Purpose: to compare the efficacy and safety of Ahmed and Molteno-3 drainage devices implantation in the surgical treatment of refractory glaucoma. Patients and methods. Two groups of refractory glaucoma patients underwent surgery. In the first group (48 patients, 48 eyes) drainage device Molteno-3 with a site size of 175 mm2 was implanted. The average IOP in the group before surgery was 31.9 ± 7.7 mm Hg. The average number of glaucoma medications was 3.3 ± 0,44. In the second group (51 patients, 51 eyes) implantation of Ahmed Valve FP7 model was performed. The average level of IOP in the group before surgery was 34.7 ± 8.07 mm Hg. The average number of glaucoma medications was 3.08 ± 0.4. Results. In the first group the average intraocular pressure level 1 month post-op was 14.6 ± 6.1 mm Hg, 3 months post-op 18.8 ± 5.2 mm Hg, 6 months post-op 16.5 ± 4.7 mm Hg. IOP сompensation (≤ 21 mm Hg) in 6 months was achieved in 91.6 % of cases and in 1 year in 100 % of cases. The total success was achieved only in 8.3 % of patients. However, the number of glaucoma medications was reduced to 1.6 ± 0.8. In the second group the average IOP level 1 month post-op was 21.25 ± 7.3 mm Hg, 3 months post-op 17.9 ± 5.3 mm Hg, 6 months post-op 15.7 ± 4.1 mm Hg. IOP сompensation in 6 months was achieved in 82.4 % of cases and in 1 year in 86.3 %. In the second group complete success was achieved in 19.6 % of patients. The number of glaucoma medications was 1.4 ± 1.1. In the first group complications were revealed in 22.9 % of cases (11 patients). Ciliochoroid detachment was revealed in 9 patients (18,8 %) and hyphema in 2 patients (4,2 %). In the second group complications were revealed in 19.6 % of cases (10 patients). Сiliochoroid detachment was revealed in 4 patients (7.8 %), diplopia in 5 patients (9.8 %), hyphema was detected in one case (1.9 %). In the first group IOP compensation (≤21 mm Hg) was achieved after 6 months in 91.6 % of cases and after 1 year in 100 % of cases. The complete success was achieved in only 8.3 %. In the second group, IOP compensation in 6 months was achieved in 82.4 % of cases and 86.3 % — in 1 year. In the second group, complete success was achieved in 19.6 % patients. There was no significant difference in complications between two groups. Conclusion. High level of safety and effectiveness of refractory glaucoma surgical treatment with implantation of Molteno-3 and Ahmed drains was confirmed.
Purpose: to compare the results of neovascular glaucoma (NVG) surgery of patients treated for the underlying eye disease with antiVEGF therapy and laser coagulation (LC) of the retina with the surgery results of patients who did not receive underlying disease treatment.Materials and methods. A retrospective analysis of case histories and outpatient charts of 70 patients (70 eyes) with NVG, operated in a surgical hospital, involved two groups of patients: group 1 — 33 eyes of patients treated for the underlying disease with anti-VEGF therapy and/or LC; of these, 13 eyes (39 %) received panretinal LC, 15 eyes (45 %) received an anti-VEGF drug intravitreally, and 5 eyes (16 %) received both anti-VEGF therapy and LC); group 2 — 37 eyes of patients not treated for the underlying disease. In group 1, NVG was caused by diabetic retinopathy (DR), which accounted for 19 eyes (57.6 %), and post-thrombotic retinopathy (PR) — 14 eyes (42.3 %). IOP data in group 1 at admission was 38.00 ± 6.82 mm Hg. In group 2, the proportion of patients with DR was 32 % (12 eyes), and those with PR — 41 % (15 eyes). The level of IOP in group 1 upon hospital admission was 38.00 ± 6.82 mm Hg, while in group 2 it was 35.97 ± 5.85 mm Hg.Results. In group 1, in most cases, the classical surgical approach to NVG treatment was used. The proportion of Ahmed drainage implantations was 46 % (15 eyes), trabeculectomy (TET) — 24 % (8 eyes), non-penetrating sinustrabeculectomy (NST) — 6 % (2 eyes), and only 24 % (8 eyes) received transscleral cyclophotocoagulation (CPC). After 7 days, the average level of IOP in group 1 was 16.80 ± 7.18 mm Hg, after 1 month, 19.50 ± 3.45 mm Hg, after 3 months, 21.80 ± 3.15 mm Hg, and after 6 months — 22.57 ± 3.34 mm Hg (p < 0.05). In group 2, the operation of choice was CFC, which was performed in 46 % (17 eyes), the Ahmed drainage was implanted less often — 36 % (13 eyes), while 18 % (7 eyes) accounted for TET. The IOP level in group 2 after 7 days was 20.00 ± 8.74 mm Hg, after 1 month, 25.30 ± 4.67 mm Hg, after 3 months 28.43 ± 6.54 mm Hg, and after 6 months 29.73 ± 4.18 mm Hg (p < 0.05).Conclusion. The timely treatment of the underlying disease with Anti-VEGF and LC of the retina allows the patient to maintain visual functions, and increases the effectiveness of NVG surgery.
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