Terminal Glaucoma Research Articles

Micropulse cyclophoto-coagulation in patients with primary open-angle glaucoma: early results

Aim – to evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) procedure in patients with primary open-angle glaucoma (POAG).
 Material and methods. The study was conducted in 21 patients with POAG and uncompensated intraocular pressure (IOP) using pharmacotherapy. All patients underwent MP-TSCPC procedure with IRIDEX Cyclo G6 device. The follow-up period lasted for 1 month. During this time, the visual acuity, IOP dynamics, complications, as well as the number of hypotensive drugs used were evaluated. Statistical analysis was performed using STATISTICA 12.0 software.
 Results. Among patients with moderate and advanced glaucoma, the IOP reduced by 46.7 (3.3; 64.3) % from baseline values by the end of the follow-up period. The target IOP was achieved in 30.7% of patients. In 75% of patients who achieved target IOP, the number of hypotensive drops used was reduced by 1 component. In all patients with terminal stage glaucoma, pain was relieved, and IOP was reduced by 35.5 (8.4; 41.1) %. No intra- or postoperative complications were reported in any case.
 Conclusion. MP-TSCPC can be considered as a relatively safe adjunctive method to achieve target IOP in addition to medical treatment in patients with moderate and advanced glaucoma, as well as appropriate method to control pain in patients with the terminal stage of the disease.

A case of combination of severe atopic dermatitis, dermatogenic cataract and glaucoma

Patient A., aged 23, was admitted with a diagnosis of atopic dermatitis with complaints of widespread rashes accompanied by intense itching. Skin manifestations: erythroderma, xeroderma, excoriations, persistent white dermographism. The conclusion of the ophthalmologist: rhegmatogenous retinal detachment, complicated cataract, ophthalmohypertension of the right eye; hemophthalmos, complicated overmature cataract, terminal neovascular glaucoma of the left eye. A diagnosis of Andogsky's syndrome was made. He received treatment: prednisolone 60 mg per day parenterally for 14 days, methotrexate at a dose of 10 mg weekly, Reamberin, folic acid 5 mg weekly, asparcam, aevit, enterosorbents, ointments and creams with corticosteroids and moisturizers. As a result of treatment, hyperemia, infiltration, peeling and itching of the skin decreased. It is recommended to continue taking methotrexate, folic acid, prednisolone (5 mg daily) and asparkam on an outpatient basis; externally moisturizing and softening creams and ointments. The patient has been referred for a medical and social examination and is preparing to be transferred to the treatment with genetically engineered biological drugs.

Новая технология имплантации глаукомного шунта

The aim of the study is to develop a polymeric microshunt of an original design and estimate the clinical effect of its using for the surgical treatment of worsening and terminal open-angle glaucoma. Material and мethods. 30 patients (30 eyes) with open-angle glaucoma and high level of intraocular pressure (IOP) were observed. All the patients were given modified partial-thickness deep sclerectomy with the polymeric microshunt implantation by means of the developed insertor. The shunt made of polymer (polycarbonate methacrylate) is a hollow square tube 2.5 mm long, the diameter of the inner hole is 0.2 mm. The needle cut angle is 45 degrees, the end of the needle has an additional lateral anti-lock hole. The microshunt consists of two parts: the needle for placing into the anterior chamber and supporting elements for the shunt fixation between the superficial and deep layers of the sclera. The insertor we created is an instrument 12.2 mm long with the 2.2 mm long thin rod at the end. Before implantation the shunt put on the needle is securely fixed due to the working part of the tool cut (45 degrees), which is congruent to the external part of the shunt. After the implantation the needle is removed from the shunt by pressing the side button of the insertor that allows to leave the shunt at the implantation site. Results. All the patients demonstrated good results at a distant time with areactive current of postoperative period. Computer static projector perimetry and visometry didn't reveal any negative dynamics during the entire observation period. According to ophthalmoscopy and optical coherent tomography results, the changes of the optic disc, ganglion cells layer in the macula and peripapillary nerve fibers remained at the same level. Conclusion. Antiglaucomatous surgery according to the invented technology of the polymeric shunt implantation with the help of the original insertor in combination with modified sclerectomy provides stable hypotensive effect and minimizes complications. In addition, the method helps to stabilize visual functions in patients with worsening and terminal open-angle glaucoma and high level of IOP. Keywords: glaucoma, surgical treatment, microshunt, insertor, sclerectomy.

Десятилетний опыт органосохраняющего лечения увеальной меланомы с использованием гамма-ножа. достижения и неудачи

Purpose. Analysis of ten years of experience in organ-conserving treatment of uveal melanomas using a gamma knife. Material and methods. The organ-preserving treatment of 73 patients with uveal melanoma aged 28 to 78 years using a gamma knife was analyzed. The radiation dose was 35-70 Gy. The follow-up period is from 6 months to 10 years. After stereotactic radiosurgery, tumor resection was performed in 35 patients. Stereotactic radiosurgery was used as monotherapy in 38 patients. Results. In 66 cases, the eyes were conserved. In the group of patients with gamma knife as a monotherapy, enucleation was performed in 4 cases due to tumor recurrence in the period 1–2 years after irradiation, in one case, repeated irradiation was applied due to tumor recurrence after 1 year, followed by enucleation 8 months after repeated irradiation. In the group of patients with tumor resection, 32 eyes were preserved without signs of tumor recurrence, in two cases enucleation was performed due to tumor recurrence 3 years after irradiation and tumor resection, in one case enucleation was performed due to terminal painful glaucoma, 4 patients from this group died from liver metastases within 2–3 years after treatment. Conclusion. The ten-year experience of using the gamma knife confirms its effectiveness in the organpreserving treatment of uveal melanomas. Keywords: uveal melanoma, organ-conserving treatment, gamma knife.

Intrascleral Prosthesis in a Dog - Evisceration and Implantation

Background: There is no hope of preserving vision at the terminal stage of glaucoma, and surgical treatment is indicated in these cases. Among the various surgical techniques used, eye evisceration with implantation of an intrascleral prosthesis provide the best cosmetic results. Even though eye evisceration with prosthesis implantation represents an excellent treatment option for terminal glaucoma, reports on the use of this technique in dogs are scarce in the current literature. The aim of this work is to report a case of a dog with end-stage glaucoma subjected to eye evisceration surgery and implantation of an intrascleral prosthesis. Case: A 7-year-old bitch mixed breed with a history of glaucoma secondary to uveitis with no response to medical therapy was referred to the Ophthalmology service of the University Veterinary Hospital of Coimbra (HVUC), Portugal At the ophthalmic examination, the glaucomatous left eye was buphthalmic, with congested episcleral blood vessels, mydriasis, and posterior luxation of the lens; there was no response to threat or obfuscation, no direct and consensual pupillary reflex, nor pupillary reflexes to chromatic light. The intraocular pressure (IOP) was 55 mmHg, and the Schirmer’s tear test (STT-1) result was 19 mm/min. Ophthalmoscopy revealed attenuated retinal blood vessels and a pale optic papilla with mild excavation. The right eye was functional, with all parameters assessed on examination and by tests within the normal ranges for the species. An ultrasound examination of the left eye confirmed the presence of posterior luxation of the lens and buphthalmia in the absence of intraocular neoplasm. In view of the patient’s history and results of the clinical examinations, a surgical approach was indicated to treat the glaucomatous eye. The patient’s tutor requested a surgical procedure that produced a more natural aspect; therefore, the procedure chosen was evisceration, with implantation of an intrascleral prosthesis. The prosthesis diameter chosen was 2 mm greater than the horizontal diameter of the cornea of the functional eye. After evisceration, a black spherical silicone prosthesis of 20 mm in diameter was implanted through a scleral incision. The eye surface was protected with a nictitating membrane flap. In the postoperative period, the cornea exhibited areas with neovascularization, pigmentation, and fibrosis, with a final aspect of gray to black in color. A reduction in tear production was also observed, with no other lesions on the eye surface or major complications. Discussion: Causes of secondary glaucoma include uveitis, disorders of the lens, and neoplasms, among other alterations. Glaucoma can cause clinical signs such as buphthalmic eyes, congestion of the episcleral blood vessels, and increased IOP with nonresponsive mydriasis. The presence of severe degenerative retinal alterations, such as atrophy and excavation of the optic nerve, causes irreversible loss of vision. Surgical treatment is indicated for end-stage glaucoma cases. Eye evisceration with implantation of a prosthesis involves replacement of the intraocular contents by a silicone sphere 1-2 mm larger than the healthy contralateral eye. Protection of the eye surface may be provided using additional procedures such as the nictitating membrane flap. The scleral incision may reduce corneal sensitivity and, consequently, reduce the tear reflex and cause a reduction in STT-1 values. After implantation of the prosthesis, the cornea may exhibit neovascularization, edema, fibrosis, and pigmentation; these are considered expected corneal reactions in the postoperative period. This surgical technique allows treatment of sore and blind eyes, and its results are more aesthetically pleasant compared to other procedures. Preservation of the eyeball with implantation of the prosthesis produced an excellent aesthetic result, with an appearance very close to natural in the case presented here. Keywords: surgery, glaucoma, intraocular prosthesis, silicone. Título: Prótese intraescleral em um cão - evisceração e implantaçãoDescritores: cirurgia, glaucoma, prótese intraocular, silicone.

A Clinical Case of Fitting Scleral Lens for Correction of Pellucid Marginal Degeneration

Background. Pellucid Marginal Degeneration (PMD) is a rare bilateral degenerative corneal disease. It causes corneal ectasia with bilateral, clear, inferior (typically 4 o’clock to 8 o’clock), peripheral corneal thinning. It usually affects about 80% of corneal stroma, which leads to the corneal ectasia above the thinning area as well as provokes the irregular astigmatism and visual impairment that are difficult to correct. Purpose. To study the possibilities of correction and social rehabilitation in a patient with PMD wearing scleral lenses. Materials and methods. The study included a patient with PMD, signs of corneal dysfunction and narrow-angle subcompensated glaucoma in the right eye, and PMD of the cornea resulted in a corneal leukoma – terminal glaucoma in the left eye. In addition to standard ophthalmic methods, we performed corneal topography and optical coherence tomography (OCT). For intraocular pressure measurement, ICARE IOP tonometer was used in several areas of the intact peripheral cornea. Results. Prior to lens fitting, UCVA in the right eye amounted to 0.06. Scleral lens helped achieve a high visual acuity of 0.9–1.0. The lens was well-tolerated by the patient. Conclusion. Scleral lenses may be a good choice for patients with irregular cornea caused by corneal dystrophy. Not only they are easy to use and have a good visual effect, but they also help patients with social rehabilitation.

Vessel Density in the Macular and Peripapillary Areas in Preperimetric Glaucoma to Various Stages of Primary Open-Angle Glaucoma in Taiwan.

Peripapillary and macular vessel density (VD) are reduced in myopic non-glaucomatous eyes, the dynamic range of VD may be decreased by myopia, and whether VD measurement has the potential in differentiating stages of glaucoma severity in patients with myopic glaucoma remains questionable. This observational, cross-sectional study aimed to clarify the changes in peripapillary and macular VDs in preperimetric glaucoma (PPG) and primary open-angle glaucoma in the early, moderate, and late stages. A total of 1228 eyes from 661 participants (540 normal, 67 PPG, and 521 glaucomatous) were included. Participants underwent free blood tests at the internal medicine clinic to retrieve systemic data. Patients with glaucoma were grouped by disease severity, defined by glaucomatous visual field mean defect, including early-(224 eyes), moderate-(103 eyes), and late-stage glaucoma (194 eyes), and further divided into advanced (158 eyes) and terminal glaucoma (36 eyes). Macular VD, peripapillary VD, circumpapillary retinal nerve fiber layer (cpRNFL) thickness, and ganglion cell complex (GCC) thickness were evaluated and divided into superior and inferior parts. One-way analysis of variance was performed, followed by Tukey’s post-hoc test. The peripapillary VD was significantly different between the healthy and PPG groups and the early-, moderate-, and late-stage glaucoma subgroups (all p < 0.001). Peripapillary VD measurements are helpful in differentiating the various stages of glaucoma even in patients with myopic glaucoma.

Микроимпульсная хирургия глаукомы в комбинированном лечении неоваскулярной глаукомы

Purpose. To evaluate the effectiveness of micropulse laser glaucoma surgery in the combined treatment of patients with secondary neovascular glaucoma. Material and methods. The study included 24 patients (24 eyes) with secondary neovascular glaucoma. All patients underwent micropulse transcleral laser treatment. Results. A week after treatment, the IOP level was 23.1±10.2 mm Hg on the hypotensive drops. A decrease in IOP was achieved by an average of 34% from the preoperative one, and then a gradual decrease in the hypotensive effect was observed with a decrease in IOP by an average of 21-22% from the initial one 1 year after the operation. In 5 cases, in patients with terminal glaucoma, normalization of IOP was not achieved, but in all cases, relief of pain was noted. Conclusion. Micropulse laser glaucoma surgery can be used in the complex treatment of neovascular glaucoma in order to reduce IOP. Key words: secondary neovascular glaucoma, micropulse laser glaucoma surgery, proliferative diabetic retinopathy, CVS thrombosis, anti VEGF.

Сравнение эффективности транссклеральной лазерной циклофотокоагуляции в непрерывном и микроимпульсном режимах в лечении терминальной глаукомы

The article evaluates the effectiveness of classical transcleral laser cyclophotocoagulation in continuous mode and micro-pulse cyclophotocoagulation in the treatment of terminal glaucoma. There were 84 patients under observation. In the transcleral laser cyclophotocoagulation group, 6 months after the operation, the average IOP decreased below the baseline by 31.6%, while the micro-pulse cyclophotocoagulation decreased by 22.9%. In the early postoperative period, there were no complications in any case in the micro-pulse cyclophotocoagulation group, and in 3 patients in the transcleral laser cyclophotocoagulation group. Key words: terminal glaucoma, transcleral laser cyclophotocoagulation, micro-pulse cyclophotocoagulation.

Показатели теплообмена глаз пациентов с терминальной неоваскулярной глаукомой при пролиферативной диабетической ретинопатии

Показатели теплообмена глаз пациентов с терминальной неоваскулярной глаукомой при пролиферативной диабетической ретинопатии

Transscleral laser therapy in the treatment of glaucoma

Nowadays glaucoma is one of the leading causes of irreversible blindness worldwide. The main goal in preservation of vision in glaucoma patients is reducing intraocular pressure (IOP), which is considered the main controlled risk factor for progression of glaucomatous optic neuropathy. The article discusses the effectiveness and safety of various transscleral laser technologies in the treatment of glaucoma. Modern transscleral laser technologies that affect the uveoscleral drainage and scleral hydro-permeability are less traumatic and more gentle making them promising in the treatment of patients with early stages of glaucoma, and not only in terminal glaucoma with pain syndrome resistant to conventional treatment ("last resort surgery").

Современный взгляд на циклодеструктивные операции при глаукоме

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

Роль брахитерапии в лечении капиллярных гемангиом сетчатки

Purpose: to evaluate the efficiency of brachytherapy treatment in capillary retinal hemangioma and the emerging complications. Material and methods. Between 2005 and 2014, 18 patients with capillary hemangioma of the retina (11 females and 7 males, mean age 29 ± 13.9 years) were treated, 8 patients had monocular and 10 patients had binocular lesion. In 12 cases, capillary hemangioma of the retina was associated with Hippel - Lindau disease, in 6 cases a sporadic tumor appeared. 90Sr and 106Ru ophthalmic applicators were used. In 7 eyes, brachytherapy was preceded by laser coagulation. After local irradiation, the patients were followed up for 1 month to 3 years. Results. The pathological process was stabilized in 13 eyes. 5 eyes, no later than 3 months after the procedure, developed a severe radiation reaction, total retinal detachment, and recurrent hemophthalmos, which later, after 6 months or more, led to the development of neovascular glaucoma. In one case, the eye had to be enucleated due to terminal painful glaucoma. In 3 eyes despite tumor regression, retinal detachment persisted over the follow-up period, although the macular area remained unaffected. Complicated cataract (12 eyes), neuroretinopathy (2 eyes), appearance of new capillary hemangiomas (1 eye), increased epiretinal fibrosis (4 eyes), and secondary central chorioretinal dystrophy (2 eyes) were observed over the period of up to 2 years. Conclusion. In most cases, brachytherapy of retinal capillary brings about a satisfactory anatomical result. However, in order to reduce postoperative complications and improve the functional result, a thorough preoperative selection of patients is needed, which should take into account the initial retinal status. For citation: Neroev V.V., Saakyan S.V., Ilyukhin P.A., Valskiy V.V., Ryabina M.V., Novikova A.Yu. The role of brachytherapy in the treatment of retinal capillary hemangiomas. Russian ophthalmological journal. 2018; 11 (3): 5-10 (In Russian). doi: 10.21516/2072-0076-2018-11-3-5-10

No Light Perception Outcomes Following Boston Keratoprosthesis Type 1 Surgery

To determine the incidence rate, principal causes, and clinical course of eyes developing no light perception (NLP) visual acuity (VA) following Boston Keratoprosthesis (B-KPro) type 1 surgery. Secondary objectives include determining the incidence rate, relative risk (RR), and survival probability with respect to NLP outcomes among eyes with congenital aniridia. Retrospective, interventional case series. All patients undergoing B-KPro type 1 surgery between October 2008 and June 2016 by a single surgeon at CHUM - Hôpital Notre-Dame. Records of patients having undergone B-KPro implantation were reviewed. Eyes with a final outcome of NLP were further reviewed to determine best recorded postoperative VA, time to NLP onset, clinical course, and principal cause. Descriptive statistics, incidence rates, Kaplan-Meier survival curves, and the RR of NLP outcomes among eyes with aniridia were determined. Statistical significance was defined as P < .05. Records of 119 patients were included, with an average follow-up of 49.1 ± 26.8months postoperatively. Nineteen eyes had a final outcome of NLP, representing 16.0%. The incidence rate of NLP was 0.04 cases per eye-year of follow-up. The most common principal causes were inoperable retinal detachment (n= 7, 36.8%), terminal glaucoma (n= 6, 31.6%), and carrier graft melt-related complications (n= 5, 26.3%). The RR of developing NLP among eyes with aniridia was 3.04 (P= .01). No light perception is a devastating but uncommon outcome of B-KPro surgery. Patients with aniridia seem to be at increased risk. In spite of all available medical and surgical interventions, some eyes may still suffer this outcome.

Diode Laser Cyclophotocoagulation in the Management of Pain and Intraocular Pressure Control in Patients with Terminal Glaucoma—Six Years’ Experience

Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.

ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПРОЛИФЕРАТИВНОЙ ДИАБЕТИЧЕСКОЙ РЕТИНОПАТИИ

The study included 48vitreoretinal surgeries performed during 2014-2015 in 39patients with advanced fibrovascular stage of proliferative diabetic retinopathy. Visual acuity before the surgery averaged from pr. l. certae to 0.01. In 7cases patients underwent intravitreal injection of Lucentis 2–3weeks before the surgery. The surgery was performed according to the standard 3-port 25G vitrectomy. In some cases, short-term tamponade of vitreous cavity by fluid perfluororganic compounds (PFOS) was performed for 2–3days. This was due to prolonged bleeding during the surgery. In these cases, fibrinolytic of direct action (hemasa) was injected directly to the blood clot. In 4 cases circular retinotomy was needed. In 35cases tamponade was made by silicone oil 5700cSt, in 13 – by air-gas mixture. In cases of air-gas tamponade 3 patients had a relapse. After vitreous cavity revision it was plugged with silicone oil 5700cSt. In 17cases visual function remained unchanged, in 18 cases the changes were imperceptible, in 9cases visual acuity improved to 0.2, in 3cases – visual function increased to 0.4 and in 1patient – to 0.7. In postoperative period IOP increased in 7 cases. In 5 of these cases compensation was achieved with antihypertensive drugs. In one case the patient was implanted leukosapphire drainage, and in one more case transscleral cyclophotocoagulation about terminal aching glaucoma was performed. The silicone oil was removed in 6patients at the period of 6 months up to 2years.

The results of the implantation of the Ahmed valve drainage devices for the treatment of refractory glaucoma in the children

Purpose. To study and evaluate the safety and the effectiveness of Ahmed valve implantation for the treatment of refractory glaucoma in the children. Materials and methods. The study included 17 patients (18 eyes) at the age varying from 7 months to 15 years who had undergone the implantation of the Ahmed valve drainage devices for the treatment of uncompensated glaucoma. The FP7 and FP8 valve models were implanted into 7 eyes and 11 eyes respectively. Primary implantation was performed in 6 patients (6 eyes) and secondary implantation in 11 ones (12 eyes). The follow-up period after the implantation ranged from 1 months to 6 years (mean 17,7 ± 5,7 months). Results. All the patients presented with the severe forms of refractory glaucoma including multiply corrected (by surgical intervention) uncompensated congenital glaucoma, concomitant glaucoma, and secondary glaucoma. Terminal glaucoma occurred in 7 eyes and far-advanced glaucoma in 9 eyes. The mean intraocular pressure (IOP) before surgery was 32,2 ± 8,3 mm Hg, mean postoperative IOP 17,5 ± 6,3 mm Hg. No intraoperative complications were documented. The postoperative complications in the form of cilio-choroidal detachment developed in 4 children, posterior retraction of the drainage tube, vertical strabismus, and eyeball subatrophy in 1 patient each. The perfectly successful outcome of the operation and compensation of IOP without the additional prescription of the anti-hypertensive drugs were achieved in 12 (70,5%) patients (13 eyes); however, the number of such eyes decreased to 8 or 44,5% within 6 and more months after surgery even though IOP remained compensated due to anti-hypertensive medication. Five (29,5%) children had compensated IOP immediately after surgery as a result of the intake of anti-hypertensive preparations; in two of them IOP was normalized within 6-12 months without prescription of the anti-hypertensive medication. Visual acuity in the end of the observation period remained unaltered in 12 eyes and was improved to 0,02 in 6 eyes upon hand motion near the face due to the reduction of corneal oedema. Conclusion. Despite the small number of the patients included in the present study, the results obtained give evidence that the application of the Ahmed valve drainage devices provides an efficient tool for the reduction of IOP in the children presenting with refractory glaucoma. However, this treatment modality is associated with the risk of serious complications that can be prevented by the choice of the correct indications, the adequate surgical techniques, and the treatment modalities ensuring careful postoperative care.

The surgical treatment of primary congenital (infantile) glaucoma

Aim. The objective of the present study was to evaluate the effectiveness of the surgical intervention for the treatment of the children at the age from 3 to 10 years suffering from primary congenital (infantile) glaucoma depending on the severity of the morphometric changes. Materials and methods. A total of 16 patients (30 eyes) were available for the examination. Three patient (6 eyes) presented with mild glaucoma, 8 ones (15 eyes) with advanced glaucoma, and 5 (10 eyes) with end-stage glaucoma. All the patients underwent the surgical treatment supplemented by a course of neuroprotective therapy during the postoperative period (6 months after surgery). Results. Based on the results of the preoperative examination, the children with mild glaucoma underwent the surgical intervention on 5 eyes with the use of non-penetrating deep sclerotomy. The patients with advanced glaucoma and the children with terminal glaucoma were operated on 15 and 8 eyes respectively by means of “ab externo” sinusotrabeculotomy. The filtering operation was performed on two eyes of the children with terminal glaucoma with the use of our original method. Conclusion. The above surgical technologies allowed to decrease the frequency of intra- and postoperative complications by 15%, avoid secondary interventions, decrease intraocular pressure in 12.3% of the patients, and improve visual acuity by 0.15 in comparison with its initial value.

Early and remote results of surgical natural uveoscleral outflow activation with collagen drainage implantation in the treatment of advanced and terminal primary glaucoma stages

Early and remote results of surgical natural uveoscleral outflow activation with collagen drainage implantation in the treatment of advanced and terminal primary glaucoma stages

Keratoprosthesis. Personal experience

AbstractPurpose Comment the Barcelona experience with different types of keratoprosthesesMethods Six cases of different keratoprostheses implanted at the Barraquer Eye Center in Barcelona from 1955 to 2014 are discussed.Results The first keratoprosthesis implanted in Spain was a Dorzee acrylic keratoprosthesis in a case of bilateral chemical burn in 1955 with good functional and anatomic result for five years, when extrusion ocurred with simultaneous superior retinal detachment. The second case refers implantation of a Dorzee‐Barraquer‐Cardona acrylic keratoprosthesis in 1958 in a patient with terminal glaucoma. There was good anatomical retention until the patient’s death in 1970. In the third case a Cardona keratoprosthesis was implanted in 1960 after severe failure of two corneal transplants. Acute endophthalmitis ocurred after a satisfactory anatomical and functional result for 8 years. The fourth case shows extrusion of a Teflon‐supported keratoprosthesis (Girard). The fifth case discusses implantation of an osteo‐odonto‐keratoprosthesis (Strampelli)after blast injury with good anatomical and functional result for 10 years. The last case refers to the experience with the Boston keratoprosthesis in our Center since 2006.Conclusion Clinical experience for more than 50 years at the Barraquer Eye Center confirms evolution of the original Dorzee‐Keratoprosthesis to the nowadays widely used Boston keratoprosthesis. In spite of progress in surgical technique, design and postoperative treatment, anatomical and functional results continue being a challenge for KPro surgeons due to the relatively high frequency of unresolvable serious sight‐destructive complications.