glaucomaНациональный журнал ГлаукомаNational Journal glaucoma2078-41042311-6862Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”glaucoma-26Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESНовый спиральный экспандер шлеммова канала в хирургии открытоугольной глаукомыA new stainless steel spiral Schlemm's canal expander in surgical treatment open-angle glaucomaКумарВ. .KumarVinodkumarvinod1955@gmail.comФроловМ. А.FrolovM. A.noemail@neicon.ruБожокЕ. В.BozhokE. V.noemail@neicon.ruДушинаГ. Н.DushinaG. N.noemail@neicon.ruБеззаботновА. И.BezzabotnovA. I.noemail@neicon.ruРоссийский университет дружбы народов; МБУЗ «Сходненская городская больница»РоссияPeople's friendship university of Russia; Ophthalmic unit, Skhodnya city hospitalRussian FederationРоссийский университет дружбы народовРоссияPeople's friendship university of RussiaRussian FederationМБУЗ «Сходненская городская больница»РоссияOphthalmic unit, Skhodnya city hospitalRussian Federation2014170120171334351Copyright © Кумар В..., Фролов М.А., Божок Е.В., Душина Г.Н., Беззаботнов А.И., 20172017Кумар В..., Фролов М.А., Божок Е.В., Душина Г.Н., Беззаботнов А.И.Kumar V., Frolov M.A., Bozhok E.V., Dushina G.N., Bezzabotnov A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.glaucomajournal.ru/jour/article/view/26

ЦЕЛЬ. Оценить эффективность и безопасность применения нового спирального экспандера шлеммова канала (ЭШК) для дилятации шлеммова канала (ШК) для снижения внутриглазного давления (ВГД) у пациентов с ОУГ. МАТЕРИАЛЫ И МЕТОДЫ. Прооперированы 18 человек (18 глаз) с открытоугольной глаукомой (ОУГ), у которых ВГД не компенсировалось на максимальной гипотензивной терапии. Всем пациентам имплантировали ЭШК наружным доступом. ЭШК изготовлен из проволоки нержавеющей стали медицинского качества толщиной 0,05 мм, длиной 4-5 мм, кривизна соответствует кривизне ШК. В 6 случаях была произведена одномоментная комбинированная хирургия по поводу катаракты и глаукомы - факоэмульсификация с имплантацией интра-окулярной линзы и имплантацией ЭШК в ШК. Критериями оценки являлись динамика ВГД, необходимость применения гипотензивных капель до и после операции и частота осложнений. Для статистического анализа использовали двухвыборочный t-тест. Результаты считались достоверными при р<0,05. Снижение ВГД более чем на 25% или ВГД, равное 18 мм рт.ст. и меньше без применения гипотензивной терапии, считалось полным успехом, с применением гипотензивной терапии - частичным. Необходимость в проведении последующей операции считалась неудачей. Средний период послеоперационного наблюдения составил 9,5±2,7 (стандартное отклонение) мес. РЕЗУЛЬТАТЫ. До операции среднее ВГД составляло 25,8±6,2 мм рт.ст. (95% доверительный интервал (ДИ) 22,7-28,9), среднее число используемых гипотензивных лекарств - 2,4±0,8 (95% ДИ 2,2-2,6). Спустя 6 и 12 мес. после операции среднее ВГД снизилось до 11,9±3,0 мм рт.ст. (95% ДИ 11,5-13,1; р=0,000000008) и 12,3±2,5 мм рт.ст. (n=10; 95% ДИ 11,2-12,6; р=0,00000001). Через 6 мес. снижение ВГД от исходного составляло 51,7±10,0% (95% ДИ 47,2-56,2), через 12 мес. - 49,8±15,3% (95% ДИ 45,0-54,6). Среднее количество лекарств сократилось до 0,6±1,1 (95% ДИ 0,3-0,9; р=0,0000002) и 0,9±1,3 (95% ДИ 0,5-1,3; р=0,004) через 6 и 12 мес. Полный и частичный успех был достигнут в 13 и 5 случаях через 6 мес. и в 6 и 4 случаях через 12 мес. соответственно. Во время операции микроперфорация трабекулы внутри ШК произошла в 3 из 18 случаев. В послеоперационном периоде воспалительная реакция, геморрагические осложнения, гипотония и мелкая передняя камера не наблюдались. Гониоскопически все ЭШК находились в ШК, кроме 2 случаев, где один конец устройства находился в углу передней камеры без контакта с интраокулярными структурами. В 3 из 18 случаев отмечалась регургитация крови в ШК, которая самостоятельно резорбировалась спустя 3-4 дня. Повышенное ВГД имело место в 1 случае, что потребовало проведения ИАГ-лазерной трабекулопунк-туры и назначения одного вида капель. ЗАКЛЮЧЕНИЕ. Имплантация ЭШК в ШК в хирургическом лечении ОУГ достоверно снижает ВГД, что в свою очередь приводит к сокращению используемых гипотензивных лекарств в отдаленные сроки.

PURPOSE: To evaluate the safety and effectiveness of Schlemm's canal (SC) dilation with stainless steel spiral Schlemm's canal expander (SCE) in decreasing intraocular pressure (IOP) in patients with open angle glaucoma (OAG). MATERIAL AND METHODS: Eighteen consecutive patients (18 eyes) with OAG, who's IOP was insufficiently controlled by their current ocular hypotensive medications were operated upon. A 4-5 mm long SCE made from 0.05 mm thick medical grade stainless steel wire was implanted into the SC lumen ab externo. In 6 cases with coexisting pathology a combined two site procedure - phacoemulsification with implantation of an intraocular lens (IOL) and SCE implantation was performed. Primary outcome measure was IOP change, secondary - number of glaucoma medications pre-and postoperatively and complications. A paired t-test was used for IOP and medication analysis. Decrease in IOP >25% or IOP 18 mm Hg or less without medication was considered a complete success, with medication - partial success. Failure was considered if the patient needed subsequent filtering surgery. Results were significant with p<0.05. Mean postoperative follow-up was 9.5±2.7 months. RESULTS: Mean preoperative IOP was 25.8±6.2 mm Hg (95% CI 22.7-28.9), mean number of medications - 2.4±0.8 (95% CI 2.2-2.6). At each follow-up a decrease in mean IOP was observed, resulting in 11.9±3.0 mm Hg (95% CI 11.513.1) at 6 months (p=0.000000008) and 12.3±2.5 mm Hg (n=10; 95% CI 11.2-12.6) at 12 months (p=0.00000001). This represents a reduction in IOP from baseline of 51.7±19.0% (95% CI 47.2-56.2) at 6 months and 49.8±15.3% (95% CI 45.0-54.6) at 12 months. Mean number of medications use decreased to 0.6±1.1 (95% CI 0.3-0.9; p=0.0000002) and 0.9±1.3 (95% CI 0.5-1.3; p=0.004) at 6 and 12 months respectively. Complete and partial success were observed in 13 and 5 cases at 6 months and 6 and 4 cases at 12 months (n=10). Intraoperatively, microperforation of trabecular meshwork (TM) in areas other than exposed part of SC occurred in 3 out of 18 cases. Postoperatively, not a single case of inflammation at insertion site, of hypotony, or shallow chamber was observed. Gonioscopically the device was in SC in all, except 2 cases, where one end of the device was lying in anterior chamber without contact with intraocular structures. Some blood was observed in SC at the device site in 3 cases, which cleared spontaneously after 3-4 days. There was 1 case with raised IOP after operation, which required Nd-YAG laser trabeculopuncture and one glaucoma medication. There were no failure cases. CONCLUSION: Six months and one year results of SCE insertion in surgical management of OAG show significant reduction in IOP from the baseline and in hypotensive medications use.

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The authors declare that there are no conflicts of interest present.