Scar Deformity Research Articles

Revision of the Retracted Posttracheostomy Scar by Anatomical Restoration; Four Layer Closure

AbstractMost tracheostomy scars are depressive and adherent to the underlying trachea, which causes up and down movement when swallowing. This tracheocutaneous tethering causes discomfort, pain, dysphagia, and bad appearance. A tracheocutaneous fistula may be accompanied. Here, we present a new method for reconstructing a tracheostomy scar deformity with tracheocutaneous tethering: layer-by-layer restoration of the anatomical structure with a subcutaneous fat tissue blanket. The scar tissue was fully excised, with the associated skin and subcutaneous tissue. The bilateral strap muscles around the scar were dissected proximally and distally and approximated to the midline, secured without tension. Bilateral platysma muscle flaps cover them firmly. The subcutaneous tissue around the incision margin, which included the superficial cervical fascia was elevated to form a fat blanket, closed transversely. The skin was closed after confirming the absence of retraction upon swallowing. From 2010 to 2018, 10 patients with tracheocutaneous tethering and one patient with tracheocutaneous fistula underwent surgery. All patients were functionally and aesthetically satisfied with the results. The only complication was a hypertrophic scar in one patient, which was managed with a triamcinolone injection. An anatomical layer-by-layer restoration with a fat blanket provided consistent, satisfying results for correcting tracheostomy scar deformities without using additional tissue. This simple method was effective for reconstructing tracheocutaneous tethering.

(039) DIVERSITY OF CAUSES OF DYSPAREUNIA IN REAL CLINICAL PRACTICE IN THE OUTPATIENT GYNECOLOGY DEPARTMENT

Abstract Introduction Dyspareunia is a women's sexual health problem that still often goes undiagnosed, despite its high prevalence and negative impact on sexual, marital and psychological well-being. Genito-pelvic pain/penetration disorder (GPPPD) refers to significant pain and difficulty with penetrative sex that lasts for at least six months and might be caused by various diseases alone and their combinations. Objective Thus, the purpose of this study is to determine the contribution of different conditions to the total number of patients who applied for a primary appointment for GPPPD. Methods Women who agreed to participate in the study were presenting complaints on painful intercourse or inability to have intercourse for more than 6 months. Patients underwent a gynecological examination consisted of inspection, Q-tip testing, pelvic floor muscle testing and bimanual palpation in the lithotomy position (if it was possible). Diagnoses were documented according to the International Classification of Diseases Tenth Revision World Health Organization guidelines. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale. Assessment of pelvic floor muscle dysfunction was based on an International Continence Society report on the terminology for pelvic floor muscle assessment. Vulvar pain conditions were classified based on the consensus vulvar pain terminology committee of the International Society for the Study of Vulvovaginal Disease, the International Society for the Study of Women's Sexual Health, and International Pelvic Pain Society. Statistical analyses were performed by SPSS Statistics. Results The average age of the examined women was 30,63±0,69 years. As a cause of GPPPD vaginismus and dyspareunia were diagnosed in 19.31 and 80.69 % respectively. Predominant cause of dyspareunia was pelvic floor muscles dysfunction (66,19%) which was combined with other pathologies (scar deformity of the perineum, endometriosis and chronic pelvic pain, candidiasis, etc.) in 20 cases. The percentage of women diagnosed with endometriosis without the formation of central pain mechanisms was 11.36%. The overlapping chronic pain conditions such as migraine, interstitial cystitis/bladder pain syndrome, irritable bowel syndrome, endometriosis and vulvodynia were diagnosed in 21.13% patients with dyspareunia. Dyspareunia due to vaginal atrophy associated with lactation, combined oral contraception use and menopause was diagnosed in 4 patients (2.82%, 1.41% and 1.41%, respectively). Scar changes of the perineum due to traumatic delivery or episiotomy amounted to 4.23%. Lichen planus was diagnosed in one patient (1.41%). Vulvodynia was diagnosed in 8 patients with dyspareunia (11.26%) and was associated with pelvic floor tension myalgia and pelvic floor myofascial pain syndrome in 75% of cases. Conclusions GPPPD can be caused by various conditions with significant involvement of the pelvic floor muscles in the process of pain formation. Taking into account the risk of overlapping chronic pain conditions, a multidisciplinary approach is required in the treatment of this group of patients. Disclosure No.

CICATRICIAL DEFORMITIES MANAGEMENT: A NARRATIVE REVIEW

Background: Treatment and prevention of the development of pathological scars (hypertrophic and keloid) is an important issue in modern dermatology and plastic surgery due to a violation of aesthetic perception (aesthetics), and in severe cases, the function of various areas of the human body. The purpose of this systematic review of the literature was to analyze the proposed effective methods for treating scar deformities of the skin. Methods: The systematic review included articles from Google Scholar, Medline, Scopus, Web of Sciences, PubMed. Search keywords terms included: pathological scar, therapy, botulinum toxin, laser, cryodestruction, hyaluronidase, skin scar prevention, new methods of wound treatment, wound and skin scarring, bioengineering surgery. Results: Conducted a preliminary search and reviewed 132 titles and abstracts in this review and 50 full-text articles were selected of high methodological quality. This review concluded the necessity of developing pre-surgical methods for preventing pathological scarring, which could potentially become a universal standard for any plastic and aesthetic surgery intervention. Treatment depends on the clinical and morphological characteristics of athological scars. Conclusion: The current systematic review demonstrated the need to develop presurgical methods for the prevention of pathological scarring, which could in the future become a universal standard for any intervention in plastic surgery, since the issue of treating skin scars is sufficiently covered in the available world literature.

Morphology of Tissues During Intraoperative Stretching in The Plastic of Scar Deformities of The Lips

Post-burn scarring of the lips often causes functional disorders. Intraoperative balloon stretching of tissues as a method of reconstructive surgery is widely used in surgical rehabilitation of this category of patients. However, structural changes in tissues during balloon stretching have not been sufficiently studied. Using light-optical and electron microscopy, samples of various areas of intact lip skin subjected to stretching during surgery in order to obtain a skin resource for plastic surgery were studied. It has been shown that stretching does not lead to significant violations of the skin structure

The method of medical anisotropy in the diagnosis of the pathological process of scarring of soft tissues after inflammatory diseases of the maxillofacial region

The presented article is devoted to the diagnostic method of anisotropy in assessing the formation of the type of pathological scar in patients after surgical treatment of acute inflammatory diseases.
 Pathological scar deformities in a significant area cause changes in aesthetics, lead to anxiety and depressive states, and sometimes cause severe functional disorders

Surgical treatment of patients with postoperative perianal scar deformities and concurrent rectal fistulas

Perianal scar deformity is referred to as a scar or deformity in the perianal area, with or without extension to the anal canal. It frequently occurs after surgical treatment for acute purulent necrotic diseases and is associated with the formation of fistulas in the scar. Objective — to evaluate the experience of the proctology department in the treatment of postoperative perianal scar deformities and concurrent rectal fistulas using one‑stage combined plastic surgery. Materials and methods. A prospective, non‑randomized study was carried out at the proctology department of the Kyiv City Clinical Hospital No. 18 to evaluate the treatment outcomes for postoperative perianal scar deformities and concurrent fistulas in the scar using one‑stage combined plastic surgery. A total of 34 patients were treated from January 2021 to February 2023, with an average age of 41.85±7.81 years. All patients had a history of surgical treatment of purulent‑necrotic perineal diseases. The observation period ranged from 1 to 6 months. Preoperative and postoperative data were collected to analyze the duration of surgery, the incidence of complications, the duration of hospitalization and rehabilitation. Results. All 34 patients underwent one‑stage combined plastic surgery, which included a combination of anoplasty or sphincteroplasty and flap plastic surgery. The size of the scar deformity was important when choosing a wound closure method, as 3 (8.82%) patients had a small lesion (up to 2 cm2), 20 (58.82%) had a moderate lesion (from 2 to 6 cm2), and 11 (32.36%) had a widespread lesion of the perianal area (more than 6 cm2). The type of rectal fistula was also taken into account: a simple fistula was observed in 26 (76.47%) patients, and a complex fistula in 8 (23.53%). The average duration of the operation was 90.41±13.48 min, and the patient’s hospitalization period was 5.88±1.41 days. Postoperative complications were observed in 3 patients (8.82%). Conclusions. Our findings demonstrate that, in the majority of patients, a single‑stage excision of postoperative perianal scar deformities and concurrent fistulas combined with skin grafting allows for the preservation of normal anal function and satisfactory cosmetic and functional outcomes.

The first experience of treating linear types of capillary angiodysplasia of the skin in children with green laser light λ 520 ± 10.0 nm

Introduction. The linear type of capillary angiodysplasia (LCA) is represented by pathologically dilated vessels of the capillary flow located between the epidermis and hypodermis. LCA may be both congenital and acquired. By the type of blood supply, LCA are arterial, venous and mixed. Local infections and injuries, excessive solar insolation and hormonal imbalance are noted among LCA causes. LCAs are benign lesions, but they may have complications which may be triggered, for example, by traumatic damage to a pathologically enlarged vessel. There is a large number of non-invasive and invasive curative methods of LCA removal: cryotherapy, electrocoagulation, sclerotherapy, laser photodestruction and others. Among disadvantages, various authors mark: high risk of scarring, hyperpigmentation and high rate of disease relapse.Purpose. To improve results of treatment of children with LCA by using laser light.Material and methods. 32 children having LCA were treated with transcutaneous selective photodestruction ( green laser light, wavelength of 520 ± 10.0 nm generated by Russian-made laser device "Malachit") in Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in 2021–2022.Results. After treatment, 31 child had good results without residual vascular elements and scar deformation in the photodestruction zone. One patient required a repeated laser session because of remained residual elements after which she also had good results.Conclusion. The presented clinical trial has demonstrated that transcutaneous selective laser photodestruction with consideration of spatial localization of LCA structural elements in the skin, provides a precise treatment of pathological dilated vascular structures, practically without skin damage, and allows to achieve radical good clinical and aesthetic outcomes.

Retrospective analysis of medical records of patients with postoperative scarring deformities of the perianal area for the period 2011-2021

surgical interventions in the perineal area account for a significant proportion of all colorectal operations. Thus, the problem of postoperative scar deformities of the perianal area has been the cause of scientific discussions for many years and remains relevant today. The reason for this is the lack of described clear approaches to the choice of treatment tactics in different clinical situations. That is why the aim of our study is to establish the relationship between clinical and anamnestic data and the choice of treatment methods for patients with postoperative scar deformities. We analyzed the medical records of 214 patients who were diagnosed with postoperative scar deformities. These patients were treated during 2011-2021 in the proctology department of the "Kyiv City Clinical Hospital No. 18". In order to facilitate the presentation of the results of the analysis, we formed 2 groups depending on the method of treatment: the first group included 78 (36.44%) patients who were treated with non-surgical methods; the second group included 136 patients (63.56%) who underwent surgical treatment. First of all, we made a comparison by gender and found that women are probably more prone to the formation of postoperative scar deformity. Also, a possible link between the duration of the disease and the choice of treatment method was found, which was shorter in group 1 compared to group 2. The main complaints of the patients were as follows: stool retention, inability to defecate without enemas, pain during defecation. According to the status localis description, it was found that anal stricture was present in 71 patients in group 1 (91.03%) and 86 (63.24%) in group 2. Regarding the method of treatment, only conservative treatment was performed in 24 patients (11.21%), bougienage - in 54 patients (25.23%), alloplasty - in 59 patients (27.57%), sphincterolevatoroplasty - in 34 patients (15.89%), and combined interventions - in 43 patients (20.09%). It was also found that in 12 cases (5.61%) patients were re-hospitalized, most of them, namely 9 patients, were in-group 1. Therefore, it should be noted that there is a possible relationship between the duration of the disease, patient complaints and the choice of treatment, but a randomized trial is needed to prove this more accurately. It was also found that postoperative scarring deformities occur more often in women, and the most common causes are hemorrhoidectomy, surgical treatment of purulent-necrotic perineal diseases and combined surgical interventions.

A wide depressed scar deformity treated with cutting wire and autologous fat graft: a case report

Scars are still a challenging problem in medical practice, despite advancements in treatment modalities. Numerous treatment modalities, ranging from simple revision, Z-plasty, and W-plasty to laser treatments, have been used to treat scar deformities. However, for wide depressed scars, additional methods are needed to completely restore the contour of the depression caused by tissue adhesion. We report on the case of a 34-year-old woman with a wide depressed scar deformity on the left upper buttock and the encouraging results of an autologous fat graft injection technique that utilized a cutting wire to form a pocket for the fat graft site, while simultaneously resolving the adhesion caused by the tissue. This method is safe and easily reproducible, making it a useful addition to the surgeon’s toolkit when dealing with such lesions.

Effect of Scar Deformation on Long-Term Outcomes of Suturing Perforated Pylorobulbar Ulcers

Despite the use of modern anti-ulcer therapy, the percentage of unsatisfactory results after suturing perforated ulcers ranges from 4.8 to 57% [1, 2, 3]. It is necessary to search for reasons explaining such significantly different values in the long-term treatment outcomes of patients with perforated ulcers. Cicatricial changes in the pylorobulbar area leading to a violation of the motor-evacuation function and, as a consequence, ulcer recurrence may be one of the causes.The aim of the study was to investigate the effect of a suture row and a type of suture material on the long-term outcomes in suturing perforated ulcer. Materials and methods. The study involved results of suturing perforated ulcers in 280 patients. When suturing, a single-row and double-row sutures, absorbable and non-absorbable suture materials were used. In the immediate postoperative period, the main attention was paid to the suture failure. In the long-term period, the results were evaluated in 106 patients, which accounted for 37.8% of the operated patients. The results were analysed according to the Visick score modified by M.Y. Pantsyrev [4]. Fibrogastroduodenoscopy findings in the long-term period were also analyzed in 56 patients; 31 of them were performed suturing with a single-row suture technique using absorbable threads, 25 patients were performed suturing with a double-row suture technique using dacron or silk threads. The severity of cicatricial deformation of the pylorobular area was evaluated based on B.P. Dergachev classification (1982) [5].Results. Evaluating the immediate results of suturing, no significant increase in the percentage of suture failure was registered when using a single-row suture technique and absorbable suture material (p=0.2). In the long-term postoperative period, the number of patients with excellent results according to the Visick score was significantly higher in the group where a single-row suture was performed (p=0.023). Analyzing endoscopic examination findings, the authors obtained the following results: no pronounced scar deformation was detected under fibrogastroduodenoscopy in patients who were performed a single-row suturing. In three cases (9.7%), no signs of scarring were found. Endoscopic signs of scar deformation were detected in all cases in patients of the second group, who were performed a double-row suturing. Of these, 6 (24.0%) patients had pronounced scar deformity. After performing a double-row suturing with non-absorbable suture material, an ulcerative defect with the ligature at the bottom was detected in the duodenum under fibrogastroduodenoscopy in two cases.Conclusion. Application of a single-row suture and absorbable suture materials is a reliable option to close perforation without increased suture failures; it results in improved long-term treatment outcomes. The use of a double-row suture and non-absorbable suture materials results in a more severe deformation of the suturing area and is one of the risk factors for ulcer recurrence.

Free Tissue Transfer in the Reconstruction of Neck Contractures after Burn Injury: A Case Series

Background: Recent advances in burn care have significantly improved the survival rate of patients with extensive burn injuries, placing greater emphasis on reconstruction to improve the long-term outcomes of scar deformities. Anterior and lateral neck contractures are common after burn injuries; they limit range of motion, complicate airway management and create significant cosmetic deformities. Traditional methods have been used to release contractures and improve function. However, they are subject to variable results, residual neck tightness, recurrence and suboptimal cosmetic appearance. Microvascular free tissue transfer is a more technically challenging and time-consuming method, but it offers the potential to overcome the long-term limitations of simpler options. In this paper, we present our experience with microvascular free flaps for the release of burn scar contractures of the neck as a potential high-quality permanent solution. Methods: Over a 10-year period, nine free flaps were performed on burn patients with total body surface area (TBSA) burns between 20 and 70%, who developed moderate to severe neck contractures. Four anterolateral thigh (ALT) flaps, four radial forearm free flaps (RFFFs) and one ulnar forearm flap were used to release neck contractures. Results: All nine flaps were completed successfully with significant improvement in the neck’s range of motion. Good aesthetic results were achieved with smooth contour and thin coverage. Overall, the patients were satisfied. However, five out of nine cases required at least one secondary procedure for flap defatting to reach optimal results. Conclusion: Post-burn scar contractures of the cervical region compromise the cosmetic appearance and airway security of recovering burn patients, imposing a significant impact on their psychological and functional quality of life. Consequently, cervical contractures can be prioritized when planning reconstruction for burn patients. Free flaps can be considered an important and reliable method of reconstruction for neck contracture deformity following burn injuries.

Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level.

Most published studies on abdominoplasty focus on methods to reduce the risk of seromas. These methods include limited dissection (lipoabdominoplasty), quilting sutures, and preservation of the Scarpa fascia. Quantitative evaluation of the aesthetic result has been lacking. A retrospective study was undertaken of all patients undergoing abdominoplasty in the author's practice from 2016 to 2022. A full abdominoplasty was performed, usually with liposuction (87%). All patients were treated under total intravenous anesthesia without paralysis or prone positioning. A single closed suction drain was removed 3 or 4 days after surgery. All procedures were performed as outpatients. Ultrasound surveillance was used to detect any deep venous thromboses. No patient received chemoprophylaxis. The operating table was flexed, often to 90°. Deep fascial anchoring sutures were used to attach the Scarpa fascia of the flap to the deep muscle fascia. Measurements of the scar level were made at intervals after surgery up to 1 year. Three hundred ten patients were evaluated, including 300 women. The mean follow-up time was 1 year. The overall complication rate, which included minor scar deformities, was 35.8%. Five deep venous thromboses were detected. There were no hematomas. Fifteen patients (4.8%) developed seromas that were successfully treated by aspiration. The mean vertical scar level 1 month after surgery was 9.9 cm (range, 6.1-12.9 cm). There was no significant change in scar level at subsequent follow-up times up to 1 year. By comparison, the scar level in published studies ranged from 8.6 to 14.1 cm. Avoidance of electrodissection reduces tissue trauma that causes seromas. Flexed patient positioning during surgery and deep fascial anchoring sutures are effective in keeping the scar low. By avoiding chemoprophylaxis, hematomas can be avoided. Limiting the dissection (lipoabdominoplasty), preserving the Scarpa fascia, and adding quilting (progressive tension) sutures are unnecessary. Total intravenous anesthesia offers important safety advantages. Avoiding electrodissection is effective in keeping seroma rates at a tolerable level (5%), and the scar low and more easily concealed. Alternative methods present disadvantages that may contribute to a suboptimal aesthetic result and require additional operating time.

Transcutaneous selective laser photodestruction for the treatment of petechial arachnoid capillary angiodysplasia of the skin in children

Introduction. Petechial – arachnoid capillary angiodysplasia (PACA) of the skin is an acquired pathological benign vascular formation that is met in 66% of children aged 4–9. PACA looks like a spider with a vascular red spot in the center and thin vascular rays coming from it. PACA has a benign course; it is slowly and gradually growing over time, and in rare cases it can disappear spontaneously. There have been proposed some techniques for removing PACA: cryodestruction, electrocoagulation, laser coagulation – with CO2-laser light (wavelength 10.6 mkm), copper vapor laser (wavelength 511 and 578 nm), pulsed dye laser (wavelength 585–595 nm). The main disadvantage of cryodestruction, electrocoagulation and laser coagulation with CO2-laser is a high risk of scarring, hyperpigmentation and frequent relapses. While irradiation with copper vapor laser and pulsed dye laser requires repeated exposures to achieve optimal results.Purpose. To improve outcomes in managing children with PACA using a new modality of transcutaneous selective laser photodestruction.Material and methods. For the last two years, 61 children having PACA were treated with transcutaneous selective laser photodestruction in Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow, Russian Federation ). The researchers used “green” laser light having the following parameters: wavelength 520±10.0 nm, peak power 2.0±0.5 W, pulse duration 1.9 ms, pulse frequency 50 Hz, exposure time 2.0±0.5 sec.Results and discussion. 59 patients had no any residual elements after the first session; the other two had repeated photodestruction because of residual elements. No scar deformity was seen in any of 61 cases after treatment.Conclusion. The present clinical trial has demonstrated that transcutaneous selective laser photodestruction, if to consider spatial localization of PACA structural elements in the skin, allows to precisely irradiate only the central vascular element and to achieve radically good clinical and esthetic outcomes after treatment.

A prospective study on the expansion rule of the directional skin and soft tissue expander in abdominal scar reconstruction

A prospective study on the expansion rule of the directional skin and soft tissue expander in abdominal scar reconstruction

The Transfer of Expanded Forehead Superthin Flap Without Frontalis and Less Hair Follicles Pedicled by Superficial Temporal Vessels.

The expanded forehead flap pedicled with superficial temporal vessel(s) is a common method to treat facial scar deformity. However, local bulkiness and hair retention have limited the use of this flap. Five cadavers were used for anatomy to confirm the forehead "safety zone." A retrospective study was performed on 15 patients with facial scar deformity who were undergoing the expanded forehead superthin flap (without the expanded capsule, frontalis muscle, and with less hair follicles) pedicled with superficial temporal vessel(s) to transfer and repair the deformity. Through cadaver anatomy, the range where the subdermal vascular network laid superficial to the hair follicle level was named the "safety zone," whose average distance between the bilateral penetrating points was 10.2 cm (8.7-11.6 cm). Fifteen patients with facial scar deformity were treated with the superthin flap technique. The trimming size of the safety zone flap was (6-10) × (12-20) cm. The median time of thinning the safety zone was 35 minutes (range, 25-40 minutes). All flaps healed well. The median residual ratio of the hair follicle was 39.8% (29.9%-50.5%). All patients were satisfied with the contour of the flap. We firstly proposed a concept of forehead safety zone and used the superthin flap without the frontalis muscle and less hair follicles to treat facial scar deformity, and obtained an improved therapeutic effect. We think this is an appealing technique that can manifest facial concave and convex in the fine part, improve compliance of the flap, and reduce the times of laser hair removal.

Пластическая реконструкция вульвы после перенесенного гнойного воспаления шва от эпизиотомии

This article presents a clinical case of suture purulent infection after lateral episiotomy in a postpartum patient with subsequent secondary intension healing. In 12 months after delivery, a reconstructive plastic surgery was performed to restore perineal integrity and, more importantly, to correct the aesthetic defect of the genital area. An original approach to mucosal flap excision and, accordingly, the use of non-standard access to anatomical structures was proposed. As a result, restoration of perineal anatomy and vulvar ring integrity was achieved. Key words: purulent infection, colporrhaphy, perineum, scar deformity, episiotomy

Сравнительная характеристика методик формирования глоточно-пищеводного анастомоза и бесканюльной трахеостомы у ларингэктомированных пациентов

Radical treatment of laryngeal cancer allows achieving good oncological results but leads to disability of patients. Restoration of voice function after laryngectomy is the main aspect of rehabilitation. The improvement of existing methods of pharyngeal reconstruction contributes to the creation of favorable conditions for subsequent rehabilitation. Objective. Improving the effectiveness of the results of the surgical stage of complex rehabilitation of laryngectomized patients. Materials and methods. The results of surgical treatment were analyzed in 70 patients diagnosed with stage III–IV laryngeal cancer. Patients were divided into 2 groups depending on the technique of suturing the pharynx and the formation of a tubeless tracheostomy. Results. The developed technique of pharyngeal reconstruction with simultaneous formation of anatomical and physiological prerequisites for early rehabilitation of patients after laryngectomy does not increase the total operation time and averages 25–30 minutes in 68.57% of cases, reduces the likelihood of complications in the postoperative period by 11.41%, reduces the incidence of scarring deformities of the pharyngeal-esophageal funnel by 11.43%, allows achieving the formation of a tubeless tracheostomy resistant to narrowing in 74.27%, and does not affect the oncological effectiveness of combined treatment of patients with stage III–IV laryngeal cancer. Conclusion. The developed method of closing the pharyngeal defect after laryngectomy showed high effectiveness and allowed improving the results of postoperative wound healing, reducing the number of local postoperative complications as well as improving functional results.

Optimization of surgical treatment of post-burn scar deformities of the lower extremities

The article presents the experience of surgical treatment of 172 patients with post-burn scar deformities and defects of the lower extremities. Based on the results obtained, practical recommendations on the optimal choice of methods of operations are given.

Reconstruction of Severe Burn Scar Deformities on the Distal Nose and Philtrum

Reconstruction of Severe Burn Scar Deformities on the Distal Nose and Philtrum

Some aspects of filtering bleb formation in patients with primary open-angle glaucoma after non-penetrating deep sclerectomy

PURPOSE. To determine the role of extracellular matrix (ECM), transforming growth factor β (TGF-β) and matrix metalloproteinase 9 (MMP-9) in the mechanisms of filtering bleb formation after non-penetrating deep sclerectomy (NPDS) in patients with primary open-angle glaucoma (POAG).METHODS. The study consisted of prospective examination of 65 patients with POAG operated by the NPDS method. Three groups were formed: group 1 — optimal hypotensive effect of NPDS (21 patients); group 2 — relative hypotensive effect (23 people); group 3 — absence of hypotensive effect (21 patients). During the postoperative period, the condition of the intraocular fluid outflow pathways was evaluated with ultra biomicroscopy, optical coherence tomography, level of intraocular pressure, as well as the concentrations of TGF-β and MMR-9 in the tear and aqueous humor.RESULTS. The anterior chamber aqueous humor was found to contain TGF-β in all patients with glaucoma. Group 1 was noted to have minimal initial TGF-β concentrations in the tear and aqueous humor, high MMR-9 level in the pre- and postoperative period. Sparse extracellular matrix was the substrate for the filtering blebs. Group 2 was revealed to have elevated initial concentrations of TGF-β in the tear and aqueous humor, extremely high level of MMP-9 in the aqueous humor, accumulation of MMP-9 in the tear after 2 weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early period, loci of rigid ECM were visualized in the filtering blebs, but functional outflow pathways were successfully formed by month two after additional therapy. Group 3 was established to have maximum TGF-β concentrations and low MMP-9 concentrations in the anterior chamber aqueous humor, a decrease in tear MMP-9 after two weeks, and inhibition of TGF-β and MMP-9 two months after NPDS. In the early postoperative period, the filtering blebs were based on rigid ECM, by month two there was scar deformation of the outflow pathways.CONCLUSION. The important conditions for the formation of functional filtering blebs after NPDS are the structural organization of temporary ECM of the filtering blebs in the early postoperative period and the timely degradation of ECM components with predominant concentration of MMR-9 over TGF-β.