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Risk factors of hyperscarring and etiopathogenetical approaches in the rehabilitation of patients after glaucoma filtering surgery

Poster Details

First Author: N.Volkova RUSSIA

Co Author(s):    T. Iureva              

Abstract Details



Purpose:

To identify risk factors, to characterize clinical manifestations of the syndrome of inadequate reparative regeneration and to develop rehabilitation measures in patients with hyperscarring of intraocular fluid outflow pathways after fistulizing glaucoma surgery.

Setting:

Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution

Methods:

A prospective study included 450 people after surgery for glaucoma. Inadequate formation of outflow pathways was diagnosed according the results of UBM monitoring, biomicroscopy and the IOP level in compliance with the original classification of validity of intraocular fluid outflow pathways. Statistical analysis of data was performed using Microsoft Excel and STATISTICA programs, using descriptive, discriminant analysis and logistic regression.

Results:

Predictors of inadequate reparative regeneration are pseudoexfoliative syndrome or axial myopia, as gender feature and age under 60 years. Signs of local metabolic disorders are preoperative IOP greater than 35 mm Hg, 2nd and 3rd degrees of involutional degenerative changes of irido-ciliary zone, 'subnormal character' of electroretinogram that can be associated with local microcirculatory disorders and increased permeability of blood-ophthalmic barrier in patients with inadequate course of healing process. Signs of dysregulated homeostasis processes are elevated levels of rod-nucleus neutrophils, triacylglycerols, cholesterol of very low density lipoproteins, low density lipoprotein cholesterol; 'subclinical' level of C-reactive protein, atherogenic index, follicle-stimulating hormone, dehydroepiandrosterone. Among patients with an inadequate course of reparative regeneration process 130 patients were divided into 3 groups. In first group ophthamohypertension occurred in ocular mechanical blockade of internal fistula or lingering course of inflammation phase (32 persons). In second group scar transformations of outflow pathways according to UBM data and dysfunction of filtering bleb combined with normal IOP (40 patients). In third group - the failure of outflow pathways combined with ophthalmotonus decompensation (60 patients). In accordance with healing process phases and their clinical manifestations, rehabilitation of patients included anti-inflammatory agents, anti-metabolites, anti-fibrotics and angiogenesis inhibitors.

Conclusions:

Identified local and systemic metabolic disorders are predictors, which determine features of healing process course after filtering surgery. Revealed signs of 'endogenous' inflammation, which markers are dislipoproteinemia and 'subclinical' C-reactive protein level, are associated with initial systemic vasculopathy, generalized endothelial dysfunction, activation of oxidative processes in tissues and excessive induction of cytokines and growth factors. Transformation of regenerative-reparative processes manifest by change of duration and sequence of phases, activation of angiogenesis and fibroplasia. In this case, pathological filtrating bleb with elements of edema, vascular injection and a tendency to scar changes clinically formed. As a result of initial assessment of risk factors and developed system of hyperscarring and developed system of rehabilitation measures in terms of 1-6 months after the operation, directed to managing of healing process, irreversible scar transformations appeared in only 35 cases (7.8%) of the total number of operated patients during 3 - 5years of follow-up period. So, the assessment of initial ophthalmologic and somatic status, timely diagnostics of clinical manifestations of inadequate reparative regeneration syndrome, monitoring of intraocular fluid outflow pathways formation and 'management' of healing process optimize morphogenesis of intraocular fluid outflow pathways and increase effectiveness of glaucoma filtering surgery in isolated or concomitant pathology. FINANCIAL INTEREST: NONE

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