LASER SUTURE LYSIS AFTER TRABECULECTOMY: INDICATIONS, TECHNIQUE, EFFECTIVENESS
Purpose of the study was to evaluate the impact of «tight fixation» of a scleral flap with the subsequent performance of the laser suture lysis on the morphogenesis of established outflow pathways and hypotensive efficacy of trabeculectomy. Material and methods. This is a retrospective study. Seventy eyes of patients underwent trabeculectomy and LSL 1–1.5 months after it were under observation for 24 months. Comparison groups are determined by the presence of inadequate reparative regeneration syndrome. Technical nuances of trabeculectomy («tight» closure of the scleral flap) were evaluated using optical coherence tomography. The effect of LSL on the remodeling of outflow pathways was evaluated by ultrasound biomicroscopy. In the first group (n = 22) LSL was as a mechanical adjuvant treatment, in the second (n = 48) – as an adjuvant option. Ophthalmic tonus was evaluated by Maklakov (Pt) in mm Hg. The indices were estimated using Sstudent’s t-test, p < 0.05 was considered statistically significant. Results and discussion. The «tight» fixation of the scleral flap minimized early postoperative complications and did not detect Pt difference in the groups. LSL led to an increase in the height of the intrascleral channel and scan height in both groups (p < 0.01). After 24 months, complete hypotensive success was 95.5 % in the 1st and 81.25 % in the 2nd group, qualified – 4.5 and 18.75 %, respectively (p < 0.01). Despite the difference in IOP achieved: 15.3 ± 1.9 mm Hg. after 12 months, 15.1 ± 1.2 mm Hg. after 24 months in in group 2 (p < 0.01), more postoperative interventions in group 2 (p < 0.01), the results of complete and qualified success in the second group were high. Conclusion. The introduction of LSL in clinical practice can improve the effectiveness of glaucomatous fistulizing operations. The use of the technique of «tight» fixation of the scleral flap and the planned implementation of LSL are an example of multimodal approaches to minimize the number of early postoperative complications and increase the hypotensive efficiency of trabeculectomy.
Yur’yeva T.N. – doctor of medical sciences, deputy director of scientific work, professor of the chair for ophthalmology, professor of the chair for eye diseases, e-mail: firstname.lastname@example.org