Safety during surgical resection of the sclera in patients with primary and secondary glaucoma

A.Yu. Kazantseva, E.A. Korchuganova Pirogov Russian National Research Medical University, Moscow, Russian Federation <b>Aim: </b>to study the incidence and nature of intra- and postoperative complications, as well as the possibility of easing the hypotensive regimen in patients with primary open-angle glaucoma (POAG) and secondary post-thrombotic glaucoma (SPTG) after surgical resection of the sclera (SRS) and transscleral diode laser cyclophotocoagulation (TDLC). <b>Materials and Methods: </b>the group included 128 patients with POAG and 36 patients with stage III–IVb SPTG after SRS (67 and 17 eyes, respectively) and TDLC (61 and 19 eyes, respectively). All patients received topical maximally tolerated antihypertensive therapy before surgery (on average, 4 drugs individually and in the form of fixed combinations). <b>Results</b>: the absence of complications during and after SRS allows to consider this operation effective and safe. After performing TDLC in the postoperative period, complications were observed in 11 (14%) of 80 patients. Complications were mainly recorded in patients with stage IV glaucoma (60%) and concomitant diseases of the endocrine and cardiovascular systems. Among the complications after cyclodestructive intervention, uveitis was most common in patients with SPTG (21%). In patients with POAG, ciliochoroidal detachment was recorded 2 times more common than other complications. In the long-term follow-up period after SRS, a decrease in intraocular pressure (IOP) allowed to reduce the hypotensive regimen by 35.9% in patients with POAG and by 33.2% in patients with SPTG. Stabilization of ophthalmotonus after TDLC provided the amount reduction of active substances by 25.7% in patients with POAG and by 20.7% in patients with SPTG. <b>Conclusions:</b> the easing of the hypotensive regimen and a tolerant IOP decrease in the long-term follow-up period allowed to recommend SRS as an alternative to cyclodestructive benefits in patients with refractory course of POAG and SPTG, as well as other glaucoma types as a combined intervention to reduce IOP. <b>Keywords:</b> surgical resection of the sclera, transscleral diode laser cyclophotocoagulation, complications, uveoscleral outflow, hypotensive regimen, ophthalmotonus. <b>For citation:</b> Kazantseva A.Yu., Korchuganova E.A. Safety during surgical resection of the sclera in patients with primary and secondary glaucoma. Russian Journal of Clinical Ophthalmology. 2024;24(3):121–126 (in Russ.). DOI: 10.32364/2311-7729-2024-24-3-4.