The dissertation is devoted to increasing the efficiency of diagnosis and surgical treatment of primary open - angle glaucoma by developing a new clinical and morphological method of diagnosis with predicting the development of glaucoma optic neuropathy and pathogenetically sound method of surgical treatment.
Despite the availability of modern diagnostic methods, a wide choice of conservative and surgical treatment, the number of patients with primary open-angle glaucoma continues to grow.
Objectives of the study.
1. To study the diagnostic value of modern methods of optic disc morphometry according to optical coherence tomography.
2. To develop a method for predicting the development of glaucoma by mathematical modeling of the deformation of the lamina cribrosa of optic disk with damage to nerve fibers and the calculation of a quantitative criterion for determining the risk of glaucoma optic neuropathy.
3. To evaluate the diagnostic significance of the proposed quantitative criterion for determining the risk of glaucomatous optic neuropathy.
4. To analyze the thickness of the choroid in patients with primary open-angle glaucoma.
5. Develop a pathogenetically sound method of surgical treatment of primary open-angle glaucoma, which improves the functioning of both anterior and uveoscleral outflow tracts, and conduct a comparative analysis of its effectiveness and sinusotrabeculotomy in the early and distant postoperative period by determining functional and structural changes operative.
For the first time, the mechanical theory of glaucomatous optic neuropathy, which consists in pinching the axons of ganglion cells at the level of the lamina cribrosa of the optic disk due to longitudinal and transverse displacements of its elements under the action of intraocular pressure, which leads to nerve fiber damage, is mathematically substantiated.
The scientific data on the relationship between the thinning of the lamina cribrosa of the optic disk with the increase in the stage of the primary open - angle glaucoma according to the results of swept-source-optical coherence tomography (r = -0,966, p˂0,05) have been supplemented.
A mathematical model of the lamina cribrosa of the optic disk with mathematical substantiation of nerve fiber damage due to longitudinal and transverse displacements of its elements under the action of intraocular pressure was developed, which allowed to propose and implement a new method of predicting the development (or progression) of glaucomatous optic neuropathy based on according to swept-source-optical coherence tomography, as well as mean intraocular pressure, followed by the use of a spreadsheet to determine the level of risk of nerve fiber damage. There is a direct noticeable relationship between the thickness of the lamina cribrosa of the optic nerve and the average thickness of the peripapillary nerve fibers (r = 0,504, p˂0,05) and between the indicators of static perimetry (MD) and the degree of risk of glaucomatous optic neuropathy (r = 0,578, p˂0,05). Analysis of long-term results of this method showed the progression of glaucomatous optic neuropathy in 20% and 50% of patients with a certain medium and high risk, respectively.
A method of surgical treatment of primary open-angle glaucoma sinusotrabeculotomy with supraciliary drainage is proposed and put into practice by performing the formed outer flap of the sclera under the preserved strip of its deep layers with a previously performed sinusotrabeculotomy.
A method of surgical treatment of primary open-angle glaucoma sinusotrabeculotomy with supraciliary drainage is proposed and put into practice by performing the formed outer flap of the sclera under the preserved strip of its deep layers with a previously performed sinusotrabeculotomy.
Extended scientific data on the higher efficiency of sinusotrabeculotomy with drainage of the supraciliary space in comparison with sinusotrabeculotomy, which is a more stable normalization of intraocular pressure by improving the hydrodynamics of the eye and stabilizing the progression of glaucomatous optic neuropathy due to improved blood flow, as evidenced by an increase in the thickness of the choroid in the peripapillary and macular area according to swept-source-optical coherence tomography.
Due to the improvement of uveoscleral outflow of intraocular fluid in the main group in the long term there was an increase in the coefficient of ease of outflow by 170% and a decrease in the Becker coefficient by 78% compared with the tonography before surgery.
