Офтальмохирургия (Oct 2015)
EFFICACY OF A NEW OPERATION IN OPEN-ANGLE GLAUCOMA ENDOTRABECULOECTOMY TREATMENT
Abstract
Purpose. To development a technique and indications for trabecula ablation ab interno with forceps (endotrabeculoectomy) and to study its efficacy for open-angle glaucoma.Material and methods. Investigations were done in two groups. The first group consisted of 35 patients (38 eyes) with open-angle glaucoma who underwent the endotrabeculoectomy, and the second group included 108 patients (126 eyes) with open-angle glaucoma and cataract who underwent the endotrabeculoectomy and phaco. The mean tonometric IOP before surgery in the first group was 26.4±1.4mmHg, in the second group – 24.2±1.7mmHg. Reflux of blood into the Schlemm’s canal has been provoked intraoperatively in 134 eyes. Three degrees of the Shlemm’s canal blood filling were estimated using the gonioscope.Results. Absence of blood filling of the Shlemm’s canal was observed in 6 out of 134 eyes (4.5%) and was evaluated as a contraindication for endotrabeculoectomy. In 12 out of 164 cases an insignificant hemorrhage was detected at the moment of trabecula capture. No other complications were revealed. On the 7-th day after surgery the IOP was 18.5±1.2mmHg in the first group, and in second group – 19.0±1.3mmHg. Further the IOP did not change essentially in both groups. The quantity of hypotensive medications in the first group decreased from 2.3±0.5 before surgery to 0.7±0.3 6 months after the surgery, and in the second group – from 2.1±0.3 to 0.6±0.1. Coefficient of aqueous outflow facility increased from 0.12±0.01 before surgery to 0.39±0.02 6 months after surgery in the first group, and in the second group – from 0.15±0.01 to 0.35±0.02.Conclusion. The developed dosed endotrabeculoectomy seems to be an effective and safe mini-invasive procedure pathogenetically oriented for surgical treatment of open-angle glaucoma. It leads to significant and stable decreasing of IOP and improving of aqueous humor outflow. The intraoperative visualization of the aqueous humor outflow system can determine the level of the outflow resistance and help to choose a surgical tactic.
