Saratov JOURNAL of Medical and Scientific Research

Drainage surgery for refractory glaucoma combined with micropulse cyclophotocoagulation

Year: 2020, volume 16 Issue: №1 Pages: 273-276
Heading: Ophtalmology Article type: Original article
Authors: Sidorova A.V., Khodzhaev N.S., Eliseeva M.A., Starostina A.V.
Organization: S. Fyodorov Eye Microsurgery Federal State Institution

The purpose of the study is to evaluate the possibility of using Micropulse technology in combined treatment of refractory glaucoma, including implantation of an Ex-PRESS micro shunt and one-stage micropulse sectoral cyclophotocoagulation (mCPC). Material and Methods. The study included 25 patients with advanced stages of previously operated primary open-angle glaucoma. IOP before surgery averaged 35.3±4.4 mmHg. Surgical treatment was carried out using combined method, including implantation of an Ex-PRESS micro shunt and one-stage sectoral mCPC. Results. In 2 cases in the early postoperative period, according to the B-scan, a detachment of the choroid was diagnosed, which was treated with medication. The IOP level on the first day after surgery averaged 8.3±1.4 mmHg, after 12 months of observation 19.9±4.1 mmHg, while hypotensive drops were re-appointed in 2 cases. Before surgery all patients underwent ultrasound biomicroscopy with measurement of the ciliary body (CB) thickness, which was an average of 0.69±0.04 mm before surgery. After 12 months of follow-up, no cases of postoperative atrophy of CB were diagnosed, the CB thickness was 0.67±0.03 mm on average. Conclusion. Combined treatment of refractory glaucoma, including implantation of the Ex-PRESS micro shunt and one-stage mCPC, is an effective and safe method for IOP reduction.

1. Erichev VP. Refractory glaucoma: treatment features. The Russian Annals of Ophthalmology 2000; 116 (5): 8-10.
2. Bessmertny AM. То the question on the differentiated surgical treatment of basic forms refractory glaucoma. Clinical Ophthalmology 2005; (2): 80-2.
3. Prokofyeva Ml. Modern surgical approaches to treatment of refractory glaucoma (Literary review). Clinical Ophthalmology 2010; 11 (3): 104-8.
4. Rascheskov AYu, Loskutov IA. Modern technologies of refractory glaucoma treatment: Review. Ophthalmology 2012; 9 (1): 4-9.
5. Kuroedov AV, Ogorodnikov VYu, Fomin NE. The results of long-term monitoring of patients with primary open angle glaucoma after implantation of mini-shunt Ex-Press. Clinical Ophthalmology 2015; (3): 131-6.
6. Sidorova AV, Khodzhaev NS, Starostina AV. The potential of ExPRESS Mini Glaucoma Shunt implantation in the treatment of secondary glaucoma induced by silicone oil emulsification in patients after vitrectomy. National Journal of Glaucoma 2017; 16 (2): 57-62.
7. Seider Ml, Rofagha S, Lin SC, Stamper RL. Resident-performed Ex-PRESS shunt implantation versus trabeculectomy J Glaucoma 2012; 21 (7): 469-74.
8. Patel HY, Wagschal LD, Trope GE, BuysYM. Economic analysis of the Ex-PRESS miniature glaucoma device versus trabeculectomy. J Glaucoma 2014; 23 (6): 385-90.
9. Aquino MC, Barton K, Tan AM, et al. Micropulse versus continuous wave transscleral diode cyclophotocoagulation in refractory glaucoma: a randomized exploratory study. Clin Exp Ophthalmol 2015; 43 (1): 40-6.
10. Khodzhaev NS, Sidorova AV, Baeva AV, Smirnova EA. Transscleral laser treatment of end-stage glaucoma in the micropulse mode: a pilot study. Glaucoma News 2019; 41 (49): 3-5.
11. Tan AM, Chockalingam М, Aquino MC, et al. Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma. Clin Exp Ophthalmol 2010; 38 (3): 266-72.
12. Kuchar S, Moster MR, Reamer CB, Waisbourd M. Treatment outcomes of micropulse transscleral cyclophotocoagulation in advanced glaucoma. Lasers Med Sci 2016; 31 (2): 393-96.
13. Williams AL, Moster MR, Rahmatnejad K, et al. Clinical Efficacy and Safety Profile of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma. J Glaucoma 2018; 27 (5): 445-9.
14. Method for combined surgical treatment of secondary glaucoma caused by silicone emulsification: Patent RF №2688960, MKP A61F 9/08/Sidorova AV, Eliseeva MA, Smirnova EA. S.N. Fedorov NMRC "MNTK"Eye Microsurgery"; №2018145816; applic. 2018.12.24; pub. 2019.05.23.
15. Noecker RJ. The benefits of micropulse TSCPC for early-stage glaucoma. Ophtalmol Times Eur2017; 30-2.

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