THE EFFECT OF DIFFERENT TYPES ANTI-GLAUCOMA OPERATIONS ON THE PROGRESSION OF GLAUCOMA OPTIC NEUROPATHY: 1 YEAR FOLLOW-UP

Abstract

Abstract. According to the WHO, the number of patients with primary glaucoma in the world ranges from 60.5 to 105 million, and in the next 10 years this number may increase by 10 million [1]. The prevalence of glaucoma in adults aged 18 years and older in Ukraine was in 2016 - 452.7, in 2017 - 458.0 per 100 thousand population, respectively [2]. Primary open-angle glaucoma (POAG) is a multifactorial disease that leads to a specific lesion of the optic nerve - glaucoma optic neuropathy (GON) [3]. The most significant risk factor for the development of POAG and subsequent GON is increased intraocular pressure (IOP) [4]. Unfortunately, IOP is one of the few risk factors for the development of POAG and GON, which we can control [5]. In this regard, the most effective method of treatment is surgery [6]. Aim is to study the influence of different types anti-glaucoma operations on the progression of glaucoma optic neuropathy 1 year after the intervention. Object and methods. 150 patients (150 eyes) with POAG were monitored. There were 72 men and 78 women; the age of patients ranged from 39 to 69 years and averaged 58.5 ±2.7. The level of IOP ranged from 15.0 to 34.0 mmHg and averaged 28.5 ±3.0 mmHg with local use of antihypertensive drugs. All patients underwent visometry, Hamphrey static perimetry, tonometry, biomicroscopy, gonioscopy, ophthalmoscopy, ultrasound and optical coherence tomography. The stage of the disease was determined by classifying the perimetric changes of glaucoma. Patients were divided into 2 observation groups. Patients of the first observation group (69 eyes) underwent trabeculectomy (TE) with implantation of the shunt ExPress. Patients of the second observation group (81 eyes) underwent two-stage treatment: Stage 1 - non-penetrating deep sclerectomy (NPDS); Stage 2 - laser descemetogoniopuncture 2 weeks after stage 1. The effect of TE with implantation of Ex-Press shunt and NPDS with subsequent laser descemetogoniopuncture on the progression of GON was studied. The observation period is 1 year. To compare the structure of groups in percent (P ±m) used the method of arcsine Fisher transform. The null hypothesis of no effect was rejected and the differences between the indicators were considered statistically significant at a significance level of p <0.05.Results. The effect of different types of antiglaucoma surgery was studied 1 year after the intervention. 65 patients from the first observation group and 76 - from the second were examined. It was found that the level of IOP observed in the first group was 21.3 ±1.7 mmHg. IOP was normal in 59 eyes (90.76%), normalized by topical application of antihypertensive drugs (0.25% Betaxolol) in instillations 2 times a day in 3 eyes (4.61%). Hypotension was detected in 3 eyes (4.61%). The boundaries of the field of view according to the static perimeter of Humphrey remained at the preoperative level or expanded by 57 eyes (87.69%), narrowed - by 8 eyes (12.3%). According to the perimetry and OCT data, the progression of GON was determined on these 8 eyes. The level of IOP observed in the second group was 22.9 ±2.4 mmHg. IOP was normal in 67 eyes (88.16%), normalized by topical application of various antihypertensive drugs in instillation in 9 eyes (11.84%). The boundaries of the field of view according to the static perimeter of Humphrey remained at the preoperative level or expanded by 66 eyes (86.84%), narrowed - by 10 eyes (13.16%). According to the perimetry and OCT data, the progression of GON was determined on these 10 eyes. Earlier we investigated that the frequency of GON at the observation period of 3, 6 months did not differ in the first and second groups of observation. After 1 year, the frequency of GON also did not differ, despite the fact that the performance of TE with implantation of the Ex-Press shunt had a lower safety profile and was accompanied by a higher frequency and range of postoperative complications. At the same time in the first group of supervision the hypotensive effect was more expressed. It can be assumed that the nature of postoperative complications and their duration, as well as the level of IOP, both low and high, are not key risk factors for the progression of GON after various types of surgery. Conclusions. 1. As a result of our study it was found that the frequency of GON progression in patients with POAG 1 year after TE with implantation of Ex-Press shunt was 12%, after NPDS with subsequent laser descemetogoniopuncture - 13.6% and did not differ statistically. 2. Performing various surgical interventions, both fistulizing type (TE with ExPress shunt implantation) and impermeable type (NPDS with subsequent laser descemetogoniopuncture) did not provide advantages in terms of prevention of GON progression in patients with POAG in the long-term follow-up. 3. Prospects for the prediction and prevention of GON after surgical treatment of POAG is presented to us in the study of new factors of its pathogenesis, followed by the development of new areas of treatment.