety outcomes, although further research is needed.

Влияние сроков проведения лазерной десцеметогониопунктуры на отдаленную гипотензивную эффективность непроникающей глубокой склерэктомии

Aim. To evaluate the influence of laser descemetogoniopuncture terms on longterm hypotensive effect of nonpenetrating deep sclerectomy. Methods. The study included patients with primary open-angle glaucoma who underwent descemetogoniopuncture after non-penetrating deep sclerectomy at different terms. The first group consisted of patients who underwent descemetogoniopuncture within 6 months after non-penetrating deep sclerectomy. The second group consisted of patients who underwent descemetogoniopuncture later than 6 months from the moment of non-penetrating deep sclerectomy. Results. The study demonstrated the greater effectiveness of non-penetrating deep sclerectomy when performing descemetogoniopuncture earlier. Conclusion. The possibility of early descemetogoniopuncture as the second stage after non-penetrating deep sclerectomy allows activating outflow of intraocular fluid and maintaining hypotensive effect of the surgical operation. Key words: non-penetrating deep sclerectomy; laser decemetogoniopuncture; primary open-angle glaucoma.

Experience in the management of patients with cataract-associated glaucoma

The results of 269 cases of performing of cataract phacoemulsification with IOL implantation (PHACO) and microinvasive nonpenetrating deep sclerectomy (MNPDS) at various stages have been analyzed. The main group included patients who underwent PHACO, followed by MNPDS 64 persons, 65 eyes. The group was divided into a subgroup based on the date of the second intervention. 1 subgroup patients who underwent MNPDS 1 month after PHACO (30 cases); 2 subgroup 3 months after PHACO (35 cases). The control group included patients who underwent MNPDS followed by PHACO 196 persons, 204 eyes. Patients of the main group showed a significant decrease in intraocular pressure after each stage of treatment. in the control group, intraocular pressure decreased after the first stage of treatment, but increased 6 months after surgery. In primary open-angle glaucoma associated with cataract, the most persistent hypotensive effect is observed when the first stage of cataract phacoemulsification is performed, and the second stage is antiglaucoma surgical intervention.

Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery.

To assess the efficacy and safety of non-penetrating deep sclerectomy (NPDS) with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips (modified deep sclerectomy technique, DS) and minimal use of mitomycin C in glaucoma surgery. A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018. Best-corrected visual acuity, intraocular pressure (IOP), post-operative need for glaucoma medications, visual field mean deviation (MD), re-interventions, needling revisions and laser goniopuncture were noted. Absolute success was defined as IOP≤18 mm Hg without topical medication. Relative success was defined as the same criteria but with the addition of any antihypertensive medication. IOP over 18 mm Hg on two consecutive follow-up visits was considered as a failure. Fifty-two eyes of 47 patients were evaluated. Mean preoperative IOP was 25.37±6.47 mm Hg, and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo (all P<0.0001). Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo (all P<0.0001). No medications were required in 45.5% of patients after 24mo. Relative and absolute success rate at 24mo were 85.5%±5% and 48.5%±7.4%, respectively. DS is a safe and effective non-penetrating glaucoma surgery variation. It aims to retain the patency of all pathways created for aqueous humor drainage: the intrascleral bleb, the supraciliary space and the open communication between intrascleral and subconjunctival compartments.

Оценка выживаемости трансплантата после ФЛ-ЗПК (FS-DSEK) у пациентов с глаукомой

Purpose. To evaluate the graft survival in the dynamics of the postoperative period of FS-DSEK in patients with concomitant glaucoma. Material and methods. In total 52 eyes were operated, 32 of them with glaucoma compensated by medication (1st group), 8 with glaucoma operated by implantation of the Ahmed valve model FP8 (2nd group) and 12 with glaucoma operated by microinvasive non-penetrating deep sclerectomy with implantation of collagen antiglaucoma drainage (3rd group). All patients have a follow-up of 12 months. Results. By 1 year, the «cornea + graft» complex retained its transparency in group 1 in 84.4% of eyes (27 out of 32 eyes), in group 2 in 87.5% of cases (7 out of 8 eyes), in group 3 in 75% of cases (9 out of 12 eyes). The highest percentage of endothelial cell loss at 12 months was observed in 2nd group (Ahmed valve) – 45,4±19,5%. In other groups, endothelial cell loss was 41,8±9,1% (group 3) and 39,6±15,2% (1st group). Conclusion. Clinical results show a lower percentage of graft survival after FS-DSEK in the operated glaucoma groups. Accumulation of clinical material and further study of patterns are required. Key words:posterior lamellar keratoplasty, glaucoma, femtosecond laser, endothelial corneal dystrophy

OPTIMIZATION OF THE METHOD OF SURGICAL TREATMENT OF PRIMARY INFANTILE CONGENITAL GLAUCOMA IN CHILDREN

Pediatric glaucoma is a term that encompasses several forms of congenital glaucoma and types of secondary glaucoma thatdiff er in etiology, pathogenesis, and clinical presentation. Surgical treatment is the main method of IOP reduction in pediatricglaucoma. To date, no uniform method of surgical treatment of infantile glaucoma has been proposed, which makes the searchfor adequate methods of surgical intervention in this pathology most urgent.The aim of this work was to evaluate the effi cacy of surgical treatment of primary congenital infantile glaucoma in children.Material and methods. In the eye department of the clinic of the Tashkent Pediatric Medical Institute, the eff ectiveness of themethod of surgical intervention in children from 3 to 10 years old with primary congenital infantile glaucoma was evaluated.Examined – 20 patients (40 eyes). Of these, 5 patients (10 eyes) entered the advanced stage, 10 patients (20 eyes) entered the far advanced stage, and 5 patients (10 eyes) entered the terminal stage, respectively. The patients underwent standard ophthalmological examination. The state of the optic nerve was investigated by optical coherence tomography Stratus OCT-3000 (Carl Zeiss Meditec), the visual fi elds – in 10 (20 eyes) patients aged over 8 years using standard automated and computer perimetry (SAP).Conclusions of the bioethical commission: This article evaluates the eff ectiveness of the method of surgical treatment ofprimary congenital infantile glaucoma in children. And gives specifi c results of diff erent operations at diff erent stages of primary congenital infantile glaucoma. Surgical treatment was chosen according to the degree of goniodysgenesis and the stage of the disease, which showed a satisfactory result in stabilizing the glaucoma process.Statistical analysis method using Microsoft Excel and SPSS programs was used for processing the results of theophthalmological study. Diff erences between the mean values (M±σ) were considered reliable at P≤0.05.Results and Discussion. All patients underwent surgical treatment, depending on the severity of morphometric changesin the anterior chamber angle, and in the postoperative period with an interval of 6 months – a course of neuroprotectivetherapy. According to the examinations, children with primary infantile glaucoma in advanced stage underwent non-penetrating deep sclerectomy in 10 eyes, with extensive – in 20 eyes and with terminal – in 10 eyes – sinusotrabeculotomy ab externo, sinusotrabeculectomy. In 2 eyes in the terminal stage, fi ltering surgery was performed according to the proposed method. Thus, the above methods of surgery reduce the number of intra- and postoperative complications by 12.5%, avoid reoperations, reduce IOP in 12.3% of cases, increase visual acuity by 0.15 compared to the original.Conclusion. The above methods of surgical treatment were chosen according to the degree of goniodisgenesis and the stageof the disease, which showed a satisfactory result in stabilizing the glaucoma process

Модифицированный способ субконъюнктивального введения антиметаболитов в хирургии глаукомы

Purpose. Comparative evaluation of the clinical and functional results of post-operative adjuvant subconjunctival administration of 5-fluororacil after a non-penetrating deep sclerectomy (npdS) compared to the control group. Material and methods. A retrospective study was conducted of two groups of patients with primary open-angle glaucoma who had undergone npdS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period. Group 1 is patients who have received post-surgical 5-fluoride injection using a standard procedure. group 2 — patients who received the injection according to the proposed method. The comparison included: best correction visual acuity (BcVa), intraocular pressure (Iop), frequency of corneal complications. Results. Demographic characteristics and preoperative BcVa and Iop parameters did not differ between the compared groups. Corneal epithelial defects stained with fluorescein were statistically significantly more common in group 1 compared to group 2, p &lt; 0.001. The highest decrease of Iop (p = 0.042) and lower loss of BcVa (p &lt; 0.001) 4 weeks after npdS was observed in group 2. Conclusions. The use of the modified method provides greater safety and efficacy of 5-fluorouracil administration in the postoperative period of npdS compared to the control group. Keywords: 5-fluorouracil, glaucoma, corneal erosion, toxicity, prevention of complications, injection

Evaluation of the Impact of Mid-Infrared Laser Radiation on Eye Tissues (Experimental Study)

Purpose — to study the effect of a mid-infrared laser with a wavelength of 3.0 μm on the eye tissue. Materials and methods. An experimental laser device “Laser scalpel in the middle infrared range 2–8 μm for precision surgery” was used. The range of the radiation spectrum generated by this laser coincides with the spectral absorption peaks of such biological tissue chromophores as water, proteins and cholesterol esters, which makes it possible to use this laser in precision surgery (ophthalmology, neurosurgery, vascular surgery). In this study, we chose a wavelength of 3 µm, which coincides with the peak of the spectral absorption of water. The retina, choroid, sclera of porcine and cadaveric eyes was used as biological tissue. The effect of laser radiation on tissue was carried out in air. The application of coagulates was performed in different modes: 1) single pulses, 2) continuous mode. The impact of laser radiation on eye tissues was assessed using a scanning electron microscope. Results. When exposed to a single laser pulse with an energy of even 1 mJ, a through defect of the retina was observed. When exposed to a single laser pulse on the choroid with an energy of 1 to 3 mJ, the depth of the crater was 110–130 µm, the width of the crater was 97–122 µm, and the zone of collateral damage was 22–28 µm. When exposed to a single laser pulse on the sclera with an energy of 1 to 3 mJ, the depth of the crater was 170–201 µm, the width of the crater was 260–303 µm, and the zone of collateral damage was 57–72 µm. With continuous exposure to laser radiation on the choroid and sclera, the depth, width of the coagulate, the zone of collateral damage with similar laser parameters were greater than with a single pulse. Conclusion. Using this laser at a wavelength of 3 μm, it is possible to dissect eye tissues, which can be useful in vitreoretinal surgery for retinotomy, cutting out the choroid-pigment epithelium complex, and in antiglaucoma surgery for non-penetrating deep sclerectomy. However, further research is needed to optimize such laser parameters as the number of pulses in a packet, pulse duration, and pulse energy.

An easy and safe method of subconjunctival injection of antimetabolites in glaucoma surgery

Aim: The use of 5-fluorouracil in glaucoma surgery is associated with a high risk of corneal complications, as even minimal doses of the drug at the ocular surface inhibit corneal epithelial cell division and lead to corneal epitheliopathy and erosion. The aim of this study was to evaluate the clinical and functional results of the proposed method of postoperative adjuvant subconjunctival injection of 5-fluorouracil after non-penetrating deep sclerectomy (NPDS) in comparison with the control group. Methods: Patients with primary open-angle glaucoma who underwent NPDS and received at least 1 subconjunctival injection of 5-fluorouracil in the postoperative period were included in a two-group retrospective comparative study. Patients who received a subconjunctival injection of 5-fluorouracil after surgery using the standard technique were included in Group 1; Group 2 included patients who received an injection using the proposed method. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), rate of corneal complications, and number of office visits during the first 4 weeks after surgery were analysed. Results: The compared groups did not differ in demographic characteristics, preoperative BCVA, and IOP parameters. Fluorescein-stained corneal epithelial defects were statistically significantly more frequent in Group 1 compared to Group 2, P &lt; 0.001. Four weeks post NPDS IOP reduction was greater in Group 2, P = 0.042. Mean BCVA loss was 1.9 lines in Group 1 and 1.3 lines in Group 2, P &lt; 0.001. The number of follow-up visits during the first month after surgery was lower in Group 2 than in Group 1, P = 0.002. Conclusions: The proposed method was simple and effective in reducing the risk of corneal epithelial defects after subconjunctival injection of 5-fluorouracil, significantly improving clinical and functional outcomes of NPDS and reducing the need for outpatient visits.

Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes.

Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.

Особенности диагностики и лечения глаукомы у лиц молодого возраста

Purpose. To reveal the features of diagnosis and treatment of glaucoma in a group of young patients. Material and methods. Complex ophthalmological examination of 10 young patients diagnosed with glaucoma. Among them, three are on conservative treatment, the rest underwent non-penetrating deep sclerectomy with Xenoplast drainage implantation. Results. Patients who have undergone surgical treatment, especially in the early stages of glaucoma, are able to stabilize the pathological process, while maintaining visual functions at a high level. In an unoperated patient with myopia and nNDST, on maximum antihypertensive therapy, a negative trend was noted according to OCT. In the only case, a patient with emmetropia has stable indicators for several years on drug treatment (prostaglandin analogues). Conclusion. Timely diagnosis and implementation of nonpenetrating deep sclerectomy in the early stages are the main links in the successful treatment of young glaucoma. Patients with axial myopia and glaucoma should be evaluated cardiologically and orthopedically for signs of connective tissue damage. Undifferentiated connective tissue dysplasia may be the pathophysiological basis of the glaucoma process. Key words: glaucoma of a young age, inherited disorders of connective tissue, juvenile glaucoma

Plasma Rich in Growth Factors as an Adjuvant Agent in Non-Penetrating Deep Sclerectomy.

The purpose of this study is to evaluate the utility and safety of plasma rich in growth factors immunosafe eye drops (is-ePRGF) in the postoperative treatment of non-penetrating deep sclerectomy (NPDS). This is a case-control study in patients with open-angle glaucoma. Group one (control) was not treated with is-ePRGF, while group two (is-ePRGF) was treated (four times a day for four months). Postoperative evaluations were performed at one day, one month, three months and six months. The main outcomes were: intraocular pressure (IOP), microcysts in blebs with AS-OCT and the number of hypotensive eye drops. Preoperatively, group one (n = 48 eyes) and group two (n = 47 eyes) were similar in age (71.5 ± 10.7 vs. 70.9 ± 10.0 years; p = 0.68), IOP (20.6 ± 10.2 vs. 23.0 ± 9.0 mmHg; p = 0.26) and number of hypotensive drugs (2.7 ± 0.8 vs. 2.8 ± 0.9; p = 0.40). The IOP at six months dropped to 15.0 ± 8.0 mmHg (IOP reduction: -27.2%) and 10.9 ± 4.3 mmHg (IOP reduction: -52.6%) for group one and group two, respectively (p < 0.01). At six months, blebs with microcysts were 62.5% (group one) and 76.7% (group two). Postoperative complications were observed in 12 eyes (25%) for group one and in 5 eyes (11%) for group two (p = 0.06). No specific complications related to the use of is-ePRGF were identified. Topical is-ePRGF seems to reduce IOP and the rate of complications in the medium term after NPDS, so it can be considered as a possible safe adjuvant to achieve surgical success.

Prospective assessment of cytokines and regulatory proteins concentration in the tear fluid of POAG patients with various hypotensive effects after non-penetrating deep sclerectomy

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.