Autogenous Scleral Drainage With Lymphotherapy Dose–Response In Stage‑3 Angle‑Closure Glaucoma: A Comparative Study Of Surgical Techniques

Angle-closure glaucoma (ACG) accounts for 20-40% of glaucoma cases, posing a major risk of vision loss due to elevated intraocular pressure (IOP). This study targets severe stage 3 unstable ACG, with IOP ranging from 26 to 47 mmHg. We compare three surgical options: classical deep sclerectomy, standard autogenous scleral drainage and autogenous scleral drainage enhanced by lymphotherapy. Lymphotherapy involves subcutaneous injection of gliatilin and retinalamin 0.8-1.2 cm below the mastoid apex, targeting second-order lymphatic vessels to reach retinal lymphatic spaces. Our goal is to evaluate postoperative IOP reduction and surgical success rates in these conditions. 

The study involved 300 eyes from 150 patients, divided into three groups of 100 eyes each. The surgical procedures were aimed at reducing IOP and improving the function of the optic nerve. Appasamy Associates visualization system for ophthalmic micro surgery (model TRUGLOW FS-1) was used during surgical procedures.

Group 1: Patients underwent traditional deep sclerectomy. Group 2: Participants received scleral drainage without auxiliary therapies. Group 3: Patients had scleral drainage accompanied by lymphotherapy using gliatilin and retinalamin. The 100 eyes in Group 3 were further randomized into four cohorts (25 eyes each) after local anesthesia with 2% lidocaine 1 mL at the mastoid injection site. Cohorts received subcutaneous lymphotherapy injections administered once a week for three weeks. Dose cohorts were: 3(a): retinalamin 2 mg + gliatilin 0.25 mg; 3(b): retinalamin 3 mg + gliatilin 0.50 mg; 3(c): retinalamin 4 mg + gliatilin 0.75 mg; 3(d): retinalamin 5 mg + gliatilin 1.00 mg. 

Postoperative evaluations focused on IOP as the primary success metric, yielding the following average reductions: Group 1: Achieved an 18% average IOP reduction, demonstrating moderate success with a few postoperative complications. Group 2: Showed a 25% average reduction in IOP, indicating improved control compared to Group 1, with some minor complications noted. Group 3: Experienced an IOP reduction of 26% along with Group 3(d) experincing the most minimal postoperative complications compared to other groups.

The results indicate that lymphotherapy in Group 3 provided a substantial improvement in surgical outcomes, establishing it as the most effective and safe intervention among the tested groups. Group 3 (d)’s minimal postoperative complications attributed to the effects of lymphotherapy which enhanced microcirculation and reduced trauma risk. Autogenous scleral drainage combined with lymphotherapy represents an effective intervention for stage 3 angle-closure glaucoma. This approach not only significantly lowers IOP but also facilitates improved postoperative recovery.