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To analyze the effect of filtration in glaucoma surgery, XEN versus trabeculectomy, on the vessel area density (VAD) of the macular, papillary and peripapillary regions using optical coherence tomography angiography (OCT-A). This prospective cohort study analyzes the vascular architecture of 47 eyes of 45 patients after two different filtrating surgery procedures (XEN stent and trabeculectomy (TE)) using the OCT-A. Participants who had an outsourced medical anti-glaucoma therapy received filtrating surgery in a 2:1 (XEN: TE) ratio. The primary outcome measurements were changes in the VAD in various layers of retinal perfusion and the foveal avascular zone (FAZ). Both interventions achieved a significant postoperative reduction in IOP (XEN 17.6 ± 3.8–13.7 ± 3.8 mmHg; TE 21.2 ± 5.4–8.8 ± 2.6 mmHg). VAD values did not change significantly after filtrating surgery. Comparing both procedures, a significantly higher VAD for patients treated with TE was seen for the superficial vessel complex (SVC) 375 µm and 750 µm (p = 0.011, p = 0.017), deep vessel complex (DVC) 375 µm (p = 0.029) and the optic disc (p = 0.028) after 6 months, while all other parameters did not differ significantly. In conclusion, VAD does not significantly improve after filtrating surgery in preoperative moderately IOP elevated eyes. The IOP lowering effect of filtrating surgery, however, can stabilize vascular parameters in all layers of perfusion.
To analyze the effect of filtration in glaucoma surgery, XEN versus trabeculectomy, on the vessel area density (VAD) of the macular, papillary and peripapillary regions using optical coherence tomography angiography (OCT-A). This prospective cohort study analyzes the vascular architecture of 47 eyes of 45 patients after two different filtrating surgery procedures (XEN stent and trabeculectomy (TE)) using the OCT-A. Participants who had an outsourced medical anti-glaucoma therapy received filtrating surgery in a 2:1 (XEN: TE) ratio. The primary outcome measurements were changes in the VAD in various layers of retinal perfusion and the foveal avascular zone (FAZ). Both interventions achieved a significant postoperative reduction in IOP (XEN 17.6 ± 3.8–13.7 ± 3.8 mmHg; TE 21.2 ± 5.4–8.8 ± 2.6 mmHg). VAD values did not change significantly after filtrating surgery. Comparing both procedures, a significantly higher VAD for patients treated with TE was seen for the superficial vessel complex (SVC) 375 µm and 750 µm (p = 0.011, p = 0.017), deep vessel complex (DVC) 375 µm (p = 0.029) and the optic disc (p = 0.028) after 6 months, while all other parameters did not differ significantly. In conclusion, VAD does not significantly improve after filtrating surgery in preoperative moderately IOP elevated eyes. The IOP lowering effect of filtrating surgery, however, can stabilize vascular parameters in all layers of perfusion.
The efficiency of outreach diagnostics was assessed in 273 patients suffering from various forms glaucoma aged from 27 to 80 years. Following the developed algorithm, a set of instrumental and diagnostic tests was carried out to select 153 patients for surgical treatment and 64 patients for laser treatment. Necessary adjustments were made to the regimens of antihypertensive treatment for most patients, and recommendations were given. All glaucoma patients selected for surgical and laser treatment received timely and qualified assistance from specialists of the Khabarovsk branch of S. Fyodorov Eye Microsurgery Federal State Institution, which allowed the course of the disease to be stabilized and visual functions to be preserved. As a result, outreach consultations for patients with various forms of glaucoma showed their high efficiency. More than 60% of the examined patients were referred for surgical and laser treatment, 20% of patients were offered a corrected hypotensive regimen. Along with examining patients, outreach consultations provide methodological assistance for local ophthalmologists concerning the development of professional competencies in managing such patients. Due to a lack of ophthalmological services in regional polyclinical departments, the organization of outreach consultations for glaucoma patients is justified in terms of reducing cases of glaucoma progression and loss of visual functions.
PURPOSE. To evaluate the anatomical-topographic parameters of the anterior chamber of the eye before and after micropulse cyclophotocoagulation (mCPC) in patients with refractory glaucoma in pseudophakic and phakic eyes.METHODS. The study included 60 patients (62 eyes) with moderate (7 eyes) and advanced (55 eyes) refractory glaucoma. Study groups were formed as follows: the 1st group consisted of 31 pseudophakic eyes (32 patients), the 2nd group included 31 phakic eyes (30 patients). All patients underwent mCPC according to a modified technique. To assess anatomical parameters patients underwent optical coherence tomography of the anterior segment (AS-OCT). Anterior chamber angle (ACA) and anterior chamber depth (ACD) were measured at specific follow-up time points after mCPC.RESULTS. Hypotensive effect by the end of 12-month follow-up was achieved in the patients of the first group in 83.1% of cases, in the second group — in 80.6% of cases (p<0.05). According to OCT findings, anterior chamber depth in patients with phakic eyes during the 12-month follow-up remained the same as before surgery — 2.43±0.21 (mm). In the other group with pseudophakic eyes, anterior chamber depth also did not change during the observation period, with an average value of 3.27±0.12 (mm). No significant changes (p>0.05) were found in the irido-corneal angle measurements in the 4 meridians over the entire follow-up period in both groups.CONCLUSION. Micropulse cyclophotocoagulation performed at fluence rate F=121 J/cm2 does not result in changes of structures of the anterior segment of the eye. The stability of anterior chamber anatomy as well as the absence of postoperative complications in early and longterm follow-up proved the minimal traumatic effect of this surgery in patients with refractory glaucoma.
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