gms | German Medical Science

Glaucoma surgery for lowering intraocular pressure (IOP) by implanting artificial drainage is of special importance (Molneto, Krupin, Ahmed, S.S. Sckocker, S.N. Fedorov). It is essential to attain IOP stability and that of visual functions affected by refractory glaucoma (RG): juvenile, uveal, neovascular, repeatedly operated initial glaucoma etc. According to A.M. Bessmertny, V.P. Erichev (2004) allegedly subdivide RG patients into there groups as to the degree of “refractability” and probability (high, medium, low) of attaining stable hypotensive effect. The aim of the study is safety and effectivity of combined treatment of RG.

23 patients (23 eyes) with noncompensated RG, aged 21-82 ( average 57,9 years); RG I - 5 patients, RG II - 6 patients, RG III - 12 patients (9 of these with formerly noncompensated secondary glaucoma; 2 with posttraumatic noncompensated glaucoma; 3 with diabetic and neovascularization; 5 with secondary glaucoma and aphakia (artiphakia); 3 - with trombosis of the central vein of the retina. The vision was from 0,2 to diffident light sense: IOP from 27 to 60 Hg mm ( average of 38,6±0,8 Hg mm). Complete fistula surgery with drainage, was performed on the 23 patients. 6 patients (5 with RG III) were operated on in two steps – sinusotrabeculectomia was followed by drainage in 2-7 days, wick allowed to avoid complications (the patients had been under medical control not less than a year).

At the early postoperative period hyphemas were registered in 60.5% of cases, detachment of vascular tunic in 30% of cases. As a result, IOP of 22 eyes was normalized (17.5±0.68 Hg mm).

Complete fistula surgery in combination with microdrainage resulted in IOP normalization. To normalize IOP with RG III and to preserve visual functions it is advisable to perform he combined surgery in two steps.