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First Author: S.Nikolashin RUSSIA
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To determine optimum conditions and terms for descemetogoniopuncture (DGP) performance after non-penetrating surgery
The Academician S.N. Fyodorov FSBI IRTC Eye Microsurgery Tambov branch, Tambov, Russia
The results of descemetogoniopuncture were analyzed in 41 patients, 18 of which had I II stage of glaucoma, 23 III stage. Operated glaucoma of the II stage was observed in 3 eyes, III stage in 13 eyes. 34 non-penetrating deep sclerectomies (NPDS) and 7 microinvasive non-penetrating deep sclerectomies (MNPDS) were performed. Preoperative intraocular pressure (IOP) P0 = 28ḟ0.26 mm Hg. Postoperative IOP was 19.62ḟ0.18 mm Hg. Intrascleral cavity, a deflection of Descemet"s membrane (DM) before and after the surgery were examined by means of ultrasound biomicroscopy. IOP before DGP was 24.82ḟ0.21 mm Hg.
Immediately after DGP IOP P0 ? 18 mm Hg was observed in 20 patients. This meant that effect after DGP was not achieved. IOP was lower than 18 mm Hg in 21 patients after DGP. With a decrease in permeability DM begins to sag toward the external scleral cavity. Deflection increases with increasing of the sclerosis of DM. System is still functioning, but DM has already got a contact with the external scleral flap. While drainage pathways are functioning one should relieve tension of DM and perform DGP. In such a case superficial scleral cavity and intraocular fluid flow are restored.
1. A deflection of DM toward the external scleral flap is a first symptom of decompensation of the intraocular fluid outflow from the anterior chamber. 2. With increasing deflection it is necessary to perform an urgent DGP even in case of IOP compensation. 3. The absence of intrascleral cavity often proves DGP to be uneffective. 4. Ultrasound biomicroscopy is an effective method of dynamic monitoring of artificial outflow pathways for the purpose of their timely correction