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Laser iridectomy: means of prophylaxis of pigmentary glaucoma and rehabilitation of patients with pigment dispersion syndrome before refractive surgery

Poster Details

First Author: T.Iureva RUSSIA

Co Author(s):    A. Shchuko   N. Volkova           

Abstract Details



Purpose:

To evaluate the effectiveness of laser iridectomy in patients with pigmentary dispersion syndrome (PDS) at various clinical stages during long-term (5 to 15 years) of treatment and the possibility of further rehabilitation of patients with refractive disorders.

Setting:

Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution, Irkutsk State Medical Academy of Continuing Education

Methods:

. To achieve this purpose 90 patients were examined. They had previous (from 4 to 15 years) diagnoses SPD on the background of myopic refractive errors of varying severity, and preventive laser iridectomy was carried out starting with the stage of the first clinical signs. Methods of examination - gonioscopy, ultrasound biomicroscopy, biometry, tonometry. Patients were examined thoroughly at the time of initial diagnostics, the next day and at long-term period after laser treatment.

Results:

In patients with latent stage without laser treatment in 38% of cases the spontaneous regression of clinical signs of PDS was revealed: decrease in anterior chamber angle at 16-24 °, increase of posterior camera area from 1,08±0.13 to 1,45±0,26 mm² (p<0.001). 62% of patients showed a change of latent stage of SPD stage to stage of first clinical signs. A reliable decrease in anterior chamber depth, increase of posterior chamber area from 0,7±0,04 to 1,56±0,10 mm² (p<0, 01) were revealed at first stage of clinical signs and stage of manifestation after iridectomy. Recovery of pigment epithelium in areas destroyed by the pathological irido-zonular friction, occurred from 26, 46±14, 28 mkm to 56, 37±10, 09 (p<0,001) according to OCT data in 1.5-2 years. Level of pigmentation of anterior chamber angle decreased after laser iridectomy in 2 times in every second patient. None of the patients treated at first stage of clinical signs during follow-up period, an average of 10±1, 4 years, had not increased intraocular pressure. That is the stabilization and even regressions of pathological condition were achieved in 100% of cases. Negative dynamics with formation of pigmentary glaucoma was observed in 40% of patients treated at stage of manifestation.

Conclusions:

Laser iridectomy, which was made at stage of first clinical signs, results in clinical recovery of patients. Treatment, which was initiated at stage of manifestation, eliminates reverse pupillary block, but the further course of disease depends on duration and severity of pathological changes of intraocular fluid outflow pathways. Anatomical and reconstructive effect after iridectomy, confirmed by UBM data, the absence of hydrodynamic disturbances within 6 months after laser treatment, allowed spending refractive surgery in 62 patients (68.8%) with different stages of PDS. In spite of PDS prevalence in first stage of clinical signs, refractive interventions were performed including 3 patients in 2nd stage and 6 patients in 3rd stage of PDS. FINANCIAL INTEREST: NONE

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