Офтальмохирургия (Oct 2015)
SURGICAL ACTIVATION OF UVEOSCLERAL OUTFLOW IN TREATMENT OF PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA
Abstract
Purpose. To evaluate long-term results of surgical activation of uveoscleral outflow in patients with primary open-angle glaucoma.Material and methods. We performed a surgical operation based on non-penetrating technique with collagen drainage fixed by sutures that strain trabecular meshwork and form the tunnel to spaces between ciliary muscle bundles. The investigated group included 105 patients, control group included 89 patients after non-penetrating glaucoma surgery with collagen drainage where the above-mentioned suture fixation was not used. The minimal follow-up period was 24 months. The measurement of uveoscleral outflow facility was performed by tonography with perilimbal vacuum-compression in addition to the conventional methods of diagnosis.Results. The total success rate i.e. P0<18mmHg without medication was 54.3% in the investigated group, 31.5% in the control group. Laser descemetogoniopuncture was required in 45.7% (investigated group) and 68.5% (control group), medication in 16.2% (investigated group) and 30.3% (control group). The average number of antiglaucomatous drugs used postoperatively was 1.1 and 1.9. Uveoscleral coefficient (represented the ratio of the outflow facility coefficient in application of vacuum Cuveo to the general outflow facility coefficient Cgen) was0.51 in the investigated group and0.39 in the control group. The significant difference between two groups was not found in patients over 70 years.Discussion. The obtained results can be explained by a more active function of ciliary muscle in the group of patients younger 60 years, that represents the key part of uveoscleral outflow pathway since subconjunctival filtration was not observed in patient of the investigated group.Conclusion. The long-term results demonstrate aneffectiveness and a safety of activation of uveoscleral outflow with collagen draining. Selection of patients for this type of surgery should be carried out taking into account the age of patients and glaucoma stage.
