Офтальмохирургия. 2016; : 28-34
Сравнительная оценка клинико-функциональных результатов непроникающей глубокой склерэктомии и каналопластики при первичной открытоугольной глаукоме
https://doi.org/10.25276/0235-4160-2016-2-28-34Аннотация
Цель. Провести сравнительный анализ клинико-функциональных результатов непроникающей глубокой склерэктомии и каналопластики у пациентов с первичной открытоугольной глаукомой за 12 мес. наблюдения.
Материал и методы. В исследование включены 93 пациента (151 глаз) с некомпенсированной первичной открытоугольной глаукомой (ПОУГ) (67 женщин и 26 мужчин), средний возраст 66,5±10,8 года, которые были разбиты на две группы. В основной группе 51 пациенту (84 глаза) было запланировано проведение каналопластики, в контрольной группе 42 пациентам (67 глаз) – непроникающей глубокой склерэктомии. Каждая группа была дополнительно разбита на 2 подгруппы согласно стадиям ПОУГ (А – начальная и развитая, Б – далеко зашедшая). Период наблюдения составил 12 мес.
Результаты. При выполнении каналопластики круговая имплантация микрокатетера в просвет шлеммова канала была реализована в 63 (75%) случаях. В раннем послеоперационном периоде наиболее частыми осложнениями в первой группе была микрогифема и гифема в 49 случаях (77,7%), транзиторное повышение ВГД – в 16 случаях (25,4%). Во второй группе наиболее часто встречались отслойка сосудистой оболочки в 14 случаях (20,9%) и транзиторное повышение ВГД в 8 случаях (11,9%). В позднем послеоперационном периоде наиболее частым осложнением во всех группах было повышение ВГД: в 1 группе – в 27 случаях (42,8%), во 2 группе – в 17 случаях (25,4%). К 12 мес. среднее ВГД в первой группе составило 21,9±4,2 мм рт.ст., во второй группе – 20,6±2,85 мм рт.ст. соответственно. К концу периода наблюдения количество гипотензивных препаратов в первой группе уменьшилось в среднем с 1,8±0,8 до 1,3±0,8 (p<0,05), во второй группе – с 1,9±0,65 до 0,7±0,65 (p<0,05) соотве тственно.
Заключение. Каналопластика и непроникающая глубокая склерэктомия являются современными и эффективными хирургическими способами лечения глаукомы. У пациентов с начальной и развитой стадиями глаукомы гипотензивный эффект каналопластики и непроникающей глубокой склерэктомии сопоставим.
Список литературы
1. Козлов В.И., Багров С.Н., Анисимова С.Ю. и др. Непроникающая глубокая склерэктомия с коллагенопластикой // Офтальмохирургия. – 1990. – № 3. – С. 44-46.
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5. Arenas E., Boyd B., editor. Trabeculectomy ab-externo. Highlights // World Atlas Series of Ophthalmic Surgery. – 1994. – Vol. 1. – P. 215-219.
6. Ayyala R.S., Chaudhry A.L. Comparison of surgical outcomes between canaloplasty and trabeculectomy at 12 months’ follow-up // Ophthalmology. – 2011. – № 12. – P. 2427-2433.
7. Bahler C.K., Hann C.R., Fjield T. et al. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments // Am. J. Ophthalmol. – 2012. – Vol. 153. – P. 1206-1213.
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9. Cameron B., Kearney J. Circumferential viscodilation of Schlemm’s canal with a flexible microcannula during non-penetrating glaucoma surgery // Digital Journal of Ophthalmology. – 2006. – № 1. – P. 12-18.
10. Camras L.J., Yuan F., Fan S. et al. A novel Schlemm’s Canal scaffold increases outflow facility in a human anterior segment perfusion model // Invest. Ophthalmol. Vis. Sci. – 2012. – Vol. 53. – P. 6115-6121.
11. Dietlein T.S., Jordan J.F., Schild A. et al. Combined cataract-glaucoma surgery usingthe intracanalicular Eyepass glaucoma implant: first clinical results of a prospective pilot study // J. Cataract Refract. Surg. – 2008. – Vol. 34. – P. 247-252.
12. Francis B.A., See R.F., Rao N.A. et al. Ab interno trabeculectomy: development of a novel device (Trabectome) and surgery for open-angle glaucoma // J. Glaucoma. – 2006. – Vol. 15. – P. 68-73.
13. Francis B.A., Singh K., Lin S.C. et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology // Ophthalmol. – 2011. – Vol. 118. – P. 1466-1480.
14. Grieshaber M.C., Pienaar A., Olivier J., Stegmann R. Canaloplasty for primary open-angle glaucoma: long-term outcome // Br. J. Ophthalmol. – 2010. – Vol. 94. – P. 1478-1482.
15. Hoeh H., Ahmed I.I., Grisanti S. et al. Early postoperative safety and surgical outcomes after implantation of a suprachoroidal micro-stent for the treatment of open-angle glaucoma concomitant with cataract surgery // J. Cataract Refract. Surg. – 2013. – Vol. 39. – P. 431-437.
16. Jordan J.F., Engels B.F., Dinslage S. et al. A novel approach to suprachoroidal drainage for the surgical treatment of intractable glaucoma // J. Glaucoma. – 2006. – Vol. 15. – P. 200-205.
17. Koerber N.J. Canaloplasty in one eye compared with viscocanalostomy in the contralateral eye in patients with bilateral open-angle glaucoma // J. Glaucoma. – 2012. – Vol. 21. – P. 29-34.
18. Lewis R.A., Tetz M., Koerber N. et al. Canaloplasty: Three-year results of сircumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat openangle glaucoma // J. Cataract Refract Surg. – 2011. – Vol. 37, № 4. – P. 682-690.
19. Matlach J., Freiberg F.J., Leippi S. et al. Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma // BMC Ophthalmol. – 2013. – Vol. 13. – P. 1.
20. Minckler D.S., Baerveldt G., Alfaro M.R. et al. Clinical results with the Trabectome for treatment of openangle glaucoma // Ophthalmol. – 2005. – Vol. 112. – P. 962-967.
21. Mosaed S., Dustin L., Minckler D.S. Comparative outcomes between newer and older surgeries for glaucoma // Trans. Am. Ophthalmol. Soc. – 2009. – Vol. 107. – P. 127-133.
22. Saheb H., Ahmed I.I. Microinvasive glaucoma surgery: current perspectives and future directions // Curr. Opin. Ophthalmol. – 2012. – Vol. 23. – P. 96-104.
23. Samuelson T.W., Katz L.J., Wells J.M. et al. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract // Ophthalmol. – 2011. – Vol. 118. – P. 459-467.
24. Scharioth G.B. Glaucolight // Congress of the ESCRS 28th: Abstracts. – Paris, 2010. – P. 120.
25. Shingleton B., Tetz M., Korber N. Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results // J. Cataract Refract. Surgery. – 2008. – Vol. 34. – P. 433-440.
26. Stegmann R. New microcatheter provides light at the end of the tunnel for glaucoma surgery // Eurotimes. – 2005. – Sept. – P. 3-6.
27. Stegmann R. Viscocanalostomy: a new surgical technique for open angle glaucoma // An. Inst. Barraquer. Spain. – 1995. – Vol. 25. – P. 229-232.
28. Stegmann R., Pienaar A., Miller D. Viscocanalostomy for openangle glaucoma in black African patients // J. Cataract Refract. Surg. – 1999. – Vol. 25. – P. 316-322.
29. Zimmerman T.J., Kooner K.S., Ford V.J. et al. Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma // Ophthalmic Surg. – 1984. – Vol. 15. – P. 734-740.
Fyodorov Journal of Ophthalmic Surgery. 2016; : 28-34
Comparative evaluation of the clinical and functional results of the non-penetrating deep sclerectomy and canaloplasty in primary open-angle glaucoma
https://doi.org/10.25276/0235-4160-2016-2-28-34Abstract
Purpose. To carry out a comparative evaluation of clinical and functional results of non-penetrating deep sclerectomy and canaloplasty in patients with primary open-angle glaucoma within the 12 month follow-up.
Material and methods. The study included 93 patients (151 eyes) with non-compensated primary open-angle glaucoma (POAG) (67 female and 26 male), the mean age 66.5±10.8 years, who were divided into 2 groups: the main group consisted of 51 patients (84 eyes) where was scheduled the canaloplasty and in the control group of 42 patients (67 eyes) the non-penetrating deep sclerectomy (NPDS) was scheduled. Each group was additionally divided into 2 subgroups according to POAG stages (initial and advanced B – far-advanced). The follow-up was 12 months.
Results. The successful micro-catheter implantation into the lumen of Schlemm’s canal was achieved in 63 cases (75%). In the early postoperative period, the most frequent complications in the group 1 were micro-hyphema and hyphema in 49 cases (77.7%) and elevated intraocular pressure was in 16 cases (25.4%). In the second group the most frequent complications were choroid detachment in 14 cases (20.9%) and elevated intraocular
pressure in 8 cases (11.9%). In the late postoperative period, the elevated intraocular pressure (IOP) was the most common complication in all groups: 27 cases (42.8%) in the group 1 and 17 cases (25.4%) in the group 2. At 12 months the mean IOP was 21.9±4.2mmHg in the group 1 and 20.6±2.85mmHg in the group 2, respectively. The quantity of glaucoma medications by the end of follow-up in the group 1 decreased on average from 1.8±0.8 to 1.3±0.8; in the second group the IOP decreased from 1.9±0.65
to 0.7±0.65, respectively.
Conclusions. Canaloplasty and non-penetrating deep sclerectomy are safe and effective in the surgical management of open-angle glaucoma. Canaloplasty procedures showed comparable efficacy to non-penetrating deep sclerectomy in the IOP reduction in patients with initial and advanced stages of glaucoma.
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6. Ayyala R.S., Chaudhry A.L. Comparison of surgical outcomes between canaloplasty and trabeculectomy at 12 months’ follow-up // Ophthalmology. – 2011. – № 12. – P. 2427-2433.
7. Bahler C.K., Hann C.R., Fjield T. et al. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments // Am. J. Ophthalmol. – 2012. – Vol. 153. – P. 1206-1213.
8. Bruggemann A., Despouy J.T., Wegent A. et al. Intraindividual Comparison of Canaloplasty Versus Trabeculectomy With Mitomycin C in a Single-surgeon Series // J. Glaucoma. – 2013. – Vol. 22. –P. 577-583.
9. Cameron B., Kearney J. Circumferential viscodilation of Schlemm’s canal with a flexible microcannula during non-penetrating glaucoma surgery // Digital Journal of Ophthalmology. – 2006. – № 1. – P. 12-18.
10. Camras L.J., Yuan F., Fan S. et al. A novel Schlemm’s Canal scaffold increases outflow facility in a human anterior segment perfusion model // Invest. Ophthalmol. Vis. Sci. – 2012. – Vol. 53. – P. 6115-6121.
11. Dietlein T.S., Jordan J.F., Schild A. et al. Combined cataract-glaucoma surgery usingthe intracanalicular Eyepass glaucoma implant: first clinical results of a prospective pilot study // J. Cataract Refract. Surg. – 2008. – Vol. 34. – P. 247-252.
12. Francis B.A., See R.F., Rao N.A. et al. Ab interno trabeculectomy: development of a novel device (Trabectome) and surgery for open-angle glaucoma // J. Glaucoma. – 2006. – Vol. 15. – P. 68-73.
13. Francis B.A., Singh K., Lin S.C. et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology // Ophthalmol. – 2011. – Vol. 118. – P. 1466-1480.
14. Grieshaber M.C., Pienaar A., Olivier J., Stegmann R. Canaloplasty for primary open-angle glaucoma: long-term outcome // Br. J. Ophthalmol. – 2010. – Vol. 94. – P. 1478-1482.
15. Hoeh H., Ahmed I.I., Grisanti S. et al. Early postoperative safety and surgical outcomes after implantation of a suprachoroidal micro-stent for the treatment of open-angle glaucoma concomitant with cataract surgery // J. Cataract Refract. Surg. – 2013. – Vol. 39. – P. 431-437.
16. Jordan J.F., Engels B.F., Dinslage S. et al. A novel approach to suprachoroidal drainage for the surgical treatment of intractable glaucoma // J. Glaucoma. – 2006. – Vol. 15. – P. 200-205.
17. Koerber N.J. Canaloplasty in one eye compared with viscocanalostomy in the contralateral eye in patients with bilateral open-angle glaucoma // J. Glaucoma. – 2012. – Vol. 21. – P. 29-34.
18. Lewis R.A., Tetz M., Koerber N. et al. Canaloplasty: Three-year results of sircumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat openangle glaucoma // J. Cataract Refract Surg. – 2011. – Vol. 37, № 4. – P. 682-690.
19. Matlach J., Freiberg F.J., Leippi S. et al. Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma // BMC Ophthalmol. – 2013. – Vol. 13. – P. 1.
20. Minckler D.S., Baerveldt G., Alfaro M.R. et al. Clinical results with the Trabectome for treatment of openangle glaucoma // Ophthalmol. – 2005. – Vol. 112. – P. 962-967.
21. Mosaed S., Dustin L., Minckler D.S. Comparative outcomes between newer and older surgeries for glaucoma // Trans. Am. Ophthalmol. Soc. – 2009. – Vol. 107. – P. 127-133.
22. Saheb H., Ahmed I.I. Microinvasive glaucoma surgery: current perspectives and future directions // Curr. Opin. Ophthalmol. – 2012. – Vol. 23. – P. 96-104.
23. Samuelson T.W., Katz L.J., Wells J.M. et al. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract // Ophthalmol. – 2011. – Vol. 118. – P. 459-467.
24. Scharioth G.B. Glaucolight // Congress of the ESCRS 28th: Abstracts. – Paris, 2010. – P. 120.
25. Shingleton B., Tetz M., Korber N. Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results // J. Cataract Refract. Surgery. – 2008. – Vol. 34. – P. 433-440.
26. Stegmann R. New microcatheter provides light at the end of the tunnel for glaucoma surgery // Eurotimes. – 2005. – Sept. – P. 3-6.
27. Stegmann R. Viscocanalostomy: a new surgical technique for open angle glaucoma // An. Inst. Barraquer. Spain. – 1995. – Vol. 25. – P. 229-232.
28. Stegmann R., Pienaar A., Miller D. Viscocanalostomy for openangle glaucoma in black African patients // J. Cataract Refract. Surg. – 1999. – Vol. 25. – P. 316-322.
29. Zimmerman T.J., Kooner K.S., Ford V.J. et al. Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma // Ophthalmic Surg. – 1984. – Vol. 15. – P. 734-740.
