Офтальмохирургия (Jul 2016)
Clinical efficacy of the combined non-penetrating deep sclerectomy with the simultaneous diod laser trabeculoplasty ab externo in patients with primary open-angle glaucoma. Long-term results
Abstract
Purpose. To evaluate the dynamics of the intraocular pressure (IOP) and clinical efficiency of the combined non-penetrating deep sclerectomy (NPDS) with the simultaneous diod laser trabeculoplasty in the micro-pulse mode ab externo in patients with primary open-angle glaucoma (POAG).Material and methods. The patients with open-angle glaucoma were divided into two groups. In the first group 94 patients (94 eyes) (mean IOP: 27.1±2.2mmHg, COF: 0.14±0.02mm3/22mmHg/min) underwent the combined NPDS with laser trabeculoplasty ab externo. In the second group 80 patients (80 eyes) (mean IOP: 26.9±2.0 mmHg, COF: 0.15±0.02 mm3/22 mmHg/min) underwent the NPDS. Visual acuity, IOP by Macklakov, tonography by Nesterow were performed in all patients. Results. In the first group the mean IOP on the sevens day after the surgery decreased from 27.1±2.2 mmHg to 17.0±0.8 mmHg. The mean IOP 12 and 24 months later was 19.1±1.2 and 19.8±2.6 mmHg, respectively. The coefficient of the outflow facility (COF) one month after the surgery increased from 0.14±0.02 to 0.34±0.03 mm3/22 mmHg/min and after two years postoperatively the COF was 0.26±0.04 mm3/mmHg/min. The mean IOP in the second group at 7 days after the surgery was 17.1±0.5 mmHg. Twelve and 24 months of the postoperative follow-up the mean IOP were as follows 20.6±1.5 and 21.5±1.2 mmHg. The COF in patients of the second group increased postoperatively from 0.15±0.02 to 0.25±0.04, and after two years was 0.19±0.03 mm3/mmHg/min.Conclusions. The combined non-penetrating deep sclerectomy with laser trabeculoplasty ab externo is a minimum invasive and safe surgical procedure in patients with open-angle glaucoma. The operation has a pronounced hypotensive effect, and also improves the eye hydrodynamics. Long-term follow-up shows more pronounced hypotensive effect in comparison to nonpenetrating deep sclerectomy.
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