Bleb independent glaucoma surgery to activate uveolymphatic outflow pathway of aqueous humor - short-term clinical and optical coherence tomography evaluation results
Kumar Vinod
Centre of eye microsurgery, Moscow province
: Int J Ophthalmic Pathol
Abstract
Deep sclerectomy technique was modified. An intrascleral reservoir (4*4mm) (ISR) is made by removing 95% of deep scleral layers and deroofing of Schlemm’s canal without a window in Descemet’s membrane to receive in future AH from anterior chamber (AC). A cyclodialysis tunnel with a collagen implant in it connects ISR to suprachoroidal space (SCS). Postoperatively, a Nd:YAG laser opening in the trabecular meshwork provides resistance free AH outflow from AC under pressure. Thirty-eight patients with open angle glaucoma were operated upon to study the safety and effectiveness of the proposed technique. OCT evaluation of surgical and adjacent sites was carried out in each case to trace and verify possible AH outflow pathway. Outcome measures were IOP change, use of additional medications and complications. At six months, mean IOP decreased from 29.1±9.2 to 14.0ï?±4.3 mmHg (p=1.4E–09) and hypotensive medication use reduced by 79.3% (from 2.9ï?±0.9 to 0.6ï?±1, p=1.3E–10). Notably, in 50% cases (19 eyes) the IOP decrease was >50%. Overall success was achieved in 94.7% cases (complete success – 63.1% and partial – 31.6%). Intraoperative complications were few and manageable. There were two failure cases, the reason being high IOP due to blockage of trabeculotomy opening by iris tissue. OCT evaluation confirmed AH filtration via conjunctival lymphatics without formation of a filtering bleb. It is concluded that the proposed technique is safe and effective in decreasing IOP. It decreases IOP by activating uveolymphatic outflow pathway. For predictable hypotensive outcomes, every caution should be taken in glaucoma surgery to preserve the lymphatics.
Biography
Kumar Vinod is a professor at the Department of Eye Diseases of RUDN University and General Director of Center of Eye Microsurgery “Pro zrenie”. His main interests are surgical treatment of glaucoma and complicated cataract cases. He had published more than 60 scientific articles in peer-reviewed journals. He has to his credit 8 patents of Russian Federation and had coauthored 10 educational monographs. He is a member of the dissertation committee of Federal Medical- Biological Agency, a member of the editor council of scientific journal “Medicine in Kuzbass”, an international member of AAO and ESCRS.
