New method of surgical treatment of glaucoma

Background. Fistulizing operations are the most commonly used types of surgery for both primary and secondary glaucoma. The development of cicatricial blockade in the area of surgical intervention is considered one of the reasons for the decrease in the hypotensive effect of surgical treatment of glaucoma, for which antiglaucoma drainages are widely used.

Aim. To evaluate the hypotensive efficacy of sinustrabeculectomy with implantation of drainage from collagen hemostatic sponge using Maklakov tonometry and quality of life indicators in patients with primary open-angle glaucoma in the course of surgical treatment.

Material and methods. The study involved 52 people (52 eyes) (mean age 64.1±4.4 years) with a diagnosis of primary open-angle glaucoma. The inclusion criteria were the age of 40–80 years, the diagnosis of glaucoma for more than 6 months, the ineffectiveness of local drug therapy, and the absence of severe concomitant ophthalmic pathology. All patients underwent surgical treatment of glaucoma: sinustrabeculectomy with posterior scleral trepanation and implantation of drains in the form of 4×2.5 mm strips from a collagen hemostatic sponge under the scleral flap in three zones: in the distal and lateral zones of the flap. In the postoperative period, the level of intraocular pressure was assessed on the 30th, 90th and 180th days. The patients' quality of life was assessed using the GQL-15 questionnaire. Statistical processing of materials was carried out using the Statistica 8.0 software package (Statsoft, Inc., USA), comparison in dynamics was carried out using Student's parametric t-test. The normality of the sample distribution was controlled using the Shapiro–Wilk test. Significance of differences in indicators was considered established at a significance level of p <0.05.

Results. The surgical treatment of patients contributed to a decrease in intraocular pressure from 42.4±6.5 to 13.4±4.9 mm Hg (p=0.0000) and improved quality of life according to the GQL-15 questionnaire from 28.6±4.3 to 19.3±1.9 points (p=0.0224) on day 30 after surgery. During the observation period, the level of intraocular pressure remained within the normal range, amounting to 16.9±4.3 mm Hg on the 90th day, and 18.1±4.6 mm Hg on the 180th day.

Conclusion. The modified method for the treatment of glaucoma leads to a long-term (6 months) effective reduction in intraocular pressure in patients and an improvement in their quality of life.