Drainage surgery for refractory glaucoma combined with micropulse cyclophotocoagulation

The purpose of the study is to evaluate the possibility of using Micropulse technology in combined treatment of refractory glaucoma, including implantation of an Ex-PRESS micro shunt and one-stage micropulse sectoral cyclophotocoagulation (mCPC). Material and Methods. The study included 25 patients with advanced stages of previously operated primary open-angle glaucoma. IOP before surgery averaged 35.3±4.4 mmHg. Surgical treatment was carried out using combined method, including implantation of an Ex-PRESS micro shunt and one-stage sectoral mCPC. Results. In 2 cases in the early postoperative period, according to the B-scan, a detachment of the choroid was diagnosed, which was treated with medication. The IOP level on the first day after surgery averaged 8.3±1.4 mmHg, after 12 months of observation 19.9±4.1 mmHg, while hypotensive drops were re-appointed in 2 cases. Before surgery all patients underwent ultrasound biomicroscopy with measurement of the ciliary body (CB) thickness, which was an average of 0.69±0.04 mm before surgery. After 12 months of follow-up, no cases of postoperative atrophy of CB were diagnosed, the CB thickness was 0.67±0.03 mm on average. Conclusion. Combined treatment of refractory glaucoma, including implantation of the Ex-PRESS micro shunt and one-stage mCPC, is an effective and safe method for IOP reduction.