Anatomo-topographic criteria of efficacy of non-penetrating deep sclerectomy
PURPOSE: To assess the anatomical and topographic features of the trabeculo-descemet membrane when forming the outflow pathways of the intraocular fluid after non-penetrating deep sclerectomy, and also to substantiate the indications and timing of laser descemetopuncture. METHODS: The effectiveness of antihypertensive laser goniopuncture was analyzed in 500 patients with primary open-angle glaucoma. Group 1 consisted of 250 patients (retrospective study), group 2 included 250 patients (prospective study). Clinical groups were comparable by gender, age, glaucoma stage and hypotensive therapy regimen. The follow-up period lasted for 3 years. All patients postoperatively underwent ultrasound biomicroscopy of internal fistula, intrascleral channel and filtering blebs by means of UBM-Hi (Opticon, Italy). The principal difference of the second clinical group was strict adherence to the technology of surgical stage of the operation (the height of the wave function was at least 0.8±0.09 mm), and to laser goniopuncture terms and technology. RESULTS: We determined optimal UBM-criteria of internal fistula: height - 0.8±0.09 mm, thickness - 0.09±0.004 mm. Performing laser goniopuncture 1-1.12 months after the surgery was justified in 100% of cases. In group 1 laser goniopuncture was conducted 3.4±1.9 months after the surgery. Intraocular fluid outflow pathways were functional in 59.6% 1 year after laser goniopuncture as compared to 24.8% after 3 years. In 2 group laser goniopuncture was conducted in 1.12±0.08 months. Absolute surgical success after 12 months amounted to 84.8%, and 60.4%after 3 years of follow-up. CONCLUSION: Regarding penetrating deep sclerectomy as a two-step procedure in all cases, strict implementation of the technology and time intervals between surgical and laser stages allows optimizing the morphogenesis of outflow pathways and increasing the hypotensive effect of the combined intervention.