Reverse cyclodialysis and implantation of a novice stainless steel supraciliary implant in management of open angle glaucoma in cataract patients
A.S. SHRADQA1, V. KUMAR1,2, M.A. FROLOV1, G.N. DUSHINA1, A.I. BEZZABOTNOV2
1Peoples’ Friendship University of Russia, Mikluho-Maklaya Str., 6, Moscow, Russian Federation, 117198
2Ophthalmic unit of Skhodnya City Hospital, Michurina Str., 31 А, Skhodnya, Khimki, Russian Federation, 141420
Shradqa A.S. – postgraduate student, M.D., Department of Eye Diseases, e-mail: sh1988moscow@gmail.com.
Kumar V. – D. Sc. (medicine), Professor of the Department of Eye Diseases, Head of Ophthalmic unit, e-mail: kumarvinod1955@gmail.com.
Frolov M.A. – D. Sc. (medicine), Professor, Head of the Department of Eye Diseases, e-mail: frolovma@rambler.ru.
Dushina G.N. – PhD (medicine), Assistant Lecturer of the Department of Eye Diseases, e-mail: dushina_galina@mail.ru.
Bezzabotnov A.I. – ophthalmologist, e-mail: magnawer@yandex.ru.
Objective: To evaluate safety and effectiveness of reverse cyclodialysis and implantation of a novice stainless steel supraciliary implant in decreasing intraocular pressure (IOP) and hypotensive medication(s) use in patients with concomitant pathology.
Material and methods: Twenty-two patients (14 male and 8 female, average age — 73.5+5.3 yrs) suffering from cataract and glaucoma were operated upon. After completion of cataract surgery, a specially designed cyclodialysis spatula was inserted through main incision, and ciliary body was gently detached from sclera creating a cleft of 2.5 mm wide and 6-6.5 mm deep. In 14 cases an original stainless steel implant was implanted in the supraciliary space (implant group). Other eight cases served as control. Outcome measures were IOP change, use of hypotensive medication(s) and complications. Success rates were evaluated using World Glaucoma Association’s guidelines. Results were significant when p <0.05.
Results: Baseline IOP in implant and control group was 22.2±5.7 mmHg and 22.4±7.3 mmHg respectively. After 12 months, IOP decreased by 47.9+13.1% and 44+24.1% and was 10.9±1 mmHg and 10.6+1.7 mmHg in implant and control groups respectively. The number of hypotensive medications used before operation was 2.4 ±0.9 and 2.5±0.5, which was reduced to 0.8 ±1.1 (p=0.002) and 0.9±1.1 (p=0.0053) in respective groups. Complete success was achieved in 57.1% in implant group and 37.5% cases in control group (p=0.044), whereas partial success was achieved in 35.7% and 50% cases respectively. Failure rate was 7.1% and 12.5% (p=0.22).
Conclusion: Ab interno reverse cyclodialysis with or without implantation of supraciliary metallic implant was safe and effective in decreasing IOP in patients suffering from concomitant pathology. However, implantation of a metallic supraciliary implant helps in further reduction of patient’s dependency on the use of hypotensive medication(s) to control IOP after cataract surgery.
Key words: minimally invasive glaucoma surgery, supraciliary metallic implant, reverse cyclodialysis ab interno, uveoscleral outflow of intraocular fluid, intraocular pressure.
(For citation: Shradqa A.S., Kumar V., Frolov M.A., Dushina G.N., Bezzabotnov A.I. Reverse cyclodialysis and implantation of a novice stainless steel supraciliary implant in management of open angle glaucoma in cataract patients. Practical Medicine. 2018)
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