ULTRA-BIO-MICROSCOPIC PARAMETERS OF ADEQUATE FORMATION OF INTRAOCULAR FLUID OUTFLOW PATHWAYS AFTER NON-PENETRATING GLAUCOMA SURGERY

Abstract

Purpose. To evaluate the ultra-bio-microscopic semiotics of internal fistula, which determines the time and indications for laser descemetopuncture after non-penetrating deep sclerectomy (NPDS), as well as a long-term hypotensive efficacy of this type of interventions. Material and methods. A full and recognized hypotensive effect was evaluated in 1000 patients with primary open-angle glaucoma after non-penetrating deep sclerectomy followed by laser descemetogoniopuncture. The group 1 included 500 patients (retrospective study), the group 2 – 500 patients (prospective study). All patients in the postoperative period underwent an ultrabiomicroscopic monitoring with an evaluation of parametric (mm) and morphometric (acoustic density) indices of internal fistula, intrascleral canal, and filtering bleb. Clinical groups were relevant to sex, age, stages of glaucoma and initial regimen of local hypotensive therapy. Follow-up period was 3 years. Results. The UBM semiotics for validity of the internal fistula are determined: a height of 0.8±0.09mm and a presence of micro-fistula after laser descemetopuncture. In the group 1: time of laser descemetopuncture was 3.4±1.9 months, a full hypotensive effect was observed in 59.6% 1 year later, in 24.8% after 3 years. In the group 2: time of laser descemetopuncture was 1.12±0.08 months, a total hypotensive success was determined in 84.8% after 12 months, up to 3 years – in 60.4% of cases. In its turn, an impact of NPDS hypotensive effect was associated with laser descemetogoniopuncture in 100% of cases 1-12 months after surgical stage of operation. Conclusion. The two-stage technology of non-penetrating deep sclerectomy with laser descemetopuncture in the absolute number of cases allows to create a penetrating internal micro-fistula and to exclude its influence on morphogenesis of newly formed aqueous humor outflow pathways. In its turn, it allows to increase a full and recognized hypotensive effect of fistulizing interventions of non-penetrating type.

Keywords

• non-penetrating deep sclerectomy
• laser descemetogonio-puncture
• ultra-bio-microscopic classification
• scarring
• fistulizing operations