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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">glaucoma</journal-id><journal-title-group><journal-title xml:lang="ru">Национальный журнал Глаукома</journal-title><trans-title-group xml:lang="en"><trans-title>National Journal glaucoma</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2078-4104</issn><issn pub-type="epub">2311-6862</issn><publisher><publisher-name>Federal State Budgetary Institution of Science “Krasnov Research Institute of Eye Diseases”</publisher-name></publisher></journal-meta><article-meta><article-id custom-type="elpub" pub-id-type="custom">glaucoma-62</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Оценка эффективности и безопасности применения экспандера шлеммова канала Кумара в лечении открытоугольной глаукомы у больных с сопутствующей катарактой</article-title><trans-title-group xml:lang="en"><trans-title>Safety and effectiveness of Kumar’s Schlemm’s canal expander in management of open-angle glaucoma in cataract patients</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кумар</surname><given-names>Винод</given-names></name><name name-style="western" xml:lang="en"><surname>Kumar</surname><given-names>V. .</given-names></name></name-alternatives><email xlink:type="simple">kumarvinod1955@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фролов</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Frolov</surname><given-names>M. .</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Душина</surname><given-names>Г. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Dushina</surname><given-names>G. .</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Божок</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Bozhok</surname><given-names>E. .</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Российский университет дружбы народов; МБУЗ «Сходненская городская больница»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Peoples’ Friendship University of Russia; Skhodnya city Municipal Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Российский университет дружбы народов</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Peoples’ Friendship University of Russia</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>МБУЗ «Сходненская городская больница»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Peoples’ Friendship University of Russia; Skhodnya city Municipal Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>17</day><month>01</month><year>2017</year></pub-date><volume>14</volume><issue>2</issue><fpage>45</fpage><lpage>55</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Кумар В..., Фролов М.А., Душина Г.Н., Божок Е.В., 2017</copyright-statement><copyright-year>2017</copyright-year><copyright-holder xml:lang="ru">Кумар В., Фролов М.А., Душина Г.Н., Божок Е.В.</copyright-holder><copyright-holder xml:lang="en">Kumar V..., Frolov M..., Dushina G..., Bozhok E...</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.glaucomajournal.ru/jour/article/view/62">https://www.glaucomajournal.ru/jour/article/view/62</self-uri><abstract><p>ЦЕЛЬ. Оценить эффективность и безопасность применения экспандера шлеммова канала (ЭШК) Кумара в лечении открытоугольной глаукомы (ОУГ) у больных с катарактой. МЕТОДЫ. Прооперировано 9 человек (9 глаз) с катарактой и ОУГ, у которых внутриглазное давление (ВГД) не компенсировалось на максимальной гипотензивной терапии. У 5 больных был диагностирован псевдоэксфолиативный синдром, у этих пациентов имели место узкие зрачки и выраженный факодонез, нуждающийся в имплантации капсульного кольца для стабилизации капсульного мешка. Всем пациентам проведена одномоментная комбинированная хирургия - факоэмульсификация с имплантацией складывающейся гидрофильной интраокулярной линзы (ИОЛ) в капсульный мешок и имплантация ЭШК в просвет шлеммова канала (ШК). ЭШК длиной 4-5 мм изготовлен из проволоки нержавеющей ванадиевой стали медицинского качества толщиной 0,05 мм, имплантирован в просвет ШК ab externo. Критериями оценки являлись динамика ВГД, необходимость применения гипотензивных капель до и после операции и частота осложнений. Для статистического анализа использовали двухвыборочный t-тест. Снижение ВГД более чем на 25% или ВГД равное 18 и меньше без применения гипотензивной терапии считалось полным успехом, с применением гипотензивной терапии - частичным. Необходимость в проведении последующей операции считалась неудачей. Успех оценивали при каждом посещений пациента с использованием кривой выживаемости Каплана - Мэйэра. Результаты считались достоверными при р&lt;0,05. Минимальное послеоперационное наблюдение - 18 месяцев. РЕЗУЛЬТАТЫ. Из 9 прооперированных больных в анализ были включены 7 пациентов. 1 пациент скончался спустя 3 месяца после операции, в 1 случае послеоперационное наблюдение было прервано, эти пациенты были исключены из анализа. До операции среднее ВГД составляло 26,1+4,6 мм рт.ст. (19,0-30,9; 95% доверительный интервал (ДИ) 22,7-29,5) среднее количество используемых гипотензивных препаратов - 2,1+0,4 (2-3; 95% ДИ 1,9-2,4). Спустя 18 месяцев после операции среднее ВГД снизилось до 11,3+3,0 мм рт.ст. (7,1-15,3; ДИ 9,1-13,5) (p=0,0000015) и среднее количество гипотензивных препаратов сократилось до 0,9+1,2 (0-3; 95% ДИ 0,0-1,8). В процентном отношении снижение ВГД от исходного составляло 56,3+11,6%. Полный и частичный успех был достигнут в 4 и 3 случаях соответственно. Во время операции микроперфорация трабекулы внутри ШК произошла в 1 случае. В 5 случаях полностью удалось имплантировать ЭШК в просвет ШК. В 2 случаях один конец устройства оставлен во вскрытом ШК. Осложнения, связанные с ЭШК и техникой его имплантации, не наблюдали. Фильтрационную подушку различной выраженности наблюдали через 1 день после операции у 5 пациентов, через 1 неделю - у 2-х и через 1 месяц - у 1 пациента. Спустя 3 месяца после операции пациентов с фильтрационной подушкой не было. В 1 случае понадобилось выполнение лазерной капсулотомии по поводу вторичной катарактой. Спустя 18 месяцев после операции устройство находилось в просвете ШК у всех пациентов. У пациента с микроперфорацией один конец устройства находился в углу передней камеры, не контактируя с внутриглазными структурами. ВЫВОДЫ. Анализ результатов имплантации ЭШК при хирургическом лечении глаукомы у больных с катарактой показывает достоверное снижение ВГД от исходного, что в свою очередь приводит к сокращению используемых гипотензивных препаратов.</p></abstract><trans-abstract xml:lang="en"><p>PURPOSE: To evaluate safety and effectiveness of Schlemm's canal expander (SCE) in management of open-angle glaucoma (OAG) in cataract patients. METHODS: A total of 9 cases (9 eyes) having visually significant cataract and insufficiently controlled by their current ocular hypotensive medication(s) glaucoma were operated upon. There were 5 cases of pseudoexfoliation syndrome, rigid pupils and weakening of Zinn's ligaments resulting in instability of native lens and requiring implantation of a capsule tension ring (CTR) into the capsular bag to stabilize it. A one-stage combined surgery - phacoemulsification with in-the-bag implantation of a foldable acrylic hydrophilic intraocular lens (IOL) and implantation of SCE in Schlemm's canal (SC) was performed in all cases. A 4-5 mm long SCE made from 0.05mm thick medical grade vanadium stainless steel wire was implanted into the SC lumen by ab externo approach. Primary outcome measure was intraocular pressure (IOP) change, secondary - number of glaucoma medications pre- and postoperatively and complications. A paired t-test was used for IOP and medication analysis. 25% decrease in IOP or IOP of 18 mm Hg or less without medication was considered a complete success, with medication - partial success. The need for subsequent filtering surgery was qualified as failure. Success was evaluated on the basis of Kaplan-Meier cumulative probability at each follow-up visit. Results were considered statistically significant with p&lt;0.05. Minimum postoperative follow-up was 18 months. RESULTS: Out of 9 operated cases a total of 7 cases (7 eyes) were included for analysis. 1 patient who died of natural causes 3 months after the surgery and another case with incomplete follow up were excluded from the study. Mean preoperative IOP was 26.1+4.6 mm Hg (range: 19.0-30.9; 95% CI 22.7-29.5) and mean number of preoperative medications was 2.1+0.4 (range: 2-3; 95% CI 1.9-2.4). At each follow-up a decrease in mean IOP was observed, resulting in 11.3+3.0 mmHg (range: 7.1-15.3; CI 9.1-13.5) at 18 months (p=0.0000015). This represents a reduction of 56.3+11.6% from the baseline IOP. A reduction in glaucoma medications use was observed at each follow up visit and was 0.9+1.2 (range: 0-3; 95% CI 0.0-1.8) at 18 months (p=0.016). Complete and partial success was observed in 4 and 3 cases at the 18-month point, respectively. Microperforation of the trabecular meshwork (TM) in areas other than the exposed part of SC occurred in 1 case. In 5 cases the device could be pushed into SC completely. In 2 cases one end (0.5 to 1.0 mm in length) of the device was left in the exposed part of SC. No specific complications related to the device were noted. A filtration bleb was noticed in 5 cases on day one, 2 cases at 1 week and 1 case at 1 month. At 3 months and afterwards no filtration bleb was noticed in any of the cases. In 1 case laser capsulotomy for secondary cataract was performed to restore vision. Goniosco-pically the device was in the lumen of the SC in all cases except the case with intra-operative microperforation, where one end of the device was lying in the anterior chamber (AC) without any contact with intraocular structures. CONCLUSION: Eighteen months results of the SCE implantation in surgical management of OAG in cataract patients show significant reduction in IOP from the baseline and in hypotensive medication(s) use.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>Schlemm's canal surgery</kwd><kwd>Schlemm's canal expander</kwd><kwd>stainless steel spiral Schlemm's canal expander</kwd><kwd>glaucoma surgery</kwd><kwd>open angle glaucoma</kwd><kwd>mini invasive glaucoma surgery</kwd><kwd>combined surgery for cataract and glaucoma</kwd><kwd>хирургия шлеммова канала</kwd><kwd>экспандер шлеммова канала</kwd><kwd>спиральный экспандер шлеммова канала</kwd><kwd>хирургия глаукомы</kwd><kwd>открытоугольная глаукома</kwd><kwd>миниинвазивная хирургия глаукомы</kwd><kwd>комбинированная хирургия при катаракте и глаукоме</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Friedman D.S., Jampel H.D., Lubomski L.H., Kempen J.H., Quigley H., Congdon N., Levkovitch-Verbin H., Robinson K.A., Bass E.B. 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