Офтальмохирургия (Apr 2019)
YAG-laser refistulization of internal fistula after trabeculectomy in children with post-uveal glaucoma
Abstract
Purpose. To develop a method for YAG-laser refistulization in a blockade of internal fistula after trabeculectomy (TE) in children with post-uveal glaucoma (PUG), to evaluate its efficiency, to determine indications and optimal timing of its conduction.Material and methods. The study included 54 children aged from 2 to 16 years with PUG in 71 eyes after 78 TEs which underwent the YAG-laser refistulization (128 sessions) because of a detection of complete or partial block of internal fistula during gonioscopy. Laser interventions were performed: within 1 month after TE - in 65.4% of cases, 1-3 months - in 16.7%, 3-12 months - in 10.2%, 1-4 years - in 7.7%. We used a patented technique of combination of the focused (to dissect adhesions) and defocused (to separate the iridotrabecular contact and to decrease exudate) radiation from an YAG-laserResults. Internal fistula was more often blocked by the root of the iris, rarer - by exudate, pigment, fibrous membrane, blood clot. In all cases YAG-laser refistulization eliminated the block, in most cases (82.3%) - in one session. Recurrences of adhesions were observed in 12.7% of cases and were also successfully eliminated by YAG-laser YAG-laser operations proceeded without serious complications. Micro-hemorrhages, that occurred during the separation of iridocorneal adhesions (13.2%), were stopped by lens compressions.Conclusion. The developed method of YAG-laser refistulization after TE, which combines defocused and focused radiation, is highly effective and atraumatic. Laser release of the lumen of the internal fistula ensures its normal functioning and prevention of secondary (ascending) scarring of the created outflow pathway. For the timely detection and elimination of blockade, a gonioscopic control of the internal fistula is necessary both at the earliest and long- term periods after the TE.
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