Clinical case of surgical treatment of advanced refractory glaucoma

Rationale: Refractory glaucoma is characterized by a high value of intraocular pressure due to a violation of the normal outflow of intraocular fluid and the features of rapid scarring of the anterior chamber angle, the growth of newly formed vessels. The use of intensive maximum antihypertensive therapy in this case is temporary, therefore, it is most advisable to use the method of choice - implantation of an Express shunt, which is directly related to the pathogenesis of the development of this disease. Objective: to present one of the possible variants for the surgical treatment of advanced refractory glaucoma. Material and methods. Patient B., 63 years old, was admitted with a diagnosis of open-angle 3 s (drops, operated) refractory unstabilized glaucoma of the left eye; open-angle 1 a (drops) glaucoma of the right eye. According to photo registration of the anterior chamber angle before surgical treatment: anterior chamber angle is open, the degree of pigmentation is -3, pronounced, mixed, multiple goniosynechia of the left eye. According to the instrumental examination, the visual acuity of the right eye (OD) was 0.5 sph (+)1.0 = 1.0; left eye (OS) - 0.1, not corrected. Intraocular pressure measured by the Maklakov method was: OD = 20 mm Hg; OS = 43 mmHg. The following surgical treatment was performed: implantation of an Ex-press shunt on the left eye in a standard way. The implantation was performed at 10 hours due to early surgical treatment in the inner meridian. Results. On the 1st day after surgical treatment of OS: the position of the eyelids is correct; the movement of the eye is in full. The conjunctiva is hyperemic. The cornea is transparent, shiny, spherical. At 9-10 o’clock the filtering bleb is diffused; the seams are strong. Anterior chamber of medium depth. Express shunt is visualized at 9-10 o’clock. Eye humor is transparent, IOL is in the center. By direct ophthalmoscopy, the fundus of the eye is without dynamics. Postoperative period was without complications. At the control examination after 6 months, the functional data of the left eye remained stable. Perimetry data was without dynamics. GS-1.