Since 1992 we’ve
been using a new operation for close-angle and secondary glaucomas –
tansciliary draining of posterior chamber (TDPC) (K.P.Takhchidi, 1992). It
includes formation of a fistula into the posterior chamber through the ciliary
sulcus with employment (since 1996) of diode laser energy with wavelength of
810 nm. 74 patients (76 eyes) were operated: 34 for posttraumatic glaucoma, 30
for neovascular, 10 for uveal snd 2 – for other forms of secondary glaucoma.
Far-advamced and terminal glaucoma made 59.2%, initial and advanced – 40.8%.
Complications were
rare: intraoperatively 5 cases of slight haemorrhage into the chamber were seen
in neovascular glaucoma. Postoperative period was quiet in 61 case. Normal IOP
postoperatively was achieved in all the eyes except 5 operated for terminal
glaucoma. Remote results (up to 5 years) were followed in 44 cases. Normal IOP
at the end of follow-up was marked in 26 eyes (59.1%), including 14 (31.8%)
with hypotensive drops or after additional manipulations (88% in glaucoma I,
57% in glaucoma II , 67% in glaucoma III and 33% in glaucoma IV). One eye with
terminal glaucoma was enucleated 2
years after TDPC; one eye after severe trauma had total retinal
detachment and one eye became phthysic.
TDPC in severe
secondary glaucomas has low complications rate which makes its advantage before
fistulizing surgery in the anterior chamber angle. Its efficacy decreases in
far-advanced stages and differs in different forms of secondary glaucomas.