Drainage surgery for primary open-angle glaucoma: past, present, future

Relevance. Despite many techniques for reducing intraocular pressure, surgical treatment of glaucoma has limited effectiveness. First, due to excessive scarring of new intraocular fluid outflow pathways and second, antifibrotics medicaments are unable to effectively control wound healing. The use of drainages reduces the risk of excessive scarring in the area of the filtration pad and forms several ways of outflow of intraocular fluid. The review presents the following sections: development history, advantages, disadvantages, surgical technique and promising directions of glaucoma drainage surgery.Purpose. Summarizing data on the possibility of drainage surgery, historical aspects, causes of scarring and methods of dealing with them. Provide data on various modern drainage devices that are used not only in Russia and their effectiveness.Material and methods. To perform the review, we searched for literature sources on the abstract databases E-library, PubMed and Scopus for the period up to and including 2018, using the keywords «glaucoma drainage surgery» (in the E-library database), «anti-glaucoma drainage» and «anti-glaucoma drainage device» (in the PubMed and Scopus databases). Abstracts of conferences were excluded from the review. A total of 40 articles related to the review topic were identified. The beginning of publications on this issue in domestic sources dates back to 1970, and in foreign sources to 1987.Results. The review presents the history of development, advantages, disadvantages of surgical techniques and promising areas of glaucoma drainage surgery. Various models of drainage devices, as well as their specific and non-specific complications are described. The effectivenes of various valves were 70%, with an average decrease in the level of IOP by at least 50% from the preoperative values. At the same time, the risk of an increase in the level of IOP above the target values is about 10% per year, which leads to the fact that after 5 years only in 50% of cases drainage devices function effectively. Therefore, studies of biomaterials, forms and techniques of drainage implantation surgery, new controlled-release antifibrotic drugs can positively affect the long-term effectiveness of glaucoma surgery.Conclusion. The data presented in the literature review allow us to identify the most effective models of drainage devices, their effectiveness, implantation techniques and possible complications

Morphometric Analysis of Corneal Nerves Condition after Laser Keratorefractive Surgery

Purpose: to conduct a morphometric assessment of the corneal nerves state after laser keratorefractive surgery using laser confocal microscopy and the software Liner 1.2S. Patients and methods. 40 eyes of 20 patients received LASIK to correct a mean refractive error of –4.5 ± 1.9 diopters (range, –2.25 to –8.25 diopters). The stroma was ablated with a Teneo Technolas 317P excimer laser. Corneas were examined by laser corneal confocal microscopy (HRT III with Rostock Cornea Module) before and in 1, 3, and 6 months after LASIK. Images were analyzed with software that automatically computes coefficients of anisotropy and orientation symmetry of corneal nerves. Result. At 1 and 3 months after surgery, the center corneal nerves were completely absent. At 1, 3 and 6 months after surgery, the paracentral corneal nerves were detected and the coefficient of anisotropy were statistically significantly reduced compared with the preoperative rates. At 6 months after surgery, both central and peripheral corneal nerves were detected and the coefficient of anisotropy were statistically significantly reduced compared with the preoperative rates. Conclusion. As a result of the study, the central corneal nerves were first detected at 6 months after surgery, whereas the paracentral cornea nerves were detected already after 1 month. At 6 months after surgery, the coefficient of anisotropy in the central of cornea statistically significant decreased compared to the preoperative rates. At all stages of the study after surgery, the anisotropy coefficient in the cornea paracentral statistically significant decreased compared with preoperative

Роль гипотензивного режима в достижении целевого уровня офтальмотонуса у пациентов с первичной открытоугольной глаукомой (результаты многоцентрового аналитического исследования)

PURPOSE: To determine the effectiveness of primary open-angle glaucoma (POAG)  treatment based on the assess-ment of hypotensive regimens used to achieve "target" intraocular pressure (IOP) depending on the clinical stage of the disease.METHODS: Analytical multicenter study was conducted based on the results of a survey of 51 ophthalmologists. Each specialist solved 18 tasks, determining the "target" level of IOP, hypotensive regimen and further tactics de-pending on preset parameters.RESULTS: “Target” values for stage I of POAG was 22 mm Hg; 20 mm Hg — for stage II of POAG; 18 mm Hg — for stage III of POAG. “Convenient” target values equaled 19.2±0.26 mm Hg for stage I; 19.02±0.23 mm Hg — for stage II and 17.35± 0.21 mm Hg for stage III. “Inconvenient” values, i.e. requiring  changing or enhancing therapy, were 23.98±0.38 mm Hg for stage I; 23.63±0.29 mm Hg — for II; 22.86±0.28 — for stage III. “Extremely inconvenient” values and the indication for surgery were 27.2±0.45 mm Hg for stage I; 26.14±0.34 mm Hg for stage II and 25.97±0.42 mm Hg — for stage III. The therapy changed if IOP was increased by 9% in stage I, 20% in II and 22% in stage III; the transition to surgery was made if the increase reached 23% in patients with stage I, 30% in II and 39% in stage III of POAG. The average transition period from drug therapy to surgery was 4 years.CONCLUSION: The achievement of "target" IOP was ensured by the use of severe hypotensive regimens that included up to 3-4 drugs. Perhaps this is an additional argument for further improvement of POAG treatment algorithms, justifying an earlier and more active use of surgical methods of IOP correction. However, a high level of evidence base practice of their efficacy and safety must be provided. ЦЕЛЬ. Определить эффективность лечения первичной крытоугольной глаукомы (ПОУГ) на основании оценки потензивных режимов, используемых для достижения целевых» значений офтальмотонуса в зависимости от линической стадии заболевания. МЕТОДЫ. Проведено аналитическое, мультицентровое сследование по результатам анкетирования 51 офтальолога. Каждый специалист решал 18 задач, определяя целевой» уровень внутриглазного давления (ВГД), гипонзивный режим и дальнейшую тактику в зависимости заранее заданных параметров. РЕЗУЛЬТАТЫ. Выявлены причины недостаточной мотивации к лечению: недооценка важности лечения и опасности болезни. Это является следствием бессимптомности заболевания (55,2%), низкого уровня информированности о заболевании (51,9%), отсутствия видимого эффекта от проводимой терапии (50,8%), наличия побочных эффектов лечения (47,5%), забывчивости (36%), отсутствия уверенности в том, что лечение может помочь (23,5%), отсутствие сопереживания и недостаточного внимания со стороны лечащего врача (63,4%) и т.д. Из трех предложенных моделей терапевтического обучения лучшие результаты отмечены при индивидуальном углубленном консультировании: уровень мотивации сохранялся до 6 месяцев после окончания обучения.ЗАКЛЮЧЕНИЕ. Для пациентов с ПОУГ характерен «низкий» и «ниже среднего» уровень мотивации. Предложенная модель терапевтического обучения позволила повысить уровень мотивации к лечению пациентов с ПОУГ, особенно пожилого и старческого возраста.