OPTIMIZATION OF THE METHOD OF SURGICAL TREATMENT OF PRIMARY INFANTILE CONGENITAL GLAUCOMA IN CHILDREN

Abstract

Pediatric glaucoma is a term that encompasses several forms of congenital glaucoma and types of secondary glaucoma that diff er in etiology, pathogenesis, and clinical presentation. Surgical treatment is the main method of IOP reduction in pediatric glaucoma. To date, no uniform method of surgical treatment of infantile glaucoma has been proposed, which makes the search for adequate methods of surgical intervention in this pathology most urgent. The aim of this work was to evaluate the effi cacy of surgical treatment of primary congenital infantile glaucoma in children. Material and methods. In the eye department of the clinic of the Tashkent Pediatric Medical Institute, the eff ectiveness of the method of surgical intervention in children from 3 to 10 years old with primary congenital infantile glaucoma was evaluated. Examined – 20 patients (40 eyes). Of these, 5 patients (10 eyes) entered the advanced stage, 10 patients (20 eyes) entered the far advanced stage, and 5 patients (10 eyes) entered the terminal stage, respectively. The patients underwent standard ophthalmological examination. The state of the optic nerve was investigated by optical coherence tomography Stratus OCT-3000 (Carl Zeiss Meditec), the visual fi elds – in 10 (20 eyes) patients aged over 8 years using standard automated and computer perimetry (SAP). Conclusions of the bioethical commission: This article evaluates the eff ectiveness of the method of surgical treatment of primary congenital infantile glaucoma in children. And gives specifi c results of diff erent operations at diff erent stages of primary congenital infantile glaucoma. Surgical treatment was chosen according to the degree of goniodysgenesis and the stage of the disease, which showed a satisfactory result in stabilizing the glaucoma process. Statistical analysis method using Microsoft Excel and SPSS programs was used for processing the results of the ophthalmological study. Diff erences between the mean values (M±σ) were considered reliable at P≤0.05. Results and Discussion. All patients underwent surgical treatment, depending on the severity of morphometric changes in the anterior chamber angle, and in the postoperative period with an interval of 6 months – a course of neuroprotective therapy. According to the examinations, children with primary infantile glaucoma in advanced stage underwent non-penetrating deep sclerectomy in 10 eyes, with extensive – in 20 eyes and with terminal – in 10 eyes – sinusotrabeculotomy ab externo, sinusotrabeculectomy. In 2 eyes in the terminal stage, fi ltering surgery was performed according to the proposed method. Thus, the above methods of surgery reduce the number of intra- and postoperative complications by 12.5%, avoid reoperations, reduce IOP in 12.3% of cases, increase visual acuity by 0.15 compared to the original. Conclusion. The above methods of surgical treatment were chosen according to the degree of goniodisgenesis and the stage of the disease, which showed a satisfactory result in stabilizing the glaucoma process

Keywords

• Primary congenital infantile glaucoma; surgery; anterior- posterior axis of the eye; primary congenital glaucoma; ocular rigidity; optic disc excavation; myopia; intraocular pressure