Open-angle
glaucoma. Non-penetrating
deep sclerectomy (NPDS) in 11745 eyes; normal IOP: 76.5% in initial glaucoma,
60.4% in advanced and 38.2% in far-advanced. In combination of NPDS and laser
goniopuncture efficacy made 90.5% in initial, 85.7% in advanced and 83.9% in
far-advanced glaucoma. Complications occurred in 4.9%.
Close-angle
glaucoma. A new approach
for organic angular block was developed by Prof. K.P. Takhchidi -transciliary
draining of posterior chamber (TDPC). The operation is like NPDS up to the
moment of circular ligament exposure. Behind the ligament ciliary body is exposed and a fistula
is formed with diode laser irradiation (810 nm). 800 eyes were treated; normal
IOP in 71%: 80% in initial glaucoma, 72% in advanced and 68% in far-advanced.
Complications: hypotony – 9%, choroidal detachment – 7%, shallow chamber –
2.5%, hyphaema – 3%, malignant glaucoma – 0.05%.
Combined
glaucoma. After argon-laser iridoplasty NPDS
is performed. In case of good filtration
the operation is finished like NPDS. If the filtration is poor, the
operation is converted into TDPC. 1250 eyes were treated; normal IOP: 73.6% of
initial, 74.25% of advanced and
64.3% of far-advanced glaucoma. Complications: shallow chamber – 1.2%,
choroidal detachment – 1.4%, hyphaema – 2.6%, hypotony – 2.1%.
Reconstruction
of filtering zone. Ultrasound
biomicroscopy revealed different status of outflow pathways in failed glaucoma
operations. In 40.9% of eyes
there were Tenon’s cysts. Needling restored filtration in 81.5% of cases. In
24.2% there were intrtascleral
cavities. Revision with a spatula-knife was performed; filtration restored in
75%. In 34.9% no outflow pathways were detected, reoperations were performed.