Possible causes of the ineffectiveness of sinustrabeculectomy in children with congenital glaucoma

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Abstract

AIM: On the basis of studying the causes of errors in finding the trabecular zone to be excised during trabeculectomy in children with congenital glaucoma, this study presents a proven and effective method for simple intraoperative localization of the trabecular area.

MATERIAL AND METHODS: The analyses of many years of experience in the examination and treatment of children with congenital glaucoma at the Department of Eye Pathology in Children of Helmholtz National Medical Research Center (100–200 children annually) revealed the anatomical and morphological features of the eyes of children with congenital glaucoma and the reasons for the insufficient effectiveness of trabeculectomy.

RESULTS: A retrospective gonioscopic analysis of the condition of the operation area and internal fistula after trabeculectomy in children with congenital glaucoma showed that erroneous choice of the area of the trabecular region to be excised during surgery is one of the reasons for the inefficiency of trabeculectomy, and it results from the incorrect determination of the projection location of the apex of anterior chamber angle (ACA) onto the sclera caused by the significantly distorted anatomical parameters of the child’s eye due to the softness and extensibility of the limbus and sclera. On the stretched eyes of children with congenital glaucoma, especially those with buphthalmos and cloudy cornea, accurate determination of the boundaries of the altered cornea, limbus, and projection of the ACA’s apex onto the sclera is visually impossible.

CONCLUSION: During trabeculectomy of the eyes of children with congenital glaucoma, for the accurate localized projection of the apex of the ACA’s onto the sclera and the trabecular zone to be excised, a simple and accessible method of clarifying diaphanoscopy intraoperatively must be used to correctly select the trabeculectomy zone, especially on stretched eyes.

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About the authors

Nataliya N. Arestova

Helmholtz National Medical Research Center of Eye Diseases; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: arestovann@gmail.com
ORCID iD: 0000-0002-8938-2943
SPIN-code: 4875-6288

MD, Dr. Sci. (Med.)

Russian Federation, 14/19, Sadovaya Chernogryazskaya Street, Moscow, 105062; Moscow

Anna Yu. Panova

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: annie_panova18@mail.ru
ORCID iD: 0000-0003-2103-1570
SPIN-code: 9930-4813

MD, PhD

Russian Federation, 14/19, Sadovaya Chernogryazskaya Street, Moscow, 105062

Alla V. Pleskova

Helmholtz National Medical Research Center of Eye Diseases

Email: dho@igb.ru
ORCID iD: 0000-0002-4458-4605
SPIN-code: 2237-5776

MD, Dr. Sci. (Med.)

Russian Federation, 14/19, Sadovaya Chernogryazskaya Street, Moscow, 105062

Aleksandr A. Sorokin

Helmholtz National Medical Research Center of Eye Diseases

Email: a.a.sorokin@inbox.ru
ORCID iD: 0000-0002-8213-8518

MD, PhD student

Russian Federation, 14/19, Sadovaya Chernogryazskaya Street, Moscow, 105062

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Supplementary files

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2. Fig. 1. Clarification of the projection of the ACA apex on sclera by diaphanoscopy.

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3. Fig. 2. Transilluminator KaWe.

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4. Fig. 3. Stage of the trabeculectomy of the eye of a 3-month-old child with congenital uncompensated advanced glaucoma after diaphanoscopy; it clarified the position of the ACA apex, according to which the trabecular fragment was excised 3 mm from the transparent border of the stretched limbus.

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