The options of an individual approach to the modification of sinustrabeculectomy for hypotensive effect prolongation

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Abstract

BACKGROUND: Reducing scarring in the postoperative period is one of the main tasks of glaucoma surgery.

AIM: To develop new modifications of sinustrabeculectomy in the surgical treatment of primary open-angle glaucoma normalizing and prolonging the outflow of aqueous humor along newly formed pathways.

MATERIALS AND METHODS: Surgical procedures were performed in 106 patients (109 eyes) with primary open-angle glaucoma of moderate and advanced stages, without any history of previous surgeries. Patients were divided into groups: 1a — 25 patients (25 eyes) who underwent sinustrabeculectomy with the formation of grooves for the intramuscular fluid outflow, 1b — 26 patients (28 eyes) who underwent of sinustrabeculectomy with scleral flap twisting, 1c — 28 patients(29 eyes) who underwent sinustrabeculectomy with scleral flap stitching, and the control group — 27 patients (27 eyes) who underwent routine sinustrabeculectomy. The follow-up duration was up to 24 months.

RESULTS: In 1 month after surgery, the average level of intramuscular pressure was comparable and remained low in all groups. Complete compensation of intramuscular pressure in groups 1a, 1b and 1c was observed in 80%, 75% and 76% of cases; partial — in 16%, 18% and 21% of cases; failure — in 4%, 7% and 3% of cases, respectively. In the control group (2), complete hypotensive success was noted in 55% of cases; partial — in 30% of cases; failure — in 15% of cases.

CONCLUSIONS: Developed new methods of sinustrabeculectomy allow to obtain a prolonged hypotensive effect.

About the authors

Elena A. Suleiman

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: elena-548@inbox.ru

ophthalmologist

Russian Federation, Moscow

Sergey Yu. Petrov

Helmholtz National Medical Research Center of Eye Diseases

Email: glaucomatosis@gmail.com

Dr. Sci. (Med.), head of Glaucoma Department

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Scheme of sinustrabeculectomy modification with the formation of grooves for aqueous humor outflow. 1 — superficial scleral flap; 2 — deep scleral flap; 3 — grooves for the aqueous humor outflow

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3. Fig. 2. Scheme of sinustrabeculectomy modification with scleral flap twisting. 1 — twisted superficial scleral flap; 2 — trabeculectomy; 3 — basal iridectomy; 4 — cornea

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4. Fig. 3. Scheme of sinustrabeculectomy modification with stitching of the scleral flap. 1 — combined superficial scleral flap; 2 — trabeculectomy; 3 — basal iridectomy; 4 — cornea

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5. Fig. 4. Dynamics of the intraocular pressure level at all follow-up periods in the group of patients after sinustrabeculectomy modification with the formation of grooves for the intramuscular fluid outflow (subgroup 1a). The x-axis — endpoints of the study, the y-axis — intraocular pressure level

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6. Fig. 5. Dynamics of the intraocular pressure level at all follow-up periods in the group of patients after sinustrabeculectomy modification with scleral flap twisting (subgroup 1b)

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7. Fig. 6. Dynamics of the intraocular pressure level at all follow-up periods in the group of patients after sinustrabeculectomy modification with scleral flap stitching (subgroup 1c)

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Copyright (c) 2023 Suleiman E.A., Petrov S.Y.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


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