DOI: 10.21689/2311-7729-2018-18-3-124-128

Technique and long-term results of surgical resection of sclera in patients with primary glaucoma
E.A. Korchuganova, O.A. Rumyantseva, A.Yu. Kazantseva
Pirogov Russian National Research Medical University, Moscow, Russian Federation

Abstract
The article describes the method of non-penetrating sclerectomy and shows remote clinical results of its application in the treatment of patients with primary glaucoma. Based on the experiments, a technique was developed to improve the uveoscleral outflow by means of the safe sclera thinning.
Aim: to study the efficacy and safety of surgical resection of sclera in patients with III and IV stages of primary open-angle glaucoma.
Patients and Methods: surgical resection of the sclera was performed in 86 patients with stage III and IV of glaucoma. Long-term results were traced in 79 patients. Objective studies included: determination of the level of intraocular pressure (IOP), EO coefficient. The results were assessed after 6 months, 1 and 2 years after the operation.
Results: regardless of the number of resections (1 and 2 resections), the IOP after the operation significantly decreased on average from 23.68 mm Hg up to 13.21 mm Hg (p≤0,05) beginning from the 3-d week and until the end of the observation period. The average EO coefficient improved in dynamics by 0.04 mm3/min/mm Hg and remained stable 6 months after the surgery and until the end of the observation period (p≤0.05). The operation is not followed by postoperative complications typical for glaucoma surgery, such as hyphema, hemophthalmia, ciliophorous detachment, uveitis.
Conclusion: the surgery is indicated for the patients with advanced stages of glaucoma, including residual visual functions, as well as on a single eye. In view of the gradual decrease in IOP, it is possible to stabilize visual functions and provide rapid rehabilitation of patients who do not need in-patient observation. For the patients aged 75 years and younger, it is advisable to perform 1 resection in case when the initial EO coefficient is at least 0.08 mm3/min/mm Hg, and 2 resections — in case when the EO coefficient is <0.08 mm3/min/mm Hg. 
For the patients older than 75 years it is recommended to perform 2 resections in case of any decrease in the EO coefficient.

Key words: glaucoma, sclera, uveoscleral outflow, intraocular pressure, ease of outflow, surgical treatment of glaucoma, surgical resection of sclera.
For citation: Korchuganova E.A., Rumyantseva O.A., Kazantseva A.Yu. Technique and long-term results of surgical resection of sclera in patients with primary glaucoma. RMJ “Clinical ophthalmology”. 2018;3:124–128.