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Results of application of ExPRESS drainage in refractory glaucoma surgery

Poster Details

First Author: N.Aldasheva KAZAKHSTAN

Co Author(s):    T. Botabekova   L. Abysheva   Z. Sangilbayeva        

Abstract Details



Purpose:

The purpose of the study is to examine the effectiveness of surgical treatment of refractory glaucoma using Ex - PRESS drainage.

Setting:

The research took place in Kazakh Eye Institute, observation took period from February, 2012 till January, 2014

Methods:

The study included the results of surgical treatment with implantation of small drainage Ex-PRESS at 19 patients (20 eyes). The distribution of patients according to the form of glaucoma, was as following : 21.4% with congenital, 15.3 % - juvenile , 25.5 % with primary open- and - closed angle, 37.8 % - secondary (of which 11.2% with uveal, 7.1% - posttraumatic, 19.4 % - neovascular). 90% of cases (18 eyes) had a diagnose of advanced stage of the disease, 10 % (2 eyes ) had terminal painful glaucoma. In 85% of cases (17 eyes) patients were previously handled by various antiglaucomatous intervention (from 1 to 3 times), including 55% of cases (11 eyes) with history of cataract surgery . Surgical treatment was performed in the following manner: mandatory produced deep sclerectomy, trabeculotomy with implantation of Ex-PRESS drainage under the scleral flap. Base of conjunctival flap in 50% of cases were cut out to the limb, in 50% to the roof .

Results:

Postoperatively, 15.7 % of cases had a trend to increased intraocular pressure (IOP), in 1 case we made a revision of drainage, at 1 patient IOP was decreased by antihypertensive drops. IOP was on average 35,0 ± 5,1 mm Hg before surgery. After surgical treatment average IOP in the early postoperative period was 10 ± 3,8 mm Hg, in 1 month - 19,1 ± 2,7 mm Hg, in 6 months - 18,2 ± 2,5. Among intraoperative complications we observed hyphema in 8% of cases, 4 patients (20 % of cases) had ciliary-choroidal detachment (CCD). Massage of filtering bleb (FB) was required in all cases, cause the feature of the operating procedure was not the removal of viscoelastic in the end of the operation, but its introduction into the anterior chamber to light hypertonus . The appearance of signs of early scarring of FB in 55 % of cases (11 eyes) required a course of injections of cytostatics (3-4 injections of 0.1 -0.2ml of 5-fluorouracil to the zone of FB).

Conclusions:

In general, compensation of IOP at long-term observation during more than 2 years was found at 70 % of patients with implantation of Ex - PRESS drainage. FINANCIAL INTEREST: NONE

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