Comparative analysis of the structure of surgically formed drainage pathways in patients with primary open angle glaucoma and pseudophakia after trabeculectomy using various types of drains

Purpose of the study: To carry out a comparative analysis of the structure of surgically formed outflow pathways in patients with primary open angle glaucoma (POAG) and pseudophakia after sinustrabeculectomy (STE) using various drains. Materials and methods. A randomized prospective study included 136 patients (140 eyes) with aphakia and advanced and far-advanced POAG who underwent STE with basal iridectomy (STE + BI) with or without implantation of different types of drains, differing in material and properties. Group 1 consisted of 35 eyes of STE + BI with implanted resorbable drainage from a composition of polylactic acid (polylactide) and polyethylene glycol Glautex (HighBi Tech LLC) (Glautex), Group 2 consisted of 35 eyes of STE + BI with implantation of hydrophilic slowly resorbable collagen drainage MP (Mak-Medi LLC Rectangular micro drainage) (MP), group 3 — 35 eyes of STE+BI with implantation of collagen non-absorbable drainage Xenoplast (Transcontact LLC). The control group included 35 eyes that underwent STE + BI without drainage implantation. The surgical drainage pathways using ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) of the eye anterior segment, as well as the number of complications were evaluated. Results. After 2 years, according to UBM and OCT data, the filtration bleb (FB) flattened to 0.40 ± 0.14 mm (group 1), to 0.42 ± 0.12 mm (group 2) and to 0.38 ± 0.21 mm (group 3), while in the control group, the height of the FB increased to 0.58 ± 0.19 mm due to the appearance of cystic changes. The thickness of the scleral flap (SF) increased to 0.44 ± 0.19 mm and 0.46 ± 0.17 mm when using Glautex and MP, whereas in the control group and using Xenoplast it decreased with loss of drainage function due to sclero-scleral adhesions (0.34 ± 0.05 mm and 0.29 ± 0.045 mm, respectively). The height of the intrascleral space (ISS) decreased with the use of Glautex, Xenoplast and in the control group (up to 0.26 ± 0.04 mm, 0.25 ± 0.15 mm, 0.35 ± 0.08 mm). The maximum height of the ISS was noted in the group using MP drainage (0.68 ± 0.28 mm). After 24 months, the IOP in group 1 approached the target value and amounted to 18.29 ± 3.67 mm Hg; group 2 — 18.6 ± 2.15 mm Hg; group 3 — 20.60 ± 3.95 mm Hg; control — 24.7 ± 5.0 mm Hg. It was revealed that the height of FB and ISS does not always correlate with IOP, and by the end of the follow-up, the prognostic significance of qualitative UBM parameters exceeds quantitative ones in several cases. Conclusions. According to UBM and OCT data, resorbable and partially resorbable drains — Glautex and MP — provide more stable maintenance of the volume of ISS and FB in the remote period, contributing to the long-term preservation of the functional patency of the filtration pathway, compared to non-resorbable Xenoplast and traditional STE + BI without the use of a drain. The use of these drains provides a longer and more stable maintenance of IOP in patients with pseudophakia.

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