A.V. MILINGERT, E.V. EGOROVA, D.G. UZUNYAN, A.A. DROBNITSA

Fyodorov Eye Microsurgery Federal State Institution, 59a Beskudnikovskiy per., Moscow, Russian Federation, 127486 

Milingert A.V. — postgraduate student, tel. +7-963-998-57-72, e-mail: milingert@yandex.ru

Egorova E.V. — D. Med. Sc., Professor of the Department of Glaucoma Surgery tel. (495) 484-96-48, e-mail: ev_egorova@rambler.ru

Uzunyan D.G. — Cand. Med. Sc., Head of the Department of Clinical and Functional Diagnostics, tel. (495) 488-85-20, e-mail: u_dzhulietta@mail.ru

Drobnitsa A.A. — postgraduate student, tel. +7-903-143-69-20, e-mail: drobnica1986@mail.ru 

Objective. The study of the dynamics of changes of acoustic parameters of the sclera and ciliary body in patients with a terminal pain glaucoma before and after the diode CYC.

Materials and Methods. The study involved 61 patients (61 eyes with a terminal glaucoma pain). Age ranged from 58 to 87 years (mean age — 73,55±6,2). Intraocular pressure before surgery averaged 39,11±7,31 mm Hg against the background of antihypertensive therapy. Standard ophthalmic studies were complemented by ultrasound biomicroscopy, which was held on the block UBM «Ellex» (Australia) with a frequency of 50 MHz and a resolution of the sensor 50 microns. Determination of the acoustic density of the sclera (ADS) at each study in decibels obtained by decreasing the ultrasonic power on the screen until the disappearance of the echo from the capsule sclera of the eye. To perform the laser diode used cyclophotocoagulation ALOD-1 (Russia) with wavelength of 810 nm, with a standard 2.5 mm working tip. The choice of parameters of laser radiation came from the presence and degree of atrophy of the ciliary body according to UBM, the procedure used in the IRTC ME [25]. Result: The method of UBM, the study of the eye with terminal glaucoma showed a significant (P<0,05) decrease in the thickness of the sclera 1.5 mm outwards from the scleral spur with maximum expression at 1 year was 0,39±0,08 mm. for 6 hours. 0,31±0,018 and 12 h., respectively, acoustic density was 55±0,86 dB (6 h) и 54,8±0,92 dB (12 h).

Key words: contact transscleral diode-laser cyclophotocoagulation, ultrasound biomicroscopy, terminal glaucoma, atrophy of the ciliary body, sclera thickness of acoustic, acoustic density of the sclera (ADS).

REFERENCES

1. Svetlova O.V., Balashevich L.I., Zaseeva M.V. et al. The physiological role of the rigidity of the sclera in the formation of the level of intraocular pressure in normal and glaucoma. Glaukoma, 2010, no.1, pp. 26-40 (in Russ.).
2. Svetlova O.V., Surzhikov A.V., Kotlyar K.E. Biomechanical features of regulation systems of production and outflow of aqueous humor. Glaukoma, 2004, no. 2, pp. 66-76 (in Russ.).
3. Balashevich L.I., Gatsu M.V., Izmaylov A.S. et al. Lazernoe lechenie glaukomy [Laser treatment of glaucoma]. Saint Petersburg, 2006. P. 55.
4. Boyko E.V., Kulikov A.N., Skvortsov V.Yu. Comparative evaluation of diode-laser thermotherapy and laser coagulation as a method tsiklodestruktsii (experimental research). Prakticheskaya meditsina. Oftal’mologiya, 2012, vol. 1, pp. 175-179 (in Russ.).
5. Boyko E.V., Kulikov A.N., Skvortsov V.Yu. Laser tsiklodestruktsiya: thermotherapy or photocoagulation. Sbornik trudov 12-y vserossiyskoy shkoly oftal’mologa. Moscow, 2013. Pp. 45-55.
6. Volkov V.V., Kachanov A.B. Diode-Laser transscleral contact tsiklokoagulyatsiya (DLTKTS) in the treatment of secondary glaucoma c ocular. Oftal’mologicheskiy zhurnal, 1993, no. 5/6, pp. 274-277 (in Russ.).
7. Deev L.A., Molchanov V.V., Malakhova A.I. Prichiny enukleatsii glaz u bol’nykh na fone terminal’noy stadii glaukomy [Causes eye enucleation in patients with end-stage glaucoma background]. Fedorovskie chteniya, 2009.
8. Libman E.S. Epidemiological characteristic of glaucoma. Glaukoma, 2009, no.1 (suppl.), pp. 2-3 (in Russ.).
9. Klyuev G.O., Privalov A.P., Kholin V.V. Contact-compression transscleral tsiklokoagulyatsiya diode laser in the treatment of refractory glaucoma. Oftal’mologicheskiy zhurnal, 2006, no. 6, pp. 195-197 (in Russ.).
10. Mazunin I.Yu. Rezul’taty primeneniya diodnoy lazernoy transskleral’noy tsiklokoagulyatsii (DLTTsK) v lechenii razlichnykh vidov i form glaukomy [The results of the application of diode laser transscleral tsiklokoagulyatsii (DLTTSK) in the treatment of various types and forms of glaucoma]. Sbornik dokladov vserossiyskoy nauchno-prakticheskoy konferentsii «Glaukoma na rubezhe tysyacheletiy: itogi i perspektivy». Moscow, 1999. Pp. 244-246.
11. Egorov V.V., Sorokin E.L., Marchenko A.N. et al. Transscleral diodlazerkoagulyatsiya ciliary body in the treatment of terminal aching glaucoma. Glaukoma, 2007, no. 4, pp. 142-144 (in Russ.).
12. Robustova O.V., Bessmertnyy A.M., Chervyakov A.Yu. Tsiklodestruktiv intervention in the treatment of glaucoma. Glaukoma, 2003, no. 1, pp. 40-46 (in Russ.).
13. Chuprov A.D., Gavrilova I.A. An analysis of the effectiveness of different organ-operations at the terminal aching glaucoma. Klinicheskaya oftal’mologiya, 2010, vol. 12, no. 4, pp. 135-136 (in Russ.).
14. Egbert P.R., Fiadoyor S., Budenz D.L. et al. Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for primary open-angle glaucoma. Arch. Ophthalmol., 2001, vol. 119, no. 3, pp. 345-350.
15. Gaasterland D.E., Pollack I.P. Initial experience with a new method laser transscleral cyclophotocoagulation for ciliary ablation in severe glaucoma. Tr.Am.Ophth.Soc., 1992, vol. 45, pp. 225-246.
16. Iliev M.E., Gerber S. Long-term outcome of trans-scleral diode laser cyclophotocoagulation in refractory glaucoma. Br. J. Ophthalmol., 2007, vol. 91, pp. 1631-1635.
17. Lima V. C. W., Mello P. A. et al. Cyclophotocoagulation with diode laser in refractory glaucoma, long-term results. Arq. Bras. Oftalmol., 2003, vol. 66, no. 4, pp. 449-452.
18. Lin S.C., Chen M.J., Lin M.S. et al. Vascular effects on ciliary tissue from endoscopic versus trans-scleral cyclophotocoagulation. Br. J. Ophthalmol., 2006, vol. 90, no.4, rr. 496-500.
19. Ryabtseva A.A., Sergushev S.G., Khomyakova E.N., Svetlova O.V., Koshits I.N. Lazernaya gipotenzivnaya nepronikayushchaya sklerotomiya. Biomekhanika glaza 2007 [Laser-penetrating sclerotomy hypotensive. Biomechanics of eyes 2007]. Sbornik trudov MNII GB im. Gel’mgol’tsa. Moscow, 2007. Pp. 147-151.
20. Khomchik O.V., Ambartsumyan A.R., Erichev V.P. et al. Ultrasound biomicroscopy of the anterior eye tissues after trans-scleral diode-laser cyclophotocoagulation. Oftal’mologiya. Vostochnaya Evropa, 2011, no. 4, pp. 50-52 (in Russ.).
21. Egorova E.V., Malyugin B.E., Uzunyan D.G. et al. Anatomo-topograficheskie izmeneniya tsiliarnogo tela posle neoslozhnennoy fakoemul’sifikatsii katarakty s implantatsiey elastichnykh IOL [Anatomical and topographical changes in the ciliary body after uncomplicated phacoemulsification cataract with IOL implantation elastic]. Sbornik trudov vserossiyskoy nauchnoy konferentsii “Klinicheskaya anatomiya i eksperimental’naya khirurgiya v 21-m veke”. Orenburg, 2009. Pp. 251-252.
22. Egorova E.V., Sokolovskaya T.V., Uzunyan D.G., Drobnitsa A.A. Evaluation of the results of the contact transscleral diode-laser tsiklokoagulyatsii with the changes of the ciliary body in the study by ultrasound biomicroscopy in patients with terminal glaucoma. Oftal’mokhirurgiya, 2013, no. 3, pp. 72-77 (in Russ.).
23. Egorova E.V., Drobnitsa A.A., Uzunyan D.G. Assessing the impact of the laser diode laser energy to the ciliary body in patients with terminal aching glaucoma. Prakticheskaya meditsina. Oftal’mologiya, 2013, vol. 70, pp. 18-23 (in Russ.).
24. Takhchidi Kh.P., Egorova E.V., Uzunyan D.G. Ul’trazvukovaya biomikroskopiya v diagnostike patologii perednego segmenta glaza [Ultrasound biomicroscopy in the diagnosis of diseases of the anterior segment of the eye]. Moscow, 2007. Pp. 13-27.
25. Drobnitsa A.A., Uzunyan D.G. Akusticheskaya morfologiya iridotsiliarnoy zony u patsientov s terminal’noy glaukomoy na osnove metoda UBM [Acoustic morphology iridotsiliarnoy zone in patients with terminal glaucoma on the basis of UBM]. Sbornik trudov 8-y vserossiyskoy nauchnoy konferentsii molodykh uchenykh “Aktual’nye problemy oftal’mologii”. Moscow, 2013. Pp. 74-75.