Anatomical and topographical features of filtering blebs after non-penetrating deep sclerectomy in patients with glaucoma according to optical coherence tomography
DOI:
https://doi.org/10.31288/oftalmolzh201443439Keywords:
optical coherence tomography (OCT), open-angle glaucoma, non-penetrating deep sclerectomy (HBSEg)Abstract
Purpose. To study morphological changes that occur in the filter cushion after non-perforating deep sclerectomy with optical coherence tomography. Materials and methods. The study involved 31 patients (31 eyes) with diagnosis of primary open- angle glaucoma of 2—3 degree. There were 20 men and 11 women. The average age of patients was 63. The apparatus of the company Heidelberg SPECTRALIS OCT + HRA was used to carry out optical coherence tomography; the study period made up 14—357 days after the operation. There were valuated: height, wall thickness, the size of the subconjunctival cavity, echogenicity inside the cushion, and the topographical interrelation between the scleral flap, the sclera and the conjunctival cushion.
Results. Depending on the tonography data the patients were divided into 2 groups with compensation of the intraocular pressure — Po within 14—18 mm Hg and with decompensation Po > 22 mm Hg (without the use of hypotensive drugs). Filtering cushions were divided into 4 types: diffuse filtering cushion -51.6 % of cases; cystic -19.35 %; fibrous type — 12.9 % and 12.9 % of the hood-type. Postoperative intraocular pressure compensation was observed in the first two types of filtering cushions. Decompensation or partial compensation has been observed in the third and fourth types of filtering cushions.
Conclusions. The method of optical coherence tomography can detect signs of scarring processes in dynamics at the preclinical level and at any time after microin-vasive nonperforating operations for glaucoma, which enables prediction of the hypotensive effect. The absence of normalization of the intraocular pressure in the postoperative period is associated with the formation of certain types of filtering cushions that combine various decompensation risk factors. Risk factors should include the height of the filtering cushion, its limitation and echogenicity as well as reduction the height or lack of intrasclera cavity.
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