Surgical activation of uveoscleral outflow in glaucoma patients
Today there are many hypotensive surgical interventions intended to activate the uveoscleral outflow of aqueous humour. Their technique has changed due to the development of understanding of morphology and physiology. The primary concept of creating a fistula between the anterior chamber and suprachoroidal space transformed into combined surgical procedures based on filtering and non-penetrating techniques. Such surgical operations were often used for treating severe forms of glaucoma. In the course of non-penetrating glaucoma surgery development, combinations of non-penetrating deep sclerectomy with surgical activation of uveoscleral outflow were proposed. Most frequently it is carried out by implanting various drainages. Draining devices with one end implanted under the scleral flap into the anterior chamber and the other end - through a sclera incision into suprachoroidal space were recently developed. This appears to be the modern embodiment of the idea of combining filtering surgery with suprachoroidal space draining. In modern surgery cyclodialysis has also developed - a number of draining devices are implanted from anterior chamber into suprachoroidal space creating a direct pathway between these expanses. Mechanism of action of hypoten-sive surgical interventions and some aspects of histotopog-raphy are also discussed in the article.