PROGRESSION OF GLAUCOMA OPTICAL NEUROPATHY AFTER DIFFERENT ANTI-GLAUCOMA OPERATIONS
About the author:
Serdiuk А. V., Mogilevskyy S. Yu.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Primary glaucoma, despite certain success of modern methods of conservative, laser and surgical treatment, remains one of the most urgent problems of ophthalmology. Primary glaucoma is a multifactorial disease; there are many known risk factors that lead to its development and progression and, ultimately, to glaucoma optical neuropathy (GON). Aim. Compare the impact of different types of anti-glaucoma operations on the progression of glaucoma optical neuropathy. Object and methods. There were 150 patients (150 eyes) with primary open-angle glaucoma (POAG) of stage I-III under observation. Longevity of the disease is 3-10 years. There were 72 men and 78 women. Age 39-69 years. The level of intraocular pressure (IOP) was 28.5 ± 3.0 mm Hg. All patients received local hypotensive therapy. They made up two groups of observation. All patients before the operation, after 1, 3, 6 months and 1 year were performed visiometry, static perimetry on the device Humphrey Field Analyzer model 540 i by Carl Zeiss Meditec in the program 30-2 Threshold for the study of local defects in the field of vision, MD (integral index of deviation of the level of light sensitivity in the field of vision, depending on the age norm and no more than 5,8 dB) and indicators of PSD (degree of local defects, not more than 1.78 dB), tonometry, refractometry, keratopachymetry, biomicroscopy, ophthalmoscopy using Volk Double aspheric or Ocular Small Pupil lenses, optical coherence tomography (OCT) on the device Optovue RTVue 100-2 (version of the program A188.8.131.52). In order to objectivize the progression of the GON, the parameters of the RNFL-layer of the nerve fibers of the retina and the GSS-complex of the ganglion cells were studied, and, if necessary, the anterior segment of the eye (A-OCT) was studied. The stage of the disease was determined by classification of perimetric changes of glaucoma. In the first stage the trabeculectomy (TE) with ExPress shunt implantation (69 eyes) was performed; in the second – two-stage treatment: 1 stage – non-penetrating deep sclerectomy (NPDS), 2 stage – laser descemethogoniopuncture in 2 weeks after the 1st stage. We studied the influence of TE with Ex-Press shunt implantation and NPDS followed by laser descemetogoniopuncture on GON progression. The observation period was 1 year. Results. It was established that in 3, 6 months and 1 year after the operation the progression of GON in the first group was 4,35%, 8,69%, 12,3%; in the second group – 1,25%, 9,88%, 13,6% respectively. The frequency of GON at the terms of observation of 3, 6 months and 1 year did not differ in the first and second groups of observation and it was in spite of the fact that the performance of TE with Ex-Press shunt implantation had a lower safety profile and was accompanied by a higher frequency and spectrum of postoperative complications. At the same time, the first group of patients had a more pronounced hypotensive effect. It can be assumed that the character of the postoperative complications and their duration, as well as the IOP level, both low and high, are not the key risk factors for the progression of GON after various types of surgery. Conclusion. 1. The frequency of GON progression in POAG patients in 3, 6 months and 1 year after the performance of TE with the implantation of Ex-Press shunt was 4.35%, 8.69% and 12%, respectively; after NPDS with the following laser descemetogoniopuncture – 1.25%, 9.88%, 13.6%, respectively. 2. Performance of various surgical interventions, both fistulizing (TE with Ex-Press shunt implantation) and non-penetrating (NPDS with subsequent laser descemetogoniopuncture) did not give any advantages in terms of prevention of GON progression in POAG patients in the long term. 3. Prospects of GON prognostication and prophylaxis after surgical treatment of POAG are presented to us in studying of new factors of its prognostication with the subsequent development of new directions of treatment.
primary open-angle glaucoma, surgical treatment, glaucoma optical neuropathy, progression.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 195-199 pages, index UDK 617.7-007.681:617.731