Bleb less glaucoma surgery activates uveolymphatic route of non-trabecular aqueous humor outflow pathway

Bleb less glaucoma surgery activates uveolymphatic route of non-trabecular aqueous humor outflow pathway

Medical & Life Science Event 2022
March 28, 2022 Webinar

Vinod Kumar

RUDN University,Moscow, Russian Federation

Scientific Tracks Abstracts : Arch Gen Intern Med

Abstract:

The imbalance between aqueous humor (AH) production and outflow results in increased intraocular pressure (IOP) leading to glaucoma. Clinical Practice: The existing deep sclerectomy (DS) technique was modified with the aim of providing AH resistance-free access from the anterior chamber to a large surface area of uveal tissue for its resorption. Purpose: To assess safety and effectiveness of the proposed technique and to trace and verify possible AH outflow pathway. Methods: Forty-two patients were operated upon. After superficial scleral flap (4*4mm), deep scleral layers were divided into three parts by three parallel to limbus incisions. DS without creating a window in the Descemetes’ membrane was carried out in the distal part. A collagen implant was placed under the sclera of the remaining two parts with one end in the intrascleral pool. The third proximal part was excised. A Nd:YAG laser trabeculotomy at the surgery site was made on postoperative days 7–10. Outcome measures were IOP change, use of hypotensive medication(s) and complications. Results: At six (n=42) and twelve months (n=17), the mean baseline IOP decreased from 28.8±8.4 mmHg to 14.4+4.2 and 15.4+5.4 mmHg; hypotensive medication use reduced from 2.9+0.9 to 0.6+1.1 and 0.5+0.9; the cumulative probabilities of success were 92.9% and 76.5% respectively. Intraoperative and postoperative complications were few and manageable. The OCT of the surgery site revealed the absence of bleb in all cases. Lymphatic vessels with characteristic bicuspid valves in their lumen were detected in conjunctiva near to operation site and over it in 33 patients. Conclusion & Significance: Bleb less glaucoma surgery was safe and effective at decreasing IOP, and hypotensive medication use in glaucoma patients. IOP decrease was achieved by activation of the uveolymphatic route of the non-trabecular outflow pathway without formation of a filtering bleb. Recent Publications Kumar V., Shradqa A.S.S., Abu Zaalan K.A. Variant of Micro-Invasive Glaucoma Surgery: Calibrated Reverse Meridional Cyclodialysis ab interno Involving Implantation of a Non-Absorbable Collagen Implant. Ophthalmology in Russia. 2021;18(1):61-69. https://doi. org/10.18008/1816-5095-2021-1-61-69 Kumar V., Abu Zaalan K.A., Frolov M.A. et al. Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports. Russian Journal of Clinical Ophthalmology. 2021;21(2):108–115. http://doi. org/10.32364/2311-7729-2021- 21-2-108-115 Kumar V., Frolov M.A., Dushina G.N., Shradqa A.S., Bezzabotnov A.I.. Reverse meridional cyclodialysis ab interno with implantation of a metallic implant in patients with glaucoma of different etiology. Vestnik Oftalmologii. 2019; 135(3)10-19. http://doi. org/10.17116/oftalma201913503110 Kumar V., Frolov MA, Dushina GN, Shradqa AS, Bezzabotnov AI, Abu Zaalan KA. Reverse meridional cyclodialysis ab interno in management of open angle glaucoma — a preliminary report. BULLETIN OF RSMU, 2019; 6:92-98. http://doi.org/10.24075/ brsmu.2019.081 Shradqa AS, Kumar V, Frolov MA, Dushina GN, Bezzabotnov AI, Abu Zaalan KA. Cyclodialysis ab externo with implantation of a collagen implant in surgical management of glaucoma. BULLETIN OF RSMU, 2019; 5:92-98. http://doi.org/ 10.24075/ brsmu.2019.068

Biography:

Kumar Vinod is a professor at the Department of Eye Diseases Medical Institute of RUDN University, Moscow, Russian Federation. His main interests are surgical treatment of glaucoma and complicated cataract cases. He had published more than 60 scientific articles in peer-reviewed journals. He has to his credit 8 patents of Russian Federation and had coauthored 10 educational monographs. He is a member of the dissertation committee of Federal Medical-Biological Agency, a member of the editor council of scientific journal “Medicine in Kuzbass”, an international member of AAO and ESCRS.

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