Surgical Treatment Of Glaucoma Research Articles

Этиопатогенез и существующие методы лечения вторичной «силиконовой» глаукомы

Purpose. To analyze the literature on the etiology, pathogenesis, and methods of treatment of secondary glaucoma caused by emulsification of silicone oil after pars plana vitrectomy. Material and methods. The search for literature sources was carried out using the reference databases PubMed, Scopus and eLibrary for the period up to 2022 using the keywords: «silicone oil induced glaucoma», «secondary glaucoma after vitrectomy», «silicone oil», «silicone oil emulsification», and the same words in Russian. Results. The use of silicone oil ensures stabilization of the retina and has a number of advantages. However, prolonged presence of it in the vitreal cavity can lead to such a complication as secondary glaucoma. The review presents an analysis of the methods of treatment of secondary glaucoma induced by emulsification of silicone oil, their effectiveness and safety. Conclusion. The main mechanism for the development of secondary glaucoma due to silicone oil emulsification is the mechanical closure of the outflow pathways by silicone oil bubbles. According to the literature, traditional methods of surgical treatment of glaucoma in this pathology are ineffective. The use of drainage devices gives a more persistent hypotensive effect. Key words: secondary glaucoma, emulsification, silicone oil, ExPRESS, Ahmed.

Quantification of Hypotony Maculopathy Using Spectral-Domain Optical Coherence Tomography.

We provide a free-to-use, open-source algorithm to quantify macular hypotony based on optical coherence tomography (OCT) images. This numerical approach calculates a metric that measures the deviations of Bruch's membrane from a smooth ideal retinal layer. Hypotony maculopathy is a recurrent complication of glaucoma surgical interventions in which extremely low intraocular pressure triggers changes in the shape of retinal layers. Abnormal folds can often be observed in the retina using standard fundoscopy, but OCT is particularly important to appreciate the severity of symptoms at different depths. Despite the need for metrics that could be used for the informed clinical decision to evaluate the progression and resolution of macular hypotony, algorithms that quantify the retinal folds are not available in the literature or included in clinical imaging equipment. The purpose of this work is to introduce a simple algorithm that can be used to assess hypotony maculopathy from OCT B-Scans and volumes and a free, open-source implementation. The pipeline we present is based on a straightforward segmentation of Bruch's membrane complex. The principal idea of quantification is to compute a smoothed version of this complex and analyze the deviations from an ideal interface. Such deviations are then measured and added to create a metric that characterizes each OCT B-Scan. A full OCT volume reconstruction is thus characterized by the average metric obtained from all planes. We tested the metric we proposed against the assessment of 3 experts and obtained a very good correspondence, with Pearson correlation coefficients higher than 0.8. Furthermore, agreement with automatic analysis seemed better than between experts. We describe the pipeline in detail and illustrate the results with a group of patients, comparing baseline images, severe hypotony maculopathy, and a variety of outcomes. The tool we introduce and openly provide fills a clinical gap to quantitatively grade hypotony maculopathy. It offers a metric of relatively simple interpretation that can be used to help clinicians in cases where the regression of symptoms is not obvious to the naked eye. Our pilot study demonstrates reliable results, and an open-source implementation facilitates easy improvements to our algorithm.

Effectiveness of minimally invasive glaucoma surgery (review of international experience)

The trends of recent years regarding the surgical treatment of the visual organ and its appendages are to minimize tissue traumatization during surgical manipulations, reduce their duration, as well as achieve the best possible outcome from the points of view of the doctor and the patient at minimal economic costs. Currently, the leading vector in glaucoma treatment remains the achievement of the target level of intraocular pressure (IOP). Taking into account the projected increase in the number of patients with glaucoma, conducting justified surgical treatment will remain relevant in the future. Its present state prompts the creation of new drugs, new means of their delivery, and surgical techniques with improved safety profile while achieving effective IOP reduction. In this regard, the trends in the development of surgical treatment of glaucoma have shifted towards procedures with minimal trauma to the eye tissues — minimally invasive glaucoma surgery (MIGS). The article discusses modern varieties of MIGS, theoretical and practical aspects of their application (effectiveness and safety profile), as well as prospects of their use.

Одномоментная хирургия катаракты и глаукомы с использованием модифицированной антиглаукомной операции

Purpose. To develop a modified antiglaucoma operation (MAO) for the combined simultaneous surgical treatment of glaucoma and cataracts and to evaluate the effectiveness of this antiglaucoma component in comparison with trabeculectomy and non-penetrating deep sclerectomy. Material and methods. 61 patients (65 eyes) with a combination of incomplete complicated cataract and previously unoperated POAG stages I–III. The patients were divided into 3 groups: 1st group (control) – 17 patients, 17 eyes with ultrasonic cataract phacoemulsification (PEC) and non-penetrating deep sclerectomy (NPDS); 2nd (control) group (25 patients, 28 eyes) of patients with PE and trabeculectomy (TE); 3rd (main) group (19 people, 20 eyes) – FEC with developed MAO (based on the NGSE technique with cyclodialysis, also including elements of iridocycloretraction and autosclercyclostomy). All patients underwent a comprehensive ophthalmological examination, which included the determination of visual acuity, kinetic perimetry, non-contact tonometry, biomicroscopy, ophthalmoscopy, and optical coherence tomography (OCT). Hypotensive and visual results were assessed a week later and in the long term after surgery. The maximum follow-up period for patients did not exceed 1.5 years (average 12.4 months). Results. Approximately equal hypotensive results in the long-term period were shown by combined operations, which included FEC with TE (absolute effect, i.e. without additional medication – in 65 % of cases) and MAO (respectively, in 60 %). A more modest result was recorded after FEC and NGSE – 41.7 %. However, the number of early postoperative complications after the latter turned out to be almost 2 times less than after simultaneous intervention with penetrating TE (28.5 %), and was quite comparable with that after FEC and NGSE (15 % and 11.8 %). At the same time, the best visual results in the studied terms were observed in the main (0.78 ± 0.06) and 1st control (0.70 ± 0.07) groups, the worst – after FEC (0.64 ± 0.05). Conclusion. Modified antiglaucoma surgery in combination with FEC in POAG surgery and complicated cataract in the long term provides a higher absolute hypotensive effect (60 %) than simultaneous surgical intervention using non-penetrating deep sclerectomy (41.7 %). At the same time, the developed operation is practically not inferior in this indicator to fistulizing trabeculectomy (65 %), but significantly exceeds it both in safety (the number of complications is almost 2 times less) and in visual acuity in the long term (0.78 ± 0.06 versus 0.64 ± 0.05, p < 0.05). Keywords: cataract, glaucoma, simultaneous combined surgery, phacoemulsification, modified antiglaucoma surgery

Gonioscopy-assisted transluminal trabeculotomy (GATT) in Indian eyes – A description of 1-year follow-up results of the GATT procedure in a series of patients with open-angle glaucoma in South India

Trabeculectomy is considered as the gold standard for surgical treatment of glaucoma. The use of conjunctiva to create a filtering bleb limits future surgical options. Gonioscopy-assisted transluminal trabeculotomy (GATT) is an ab interno trabeculotomy technique that has the advantage of reducing the intra-ocular pressure (IOP) in a conjunctiva sparing manner. Ten eyes of eight patients underwent GATT and were followed up for a minimum period of 6 months. Eight eyes were not on any glaucoma medication till the end of their last follow-up, which ranged from 6 months to 1 year. Two eyes were advised to undergo additional glaucoma surgery. All eyes except one retained their visual acuity in the post-operative follow-up period. GATT is a promising technique for the treatment of mild to advanced open-angle glaucoma with an added benefit of sparing the conjunctiva for future interventions.

Surgical treatment of glaucoma with filtration bleb activation of a patient with Sturge — Weber syndrome: a clinical case

Purpose:to describe surgical treatment of glaucoma of a patient with Sturge — Weber — Krabbe syndrome. We present a clinical case of a patient with Sturge — Weber — Krabbe syndrome who sought assistance with us due to secondary stage III glaucoma with moderately elevated intraocular pressure. The examination revealed a cutaneous hemangioma of the frontal, and zygomatic area of the left half of the face, the upper and the lower eyelids, and conjunctival and episcleral hemangioma of the left eye. Since local hypotensive drug therapy produced no effect, the patient was offered a surgical treatment: sinus trabeculectomy. A pronounced hemorrhage from the conjunctival vessels, the episclera and choroidal vessels that occurred during the operation increased its duration, but severe complications could be avoided. A hyphema that appeared during the operation was almost completely washed out and dissolved within 5 days. Since scarring processes of the filtration zone were activated in the postoperative period, we resorted to an active tactics of the patient’s management, namely the needling of the filtration zone with the use of antimetabolites and corticosteroids.Conclusion. Sinus trabeculectomy is an effective method of IOP normalization in glaucoma patients with Sturge — Weber — Krabbe syndrome. Active management of the patient in the postoperative period of the case described allowed us to avoid severe intra- and postoperative complications and to achieve stable clinical and functional results.

New techniques of sinus trabeculectomy with prolonged hypotensive effect

Long-term hypotensive effect in the postoperative period is one of the main tasks of modern glaucoma surgery.Purpose. To develop new modifications of sinus trabeculectomy in the surgical treatment of primary open-angle glaucoma (POAG), aimed at reducing scarring, normalization and prolongation of the outflow of intraocular fluid along newly formed pathways.Material and methods. During the first operation, a superficial scleral flap was formed. After trabeculectomy, the scleral flap was twisted by 180° in the middle, then fixed with sutures to the sclera. During the second operation, after the formation of the superficial scleral flap, and the trabeculectomy, the scleral flap was stitched in the middle and assembled in such a way that its width decreased by 1/3–1/2, after which it was fixed with sutures to the sclera. The operation was performed on 84 patients (84 eyes) aged 43 to 86 years (mean age 63.12 ± 1.17). Of these, 59 patients had POAG in advanced and far advanced stages, and 25 patients had a history of previous laser and surgical POAG interventions. The patients were divided into groups: 1a — 28 patients (28 eyes) who underwent sinus trabeculectomy with twisting the scleral flap, 1b — 29 patients (29 eyes) who underwent sinus trabeculectomy with stitching of the scleral flap and the control group – 27 patients (27 eyes) who underwent standard sinus trabeculectomy. The follow-up lasted 24 months. Standard methods (visometry, tonometry, computer perimetry, tonography, etc.) were used in the pre-surgical and post-surgical examination. In addition, we performed, in the early postoperative period, optical coherence tomography of the anterior eye segment followed by ultrasound biomicroscopy.Results. 1 month after surgery, the average IOP levels were simliar and remained low in all groups: 1a — 16.1 ± 0.5 mmHg, 1b — 16.4 ± 0.8 mmHg, 2 — 17.1 ± 0.7 mmHg. By the 1st year of the study, normalized IOP was maintained in both the two main groups and the control group. By 24 months of the follow-up, the effect was retained in 82.1 % in group 1a and in 82.7 % in group 1b. If the patients were IOP compensated with medication, the effect rose to reach 92.8 % and 96.4 %. In the control group, the hypotensive success rate was 74 %, if patients IOP were compensated with medication it rose to 88.8 %.Conclusion. The developed new methods of sinus trabeculectomy for surgical treatment of glaucoma ensures a prolonged hypotensive effect.

Результаты применения GATT при вторичной глаукоме после витреоретинальной хирургии

Glaucoma is one of the leading causes of vision loss and decline worldwide. Today, with the development of vitreoretinal surgery, such a complication as secondary glaucoma has appeared, their combination requires a personalized approach to the choice of treatment tactics. An analysis was made of the surgical treatment of 12 patients (12 eyes) with secondary glaucoma after vitreoretinal surgery with the removal of SO 1300 according to the GATT technique in order to evaluate efficacy and safety. Keywords: glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma, silicone oil.

A new trabeculectomy technique for the treatment of glaucoma

PURPOSE. To develop a new modified technique of sinus trabeculectomy for the surgical treatment of primary open-angle glaucoma (POAG) aimed at reducing scarring and improving and prolonging the outflow of aqueous humor along newly formed pathways. METHODS. In the course of the surgery, superficial and deep scleral flaps were formed. After trabeculectomy, the lateral edges of the deep flap were turned inside out and superimposed on each other, forming a roller with "grooves" on its sides used for the outflow of aque-ous humor. The operation was performed in 52 patients (52 eyes) aged 43 to 84 years old (mean age 63.4 ± 1.49 years). Of these, 39 patients were diagnosed with POAG at advanced and far advanced stages, and 13 patients with POAG and a history of previous laser and surgical interventions. The patients were divided into groups: group 1 (main) — 25 patients (25 eyes) who underwent the modified sinus trabeculectomy involving the formation of grooves for the outflow of aqueous humor, and group 2 (controls) — 27 patients (27 eyes) who underwent standard sinus trabeculectomy. The follow-up lasted up to 24 months. Standard methods of examination were used (visometry, tonometry, computer perimetry, tonography, etc.). Optical coherence tomography of the anterior segment of the eye was performed in the early postoperative period, followed by ultrasound biomicroscopy. RESULTS. One month after surgery, the average level of intraocular pressure was comparable and remained low in all groups: 1 — 16.7 ± 0.6 mm Hg, 2 — 17.1 ± 0.7 mm Hg. After one year post surgery, IOP remained normalized in both groups. By 24 months, IOP normalization was preserved in 84 %, and including patients compensated on medication — 96 %. In the control group, the hypotensive success rate was 74 %, and including patients compensated on a medication regimen — 88.8 %. CONCLUSION. The newly developed sinus trabeculectomy technique for the surgical treatment of glaucoma achieves a prolonged hypotensive effect.

Wound Healing Response After Bleb-Forming Glaucoma Surgery With a SIBS Microshunt in Rabbits.

PurposeThe PreserFlo MicroShunt is an innovative implant for the surgical treatment of glaucoma. Although usually effective, surgeries can still fail due to fibrosis. This study was conducted to gain insight into the histological aspects of the fibrotic response and find potential targets to reduce postoperative fibrosis.MethodsFifteen New Zealand White rabbits were implanted with a microshunt and followed up for 40 days. Animals were euthanized at postoperative days (PODs) 1, 5, and 40 to collect eyes for histological evaluation. Bleb formation and ocular health were assessed by slit-lamp (SL) biomicroscopy and optical coherence tomography (OCT). Intraocular pressure (IOP) was measured using rebound tonometry.ResultsBlebs failed after approximately 2 weeks based on bleb survival and IOP measurements. No severe complications were observed with OCT and SL. Histology revealed a wide variety of cells, in the bleb and around the microshunt, including polymorphonuclear leucocytes (PMNs), myofibroblasts, and foreign body giant cells, at different PODs.ConclusionsImplantation of a poly(styrene-b-isobutylene-b-styrene) microshunt in rabbits resulted in the occurrence of a wide variety of cells during the wound-healing response. Future research should further elucidate the potential of these (earlier often overlooked) cells to target the fibrotic response in vivo—for example, by developing novel antifibrotic drugs, methods for sustained delivery of medications, or augmenting material properties.Translational RelevanceCurrent antifibrotic therapies aim to inhibit myofibroblasts; however, a wide variety of cells are involved in the fibrotic response. Future research focusing on these cells could offer novel methods for reducing the fibrotic response after glaucoma surgery.

Trace elements composition of the scleral shell of the eye in various forms of glaucoma

Purpose: a comparative study of the elemental composition of scleral biopsy specimens from patients with various clinical forms of glaucoma. Material and methods. 44 patients aged 79.5 ± 2.5 were divided into three groups depending on the form of glaucoma: 16 patients with primary open-angle glaucoma (POAG) (group 1); 13 patients with normal tension glaucoma (NTG) (group 2); 15 patients with pseudoexfoliative glaucoma (PEG) (group 3). For elemental analysis, we used scleral biopsies obtained during planned surgical treatment of glaucoma (non-penetrating sinus trabeculectomy). Scleral fragments of 14 donor eyes with no history of glaucoma served as controls. The concentration of macroelements K, Mg, Ca, and Fe was determined using inductively coupled plasma atomic emission spectrometry (ICP-AES, Agilent ICP-AES 720 ES, USA), while microelement concentration (Zn, Cu, Al, Mn) was measured using inductively coupled plasma mass spectrometry (ICP-MS, Bruker ICP-M S 820, Germany). Results. In all forms of glaucoma, scleral samples showed a varying increase in the content of such elements as Zn, Fe, Mg, AL, Ca, K. The highest content of Zn and Fe was found in the scleral tissue of patients with NTG, the difference with the control (p = 0.0001 andp = 0.0003) and with POAG (p = 0.0002, p = 0.0001) being highly significant. The difference between the content of Zn in scleral biopsies of patients with POAG and PEG was also statistically significant (p = 0.0002), whilst no significant difference in Fe content in the sclera (p = 0.69) was found between POAG and PEG Higher Mg concentrations as compared to the control were found in NTG (p = 0.00014) and POAG (p = 0.00002).Patients with POAG (p = 0.0005) and PEG (p = 0.00022) showed the highest accumulation of Ca in the sclera. No differences were found in Mg content of scleral biopsies between patients with NTG and POAG (p = 1.0), while the level of Ca in POAG (p = 0.02) and PEG (p = 0.00001) was significantly higher than in NTG. A significantly lower content of Cu was found in the sclera samples of patients with NTG (p = 0.022), POAG (p = 0.004) and PEG (p = 0.00004) as compared to the control, as well as a reduced content of Mn in POAG (p = 0.00003) and PEG (p = 0.0012). Contrarywise, NTG patients showed an increased content of Mn (p = 0.000003). No differences were found in the Cu content between the sclera of patients with NTG and POAG (p = 0.47), while Cu level in PEG was significantly lower than in POAG (p = 0.034) and NTG (p = 0.013). Conclusion. The macro- and microelement imbalance of the sclera of the eyes with different forms of glaucoma indicates differences in their pathogenesis. This can be the reason for the different severity of disorders of collagen biosynthesis and the formation of cross-links in the connective tissue structures of the sclera, as well as the varying degree changes in the hydrodynamics of the intraocular fluid, which on the whole can affect the level of intraocular pressure and the pattern of glaucoma development.

Reimplantation of a drainage valve device in refractory glaucoma. A clinical case

Background: Implantation of various drainage devices is one of the treatments for refractory glaucoma, resistant to traditional surgical methods. The most commonly used glaucoma drainage device for refractory glaucoma is the Ahmed glaucoma valve. However, the long-term success rate of the surgery may be limited because of the development of complications during the late postoperative period. The complications do not allow the control of the achieved intraocular pressure (IOP) level. In such cases, a repeated implantation of the Ahmed valve may be one of the options for the surgical treatment. Clinical case description: Second Ahmed valves were implanted to two patients with refractory repeatedly operated glaucoma at the Department of surgical glaucoma treatment of the S. Fyodorov Eye Microsurgery Federal State Institution in Moscow. Previously, both patients had the Ahmed valves installed at their places of residence. During the postoperative period, one patient was found to have an encapsulated cyst around the drainage body, and later the revision of the operation area was performed. As a result of the repeated Ahmed valve implantation, the IOP compensation was achieved 9 months after the surgery. Conclusion: A repeated implantation of the Ahmed valve may be an option for the surgical treatment, if the first implant failed to control the IOP, in order to compensate the IOP and preserve the visual functions in patients with refractory repeatedly operated glaucoma.

Эффективность гониоассоциированной транслюминальной трабекулотомии при вторичной глаукоме на фоне силиконовой тампонады витреальной полости

The main goal of glaucoma treatment is to preserve visual functions and quality of life of patients. In recent years, in connection with the development of vitreoretinal surgery, a number of complications has appeared, one of which is ophthalmic hypertension and progressive glaucomatous damage to the optic disc. An analysis was made of the surgical treatment of 12 patients (12 eyes) with secondary glaucoma after vitreoretinal surgery with the removal of SO 1300 according to gonioscopy-assisted transluminal trabeculotomy (GATT) technique in order to evaluate efficacy and safety. Key words: glaucoma; secondary glaucoma; gonioscopy-assisted trabeculotomy; minimally invasive glaucoma surgery; surgical treatment of glaucoma; silicone oil.

Clinical and demographic data of patients operated on for primary open-angle glaucoma in Krasnoyarsk Krai in 2007–2021

PURPOSE. Comparative analysis of clinical and demographic characteristics of patients admitted for surgical treatment of primary open-angle glaucoma in the Krasnoyask Krai over the past 15 years.METHODS. The study analyzed 2426 medical histories of patients with primary open-angle glaucoma who underwent surgical antihypertensive intervention at the Krasnoyarsk Regional Ophthalmic Clinical Hospital named after Professor P.G. Makarov in 2007–2021.RESULTS. It was found that the proportion of men was significantly higher than women among patients who underwent surgical treatment of glaucoma. The mean age of operated patients was comparable across the entire period and ranged from 66.4 to 69.0 years. The proportion of patients with advanced stage of the disease increased during the study period from 50.7% to 75.5% (p<0.001). In 73–83% of cases, interventions were performed on patients with uncompensated, moderately elevated or high intraocular pressure.CONCLUSION. Considering the dominating proportion of eyes with advanced stage of the disease (50.7–75.5% of cases), as well as high initial levels of intraocular pressure, it can be assumed that in some cases such patients are still referred to surgical treatment late, although presently it can be associated with problems in planned care due to the ongoing pandemic.

Non-penetrating deep sclerectomy and implantation of collagen drainage in the surgical treatment of glaucoma

PURPOSE. Analysis of the results of surgical treatment of glaucoma by non-penetrating deep sclerectomy (NPDS) combined with suprachoroidal implantation of collagen drainage.METHODS. This open prospective study included a total of 98 patients (104 eyes), 45 men and 53 women with primary open-angle glaucoma who were examined and operated on. All patients underwent non-penetrating deep sclerectomy with implantation of the "Xenoplast" drainage. Group I (n=72) consisted of patients without suprachoroidal drainage, and Group II (n=32) — patients who were implanted the drainage. Group I included 15 cases (20.8%) with stage I glaucoma, 17 (23.6%) — stage II, 38 (52.8%) — stage III and 2 (2.8%) — stage IV. Group II patients had stage I glaucoma in 8 cases (25%), stage II in 5 (15.6%), stage III in 17 (53.1%) and stage IV in 2 cases (6.3%). The mean age of study patients was 68.2±7.4 years.RESULTS. All early postoperative complications were transient. There were no significant differences in the frequency of complications between the two groups (p>0.05). In group I patients, Descemet’s goniopuncture was performed significantly more frequently than in group II (p<0.05). No complications were detected in the late postoperative period. Pronounced hypotensive effect wasobserved in both groups on the first day after the operation, IOP in group I was slightly lower and amounted to 15.5±2.3 mm Hg in comparison with 17.3±2.5 mm Hg in group II (p>0.05). Further, after 7 days and 1 month, we observed a slight increase of IOP in group I up to 17.2±2.0 mm Hg, while in Group II it remained practically unchanged. After 1 and 2 years of observation, a respective increase of the mean IOP to 18.5±2.8 and 17.8±2.6 mm Hg was registered in group I. Group II, on the contrary, showed a decrease in IOP in these periods to 16.8±1.9 and 16.2±1.8 mm Hg, respectively (differences between the groups were not statistically significant, p>0.05). In group I, the mean number of instillations used to achieve target IOP was 0.89±0.27; in group II it was 0.83±0.26 (p>0.05). The rate of achieving "complete" success after 6 months and 2 years of observation in groups I and II did not differ significantly and was 94.4% and 90.6%, 65.3% and 59.4%, respectively (p>0.05).CONCLUSION. This paper presents a comparative analysis of the results of non-penetrating deep sclerectomy and collagen drainage implantation depending on the involvement of the suprachoroidal space in the operation with 24 months follow-up. Both groups were comparable in the majority of studied parameters, except for the frequency of laser Descemet’s goniopuncture in the postoperative period (it was significantly lower in the group with suprachoroidal drainage). The proposed technique is effective and safe in the treatment of primary open-angle glaucoma.

Ahmed valve implant and its place in the surgical treatment of glaucoma

PURPOSE. To determine the indications for Ahmed glaucoma valve implantation by analyzing the duration and regimen of hypotensive therapy, and the configuration of previous interventions.METHODS. Retrospective evaluation of the duration and intensity of therapeutic treatment, and the configuration of laser and surgical procedures in a group of 139 patients (153 interventions) who underwent Ahmed glaucoma valve implantation in 2009–2011, and another group of 270 patients (272 interventions) who were treated in 2019–2010.RESULTS. The average age of candidates for implantation of the Ahmed valve increased from 63 y.o. in 2009–2011 to 70 y.o. in 2019–2020. The treatment preceding Ahmed valve implantation had extended in duration from 8.8±1.4 to 11.2±1.1 years leading to an increase in cumulative preservative toxicity from 9 293.8±968.6 to 10 038.1±888.9 µg. The main classes of intraocular pressure (IOP)-lowering drugs were prostaglandin analogues (75.4% in 2009–2011 and 77.1% in 2019–2020), carbonic anhydrase inhibitors (75.4% and 82.6%), and beta-blockers (57.4% and 61.1% accordingly). Laser trabeculoplasty was performed in only 11.8% and 28.7% of cases, respectively. Hypotensive filtering operations preceded valve implantation in 63.4% (2009–2011) and 80.5% of cases (2019–2020), while in the rest of patients the installation of the Ahmed device was the first surgical procedure. Despite treatment, the rate of glaucoma progression to an advanced stage increased from 62.1% in 2009–2011 to 82.7% in 2019–2020.CONCLUSION. With increase in the duration of conservative management of glaucoma its progression continues, while the increased preservative toxicity reduces the effectiveness of conjunctival surgery. In conclusion, earlier switch to surgical methods of IOP normalization involving the use of the Ahmed valve is advisable not only in secondary, but also in primary open-angle glaucoma treated conser-vatively for a long (over 7–8 years) period.

Corneal Endothelial Cell Loss in Patients After Minimally Invasive Glaucoma Surgery: Current Perspectives.

Minimally invasive glaucoma surgery (MIGS) is a rapidly expanding category of surgical glaucoma treatment options that offer a superior safety profile compared with traditional approaches for reducing intraocular pressure. However, MIGS may cause corneal endothelial cell loss; therefore, it has been receiving increasing attention. This systematic review aimed to evaluate and compare the rate and degree of corneal endothelial loss after MIGS. First, this paper presents an overview of the theoretical effectiveness of MIGS, the fundamental aspects regarding the roles of endothelial cells, and the effect of cataract surgery on the quality and count of endothelial cells. Further, we detail the various surgical techniques involved in MIGS, the development of these techniques over the time, and clinical aspects to consider with respect to the endothelial cell count. We discuss in detail the COMPASS-XT study, which was based on data collected over 5 years, reported that withdrawal of the CyPass Micro-Stent (Alcon Laboratories) yielded increased corneal endothelial cell loss. Generally, MIGS procedures are considered safe, with the incidence of complications ranging from 1% to 20% depending on the surgery type; however, there is still need for studies with longer follow-up. Thus, an adequate count of endothelial cells in the central cornea portion is recommended as necessary for candidate patients for MIGS.

Коррекция вторичной глаукомы с применением гониоассоциированной трансиллюминальной трабекулотомии у пациентов после витреоретинальной хирургии

Purpose. To study the efficacy and safety of gonio-associated transluminal trabeculotomy (GATT) in patients who developed secondary glaucoma after vitreoretinal surgery (VRS) see Silicone Oil Removal (SO) 1300. Material and methods. The analysis of surgical treatment of 12 patients (12 eyes) with a history of vitreoretinal intervention with silicone oil (SO) 1300 tamponade, the average age of patients was 53.6 ± 11.8 years, who underwent surgery according to the GATT method, was performed. Results. Before surgery, the mean IOP was 31.0 ± 4.1 mmHg; at the last postoperative visit, the mean IOP was 15.6 ± 4.6 mmHg (p = 0.033 compared to preoperative data). In the postoperative period, IOP values were significantly lower than in the preoperative period. Before surgery, the average number of antiglaucoma drugs used was 4.8 ±0.9; after surgery, the mean value of antiglaucoma drugs used was 1.6 ± 1.4 (p = 0.025 compared to preoperative data). The most common complication was hyphema, it was observed in 4 patients, which accounted for 33.3 %. Hyphema resolved within 1–3 days. In the postoperative period, jumps in IOP, detachment of the Descemet's membrane, detachment of the choroid, corneal edema and iridodialysis were not observed. The success of surgery was achieved in 11 (91.6 %) patients, while complete success without the use of antiglaucoma drops was achieved in 3 (25.0 %) patients (p = 0.024). Conclusion. The main goal of glaucoma treatment is to preserve the visual function and quality of life of patients. In recent years, in connection with the development of vitreoretinal surgery, a number of complications have appeared, one of which is ophthalmohypertension and progressive glaucomatous damage to the optic disc. There is a need for methods of surgical treatment with minimal trauma to the conjunctiva and sclera, for the possibility of future operations. Based on this study, it can be concluded that GATT is a safe and effective method in the treatment of patients with secondary glaucoma after VRS with CM 1300 removed. However, most patients may require antiglaucoma drugs in the postoperative period. Keywords: glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma, silicone oil.

Hydrogels on the Base of Modified Chitosan and Hyaluronic Acid Mix as Polymer Matrices for Cytostatics Delivery.

The development of biodegradable polysaccharide hydrogel matrices for cytostatic delivery can improve the therapeutic results of patients by prolonging the action of the drug, reducing its toxicity and providing additional biological activity by polysaccharides. In this work, N-succinyl chitosan/hyaluronic acid dialdehyde/cytostatic formulations have been prepared using two different chitosan grades (30 kDa and 150 kDa) and hyaluronic acid dialdehyde. The interaction of amino groups of N-succinyl chitosan and aldehydes of hyaluronic acid resulted in the formation of azomethine bonds and was demonstrated using 13C NMR. The elastic properties of the obtained hydrogels determine their use as implants. Two cytostatics—5-fluorouracil and mitomycin C were chosen as drugs because of their using both in oncology and in ophthalmology for the surgical treatment of glaucoma. Hydrogel formulations containing cytostatic were prepared and drug release was studied using in vitro dialysis method. It was established that the molecular weight of N-succinyl chitosan and rheological properties of hydrogel influenced the drug release behavior of the gelling delivery system. Formulations prepared from N-succinyl chitosan with greatest molecular weight and mitomycin C were found to be the most promising for medical application due to their rheological properties and prolonged drug release. Mild preparation conditions, simplicity of the technique, short gelation time (within a minute), 100% yield of hydrogel, suitability for drug release applications are the main advantages of the obtained hydrogels.

Pharmacological modulation of wound healing in glaucoma surgery

Despite the well-known effectiveness of pharmacological glaucoma therapy, surgical approach remains one of the main treatment options for some forms and stages of the disease. The long-term success of glaucoma surgery depends on the intensity of local wound healing processes at the surgical site. The most common way to influence healing processes in surgical treatment of glaucoma is the use of antimetabolites. However, given the high risk of serious complications associated with their use, the search for new drugs devoid of these disadvantages continues. The aim of this review is to describe the efficacy and safety of both currently used and upcoming pharmacological ways to influence the wound healing process after glaucoma surgery in order to improve the stability of hypotensive effect.