Benefits of a combined surgical technique for patients with secondary neovascular glaucoma.

OBJECTIVE: Aim: To assess the effectiveness and safety of the proposed surgical technique for treating secondary neovascular glaucoma. PATIENTS AND METHODS: Materials and Methods: We examined 28 eyes of 28 patients (16 women and 12 men), aged 46}7,2 years, with secondary neovascular glaucoma. All patients underwent a comprehensive ophthalmological examination before and during treatment. Two-stage treatment was applied to all patients. At the first stage - performed an advanced technique of non-penetrating deep sclerectomy while administering anti-VEGF (anti-vascular endothelial growth factor) intravitreal or intracameral injections. At the second - we performed externalization of Schlemm's canal followed by YAG laser trabeculectomy. Statistical analysis of the results was used the SPSS v. 11.0, MedStat v.15.1 software package for medical and biological research. RESULTS: Results: The proposed surgical technique, leads to a gradual decrease in intraocular pressure (IOP) and regression of the iris and anterior chamber angle neovascularization. The postoperative course was uneventful for all the patients. In the early postoperative period, the IOP was observed to be normalized in all the eyes. The IOP ranged from 12 to 16 mm Hg. The neovascularization regression occurred (in 100 % of cases) within 5-7 days. CONCLUSION: Conclusions: Gradual reduction of IOP reduces intraoperative complications. Intravitreal or intracameral injections of anti-proliferative agents contribute to the regression of neovascularization and further gradual reduction of IOP. Performing a laser trabeculectomy in the area where a non-penetrating deep sclerectomy was previously performed creates new pathways for the outflow of intraocular fluid from the anterior chamber and reduces the risks of reintervention.

Corneal biomechanical property measurement with an IOP loading method in keratoconic patients.

PURPOSE: To study the biomechanical properties of the corneas of both eyes in patients with evident keratoconus manifestation in one eye. METHODS: Our study consisted of nine patients with keratoconus and 25 volunteers in the control group. Both eyes of all participants were measured twice with a Pentacam Scheimpflug system: first with the standard Scheimpflug system and subsequently with the original version of the same technique in combination with a new device that can generate experimental artificial intraocular pressure (IOP) elevation. Diagnoses of keratoconus or non-keratoconus were made using the Pentacam Scheimpflug system software (StatSoft, Inc., Tulsa, OK). RESULTS: The artificially elevated IOP caused bulging of the anterior corneal surface in both eyes of keratoconic patients and a small flattening of the cornea in the eyes of the control group. Corneal ectasia, expressed in terms of diopters, during IOP loading in both keratoconic and nominally unaffected eyes was 4.12 D and 1.37 D, respectively. The changes were statistically significant (p < 0.05). Our dynamic study revealed a distinct weakness of the corneal tissue and an inability of keratoconic and contralateral eyes to resist IOP elevation. CONCLUSION: The IOP loading method permits evaluation of the biomechanical properties of the cornea across its entire surface. All nine contralateral unaffected eyes in patients with a diagnosis of unilateral keratoconus presented weak biomechanical properties and in fact should be considered as forme fruste keratoconus.