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With the advent of nonpenetrating glaucoma surgeries (NPGS), these techniques are noticed more considerably by glaucoma surgeons due to lower complications in comparison to penetrating surgeries with comparable outcomes. One of the main objectives in these surgeries is the creation of an intrascleral filtering space as an alternative for subconjunctival filtering bleb. Intrascleral fibrosis in the long term reduces the volume of intrascleral bleb, so the use of implants as a space holder for preventing the collapse of scleral flaps and continued aqueous humor drainage is recommended. A lot of materials with diverse designs have been used as implants in NPGS. In this study, the remaining of Ahmed valve's tube was used as an implant in four eyes of four patients. The technique for the implant we introduced, offers significant advantages over previously reported implants. The material is biocompatible, low cost, and easily accessible in all the centers performing glaucoma surgeries.

Aim or purpose: To present a modified technique of trabeculectomy. Design: Ahmad’s modified trabeculectomy technique aims to utilize subtle modifications to the classical trabeculectomy technique in order to achieve a better filtering bleb leading to lesser complications. Methods: Retrospective interventional case series. Results: Thirty-four patients underwent this surgery. There was a significant difference in the preoperative and postoperative median intraocular pressure (IOP; z = 3.928; p < 0.001). The postoperative IOP (median = 12) was significantly lower than the preoperative IOP (median = 28; interquartile range = 9). Conclusion: This modification can prove to be an effective method to reduce IOP with minimal complications.

Purpose We herein describe possible intraluminal obstruction because of a hyperreflective material found in anterior segment optical coherence tomography (AS-OCT) in 16 of 46 cases with XEN45 gel stent. Materials and methods This is a retrospective case series of 46 eyes of 39 patients with noncomplicated XEN45 gel stent surgery, analyzed with AS-OCT and slit-lamp photography after at least 6 postoperative months. Results Possible luminal obstruction in the subconjunctival segment of the implant was observed in 16 eyes of 15 patients, characterized by hyperreflective material on AS-OCT, which was not visible in slit-lamp photography. This was found in 15 eyes following combined procedures and in 1 eye following XEN45 alone. None showed signs of filtering bleb on AS-OCT or slit-lamp photography. In 1 case, the discontinuity between the hyperreflective material and subconjunctival opening of the implant tube was evidenced, and in another case, a focal deposit in the intracameral end of the implant was seen. Conclusions We have successfully described the lumen implant deposit of material as a possible cause of late failure of the implant. AS-OCT allows the identification of such cases and may be useful to plan further postoperative interventions for better patient outcomes.

The mechanisms of intraocular pressure (IOP) lowering in deep sclerectomy (DS) are multiple. Using collagen implants is one of the proposed mechanisms of DS success. It has been established to work via maintenance of subscleral decompression lake. However, the relation to conjunctival bleb formation is not fully established. This study is a retrospective review of the records of 40 eyes of 30 patients with chronic open-angle glaucoma. Patients were divided into two groups; 20 eyes with DS using the Ologen implant (group A), and 20 eyes with DS without implant (group B). The records of UBM that was done for all patients 1 and 6 months after surgery were assessed for the extent, height of conjunctival bleb, depth of AC, the presence of intrascleral bleb and presence of collagen implant. Extent and height of conjunctival bleb by UBM in group A at 1 and 6 months were 3.46 ± 0.77 mm, 1.6 ± 0.38 and 3.71 ± 1.24 mm, 1.6 ± 0.64, respectively. In group B, they were 2.4 ± 1.12 mm, 0.99 ± 0.69 and 2.69 ± 1.77 mm, 0.81 ± 0.67 mm, respectively; the difference was statistically significant. Correlation using Pearson’s correlation coefficient test showed significant negative correlation between extension of the bleb at 6 months and 3rd month postoperative IOP (r = − 0.447, P value 0.048) and significant negative correlation of the height at 6 months to 5th month IOP (r = − 0.491, P 0.028). Using collagen implant in DS significantly increases conjunctival bleb dimensions, which reflects on lower postoperative IOP.

Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF6) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF6 gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF6 volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF6 gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery.

To investigate the predictors of long-term intraocular pressure (IOP) in chronic primary angle-closure glaucoma (CPACG) treated with primary trabeculectomy. This study systematically reviewed cases of CPACG treated with primary trabeculectomy. The scleral flaps in all cases were sutured with two stitches in situ and two releasable sutures to ensure watertight under normal IOP conditions during surgery. Mitomycin C was used in all eyes. All patients were followed for 2 years. Digital massage of the bulbus and removal of the releasable suture were performed according to the IOP and shape of the filtering bleb. Demographic data and clinical outcomes were recorded. Factors predicting long-term IOP were identified. A total of 72 patients (88 eyes) with a mean age of 58.51 ± 10.60 years were included in this study. The complete success rate was 89.77% after 2 years. The IOP began to stabilize after 7 days and reached its lowest point at the 1-month follow-up. The preoperative and early postoperative high or low IOP does not affect long-term effects (P > 0.05). There was a positive correlation between postoperative IOP at the 1-month and 2-year follow-ups (r = 0.64, P

Purpose To report a case of partial scleral rupture after laser in situ keratomileusis (LASIK) surgery. Methods This is a retrospective case report describing a late complication of LASIK surgery. Results A 32-year-old white woman with a history of LASIK surgery performed with a mechanical microkeratome 4 years previously presented for evaluation of partial bilateral scleral ruptures. An arcuate filtering bleb along the contour of the cornea was found on the right eye with associated hypotony and corneal astigmatism. There were no signs or symptoms of prior inflammation, and rheumatologic workup was negative. Imaging revealed scleral microbreaks in the absence of adjacent thinning. Conclusions The pattern and location of thinning without findings consistent with inflammatory disease suggest that the partial bilateral scleral rupture was because of mechanical damage at the time of LASIK, possibly compounded by the hormonal changes of pregnancy.

V. Kumar1,2, K.A.Abu Zaalan1, M.A. Frolov1, A.S. Shradqa2, G.N. Dushina1,2, A.I. Bezzabotnov2, Z.Sh. Rustamova1 1RUDN University, Moscow, Russian Federation 2LLC Center of Eye Microsurgery “PRO zrenie”, Moscow, Russian Federation The authors propose a modified technique of non-penetrating filtering glaucoma surgery for primary open-angle glaucoma (POAG) to improve the uveoscleral outflow. The study enrolled 11 patients with POAG. A novel surgical technique included two steps. The first step was modified deep sclerectomy and cyclodyalysis with collagen implant placed into the supraciliary space. The second step (after 7–10 days) was YAG laser trabeculotomy. Surgical site and adjacent areas were examined by optical coherence tomography (OCT). After 6 months, mean IOP significantly reduced by 52% (from 30.0±10.3 mm Hg to 14.6±5.0 mm Hg, р=0.0004) while the number of IOP-lowering medications reduced by 79% (from 2.9±1.0 to 0.6±0.4, р=0.000001). The aqueous humor outflow occurred through conjunctival lymphatic vessels without filtering bleb formation, as illustrated by OCT. Postoperative complications were minor and easy-to-treat. Three case reports are discussed. Keywords: open-angle glaucoma, glaucoma surgery, conjunctival lymphatics, filtering bleb, non-penetrating glaucoma surgery, uveolymphatic outflow pathway. For citation: Kumar V., Abu Zaalan K.A., Frolov M.A. et al. Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports. Russian Journal of Clinical Ophthalmology. 2021;21(2):–115. DOI: 10.32364/2311-7729-2021-21-2-108-115.

Surgical management for medically uncontrolled glaucoma focuses on creating alternative conduits for aqueous outflow. Ex-Press shunt insertion is a filtration surgery where a tract is created from the anterior chamber to the subconjunctival space using a standard lumen-maintaining device. This procedure allows for aqueous drainage without the need for an iridectomy. This aqueous fluid flows through the shunt and creates a filtering bleb. Antimetabolite medications such as mitomycin C or 5-fluorouracil may be utilized to prevent excessive fibrosis over this filtration bleb, which allows for more efficacious lowering of the IOP. If repositioning is needed, it is important to turn the device 90° first to avoid tearing of ocular structures by the device’s spur. Though flow control depends predominantly on the method of scleral flap creation, the Ex-Press shunt allows for lumenal control and aqueous drainage directly from the anterior chamber.

The XEN gel stent is a minimally invasive glaucoma procedure that creates a filtering bleb without the need for tissue dissection. It is thought to have fewer risks of hypotony when compared to traditional glaucoma filtering procedures, all the while achieving moderately low postoperative target pressures.

Correct assessment of anterior chamber angle is important as it will determine the management plan and prognosis for the angle closure glaucoma. The advent of anterior segment optical coherence tomography (ASOCT) considerably improved the visualization of angle structures and facilitated more detailed assessments of the angle. The anterior segment images obtained using ASOCT can help in diagnosis, screening, and making decisions regarding performing laser treatments, choosing the appropriate surgical approach, and predicting success after procedures. In this chapter we discuss the information provided by the ASOCT, and various applications of ASOCT for glaucoma disease, such as angle assessment, pathophysiology of angle closure, or evaluation of the filtering bleb and tube.

Background: To evaluate the relationship between bleb vascularity and surgical outcome one year after mitomycin C (MMC) augmented trabeculectomy. Methods: This was a prospective study of 51 eyes of 44 patients after MMC-augmented primary trabeculectomy with follow-up of 12 months. The total vessel area of a bleb was measured with ImageJ software on color photographs of the bleb on day 1 and 14, then months 1, 3, 6 and 12 after trabeculectomy. Blebs were classified clinically as successful (intraocular pressure (IOP) &le, 18 mmHg and a &gt, 30% reduction in IOP without antiglaucoma medications or additional surgical interventions) or failed. Linear regression analysis was performed to determine the correlation of bleb vascularity with IOP and outcome. Results: At 1 year, 40 eyes (78.4%) were classified as successful and 11 eyes (21.6%) as failed. The mean bleb vascularity at 1, 3 and 12 months after surgery was significantly higher in failed blebs (16.31% vs. 13.01%, p = 0.005, 14.93% vs. 10.15%, p = 0.001, 8.99% vs. 6.37%, p = 0.011, respectively). There were no significant differences in mean bleb vascularity at 1 and 14 days postoperatively in successful and failed blebs. The results revealed a significant association between vessel area at 1 and 3 months after trabeculectomy with IOP at 6 months postoperatively (p = 0.005 and p = 0.009, respectively). Conclusions: In this prospective study, we demonstrated a strong relationship between bleb vascularity and the surgical outcomes of trabeculectomy. Vascularity of the filtering bleb during early postoperative period was not correlated with IOP or success of trabeculectomy at one year. Increased bleb vascularity 1, 3 and 12 months after trabeculectomy appears to predict surgical failure at 1 year after trabeculectomy.

Currently, there is a need to assess the condition of structures at the surgery site after glaucoma intervention due to the necessity to decide further treatment tactics after performed operations, as well as the possibility of developing more advanced methods of surgical treatment of glaucoma. Despite the fact that there are several methods of examining the filtration bleb (FB), some of them have both clear advantages and significant disadvantages. This article reviews the possibilities of using optical coherence tomography (OCT), ultrasound biomicroscopy (UBM), thermography, confocal microscopy, and the Hyperemia-3 program for assessing the structural and functional state of the FB.В настоящее время существует потребность в оценке структур в зоне хирургического вмешательства после антиглаукомной операции. Это связано с необходимостью решения дальнейшей тактики лечения после выполненных операций, а также с возможностью разработки более совершенных способов хирургического лечения глаукомы. Несмотря на то что существует несколько методов исследования фильтрационной подушки (ФП), некоторые из них имеют как явные преимущества, так и существенные недостатки. В данном обзоре описаны возможности применения оптической когерентной томографии (ОКТ), ультразвуковой биомикроскопии (УБМ), термографии, конфокальной микроскопии, а также программы «Гиперемия-3» для оценки структурного и функционального состояния ФП.

Polarization-sensitive anterior-segmental optical coherence tomography (PS-OCT) is useful to evaluate the filtering blebs after trabeculectomy. However, the attenuation phenomenon of OCT signal disturbs the visibility of intra-bleb's structure and distribution of birefringence; a specific parameter of PS-OCT. This study aimed to evaluate the effectiveness of the attenuation-coefficient image of the filtering blebs.This study included 25 eyes 6 months after TLE. The attenuation-coefficient image of blebs was calculated from OCT intensity signal information. The contrast level of the image (reflectivity of bleb's surface wall/reflectivity of scleral flap) in both attenuation-coefficient image and intensity image and the height of the bleb's wall were calculated. The improvement extent of contrast was defined as the ratio of contrast (attenuation-coefficient image's contrast/intensity image's contrast). We compared the contrast of attenuation-coefficient image and intensity image and investigated the relationship between improvement extent of contrast and height of bleb's wall.The contrast of the attenuation-coefficient image (317.7 ± 255.4%) was significantly higher than that of the intensity image (39.1 ± 24.5%) (The contrast of the image at depth of filtering blebs was improved by attenuation-coefficient image. It is suggested that the attenuation-coefficient image may improve the visibility of the structure and distribution of birefringence in the blebs compared to the intensity image.

BACKGROUND: Deep learning has had a large effect on medical fields, including ophthalmology. The goal of this study was to quantitatively analyze the functional filtering bleb size with Mask R-CNN. METHODS: This observational study employed eighty-three images of post-trabeculectomy functional filtering blebs. The images were divided into training and test groups and scored according to the Indiana Bleb Appearance Grading Scale (IBAGS) system. Then, 70 images from the training group were used to train an automatic detection system based on Mask R-CNN and perform a quantitative analysis of the function bleb size. Thirteen images from the test group were used to evaluate the model. During the training process, left and right image-flipping algorithms were used for data augmentation. Finally, the correlation between the functional filtering bleb area and the intraocular pressure (IOP) was analyzed. RESULTS: The 83 functional filtering blebs have similar morphological features. According to IBAGS, the functional filtering blebs have a high incidence of E1/E2, H1/H2, and V0/V1. Our Mask R-CNN-based model using the selected parameters achieves good results on the training group after a 200-epoch training process. All the Intersection over Union (IoU) scores exceeded 93% on the test group. The Spearman correlation coefficient between the area of functional filtering blebs and the IOP value was −0.757 (P

A 49-year-old man presented to the emergency eye clinic with a 3-week history of redness, irritation and blurred vision in his right eye, with a noticeable lesion superotemporally on the conjunctiva. He had a previous ocular history of penetrating glass injury in the right eye at the age of 9 years (40 years ago), of which no surgical intervention was performed at that time, as his parents did not seek medical attention. Slit lamp examination revealed a thin, conjunctival cystic bleb at 10 o’clock position with surrounding conjunctival injection and chemosis at close proximity to the site of previous ocular trauma. Investigations confirmed a diagnosis of trauma-induced filtering bleb with blebitis (bleb inflammation). The patient was treated with a combination of steroid and antibiotic drops for duration of 2 weeks. Subsequent follow-up revealed marked improvement of symptoms with reduced inflammation. Patient is being monitored regularly to prevent recurrence of blebitis and bleb associated complications.

ЦЕЛЬ. Провести исследования фильтрационной подушки (ФП) с помощью метода термографии у пациентов с открытоугольной глаукомой в разные сроки после хирургического лечения. МАТЕРИАЛЫ И МЕТОДЫ. Обследовали 35 пациентов (35 глаз) с открытоугольной глаукомой через 1, 7 дней, 1, 3, 6 месяцев после микроинвазивной синустрабекулэктомии. Использовали тепловизор Тesto 875-2i с предустановленной технологией SuperResolution, телеобъективом 9×7°. Определяли площадь и температуру ФП с помощью программ IRSoft и Universal Desktop Ruler. Роговично-компенсированное давление (IOРсс) определяли с помощью двунаправленной пневмоаппланации роговицы с помощью прибора Ocular Response Analyzer®, ORA. Сформировано 2 группы пациентов: группа 1 — 15 пациентов (15 глаз) с развитой стадией первичной открытоугольной глаукомы (ПОУГ); группа 2 — 20 пациентов (20 глаз) с далеко зашедшей стадией глаукомы. Всем пациентам проведено хирургическое лечение — микроинвазивная синустрабекулэктомия. Наблюдение и повторные обследования проводили в 1 и 7 день после операции, затем через 1, 3 и 6 месяцев. РЕЗУЛЬТАТЫ. У всех пациентов уровень внутриглазного давления (ВГД) достоверно снизился во все сроки наблюдения по сравнению с исходным офтальмотонусом. У пациентов 1-й группы выявлена высокая статистически достоверная корреляция (коэффициент корреляции >0,7) между ВГДрк и разницей в температуре между фильтрационной подушкой и окружающей конъюнктивой во все сроки наблюдения после хирургического лечения (через 1, 3 и 6 месяца). Во 2-й группе пациентов выявлена статистически достоверная корреляция (коэффициент корреляции 0,3-0,7) между ВГДрк и разницей в температуре между фильтрационной подушкой и окружающей конъюнктивой (Δ Ток — Тфп) через 1 неделю, 1 и 3 месяца после антиглаукомной операции (АГО). Такой же коэффициент корреляции обнаружен между температурой фильтрационной подушки и Δ Ток — Тфп через 6 месяцев после АГО. ЗАКЛЮЧЕНИЕ. Термография — безопасный, неинвазивный метод, достоверно выявляет повышение температуры в зоне хирургии, что свидетельствует о повышении уровня ВГД и предсказывает начинающийся процесс рубцевания фильтрационной подушки. Метод определяет необходимость проведения нидлинга в разные сроки после хирургического лечения и позволяет контролировать его эффективность., PURPOSE: To assess the state of the filtration bleb in patients with open-angle glaucoma in different terms after glaucoma surgery by method of thermography. MATERIALS AND METHODS: 35 patients (35 eyes) with open-angle glaucoma were examined 1, 7 days, and 1-3-6 months after minimally invasive sinustrabeculectomy using the infrared camera Тesto 875-2i with SuperResolution technology and telephoto lens 9×7°. The bleb area and temperature were evaluated With IRSoft and Universal Desktop Ruler software. Intraocular pressure (corneal compensated) (IOPcc) was measured with Ocular Response Analyzer® (ORA). Investigation protocol included 2 groups. Group 1 — 15 patients (15 eyes) with moderate glaucoma. Group 2 — 20 patients (20 eyes) with advanced glaucoma. All patients went through glaucoma surgery, microinvasive sinustrabeculectomy. Management and recurrent examinations were carried on the first day and 7 days after glaucoma surgery; then 1, 3 and 6 months after surgery. RESULTS: The IOP level was significantly lowered in all patients in all terms of management in comparison with the baseline IOP level. High statistical correlation was determined in patients of 1 group between IOPcc and the index of temperature difference between the filtering bleb (Tfb) and surrounding conjunctiva temperatures (Tsc), in all management terms after surgery (in 1, 3, 6 months) with correlation coefficient of >0.7. In group 2 statistical correlation was determined between IOPcc and index of temperature difference between filtering bleb and surrounding conjunctiva temperatures (Δ Тsc – Тfb) at 1 week, 1 and 3 months after surgery. The same correlation coefficient was determined between filtering bleb temperature and Δ Тsc – Тfb at 6 months after surgery. CONCLUSION: Thermography is a safe and noninvasive method that credibly detects temperature elevation in surgery zone, indicates IOP level raise and can predict the beginning of filtering bleb scarring. This method shows the necessity of needling procedure in different terms after surgical treatment and allows to control its effectiveness. KEYWORDS: open-angle glaucoma, filtering bleb, scarring, thermography, corneal compensated intraocular pressure, Ocular Response Analyzer., Национальный журнал глаукома, Выпуск 4 2020

Objective: To investigate the clinical effect of microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique in the treatment of primary glaucoma. Methods: One hundred primary glaucoma patients (120 eyes) in Xinyu People’s Hospital of Jiangxi province were selected from July 2014 to June 2016. The patients were randomly divided into control group and study group. The control group was treated with compound trabeculectomy, while the study group was treated with microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique. In both groups of patients, intraocular pressure, functional filtering bleb formation, and complications before and after surgery were monitored for three days, one week, one month, three months, six months and one year, while anterior chamber depth was determined one week after operation. The extent of success of operation was compared between the two groups. Results: At three days, one week, one month, three months, six months and one year after surgery, intraocular pressure of study group was significantly lower than that of the control group (P

AIM: To study the role of ultrasound biomicroscopy (UBM) in the assessment of the bleb function after trabeculectomy with mitomycin C (MMC). METHODS: This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mm Hg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36mo after trabeculectomy (13.6±9.7mo). RESULTS: This study included 33 trabeculectomy filtering blebs of 25 patients (9 males and 16 females). The mean age of patients was 53.2±14.2y (range 25-71y). We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs (IOP ≤18 mm Hg without antiglaucoma medications), others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings (intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts) and cases with different grades of clinical functional success (P

Purpose To compare the surgical results of PRESERFLO MicroShunt (MicroShunt) insertion and trabeculectomy in rabbit eyes. Methods Trabeculectomy or MicroShunt insertion was performed on the eyes of Japanese white rabbits. Intraocular pressure (IOP) was measured on conscious rabbits using a rebound tonometer for up to 12 weeks after surgery. Filtering bleb appearance was evaluated. Scarring in the filtering bleb was assessed by immunohistochemical analyses. The change in mRNA expression in the conjunctiva was evaluated using RNA sequence analyses. Results The preoperative IOP of the operative eye did not differ significantly between trabeculectomy (11.6 ± 1.0 mmHg, n = 10) and MicroShunt insertion (12.6 ± 1.3 mmHg, n = 10). In both groups, the IOP of the operative eye was significantly lower than that of the contralateral eye at one day postoperatively, which continued until 12 weeks after surgery. The peak differences in IOP were -8.4 ± 3.0 (trabeculectomy) and -8.1 ± 2.1 mmHg (MicroShunt) at two weeks after surgery; no significant differences were observed in IOP reduction between the groups. Appearance and immunohistochemical analyses of the filtering bleb showed no significant difference between the groups. Moreover, RNA sequence analysis results showed no difference between the groups in mRNA expression fluctuations. Conclusions Postoperative IOP, bleb appearance, and immunohistochemical analysis results were similar in the trabeculectomy and MicroShunt groups, indicating that MicroShunt insertion is as effective as trabeculectomy in lowering IOP. Translational relevance Comparison of surgical procedures using animal models has made it possible to predict clinical efficacy and safety.

When vitrectomy is performed in eyes that have undergone glaucoma surgery, the site of sclerotomy often overlaps with the previous glaucoma operation site. It can lead to serious complications such as postoperative hypotony, leakage, and/or infection. Our technique involves modification of surgeon's position and two sclerotomy sites 45° away from the original position, with an infusion cannula inserted infranasally to avoid damage to the glaucoma drainage implant or filtering bleb. The modified approach was applied to seven eyes with various indications. Vitrectomy was successfully completed, and there were no sclerotomy site complications, leakage, or hypotony in any case. Good intraocular pressure control was maintained throughout the postoperative course in all cases.

Purpose: to analyze the effectiveness of Ex-Press drainage device implantation for refractory glaucoma of different origin for 3 years. Patients and methods : The study consisted of 82 patients (86 eyes) with refractory glaucoma aged 26–86 years (67.37±0.53). Pre-operative IOP level averaged 37.8±1.04 mm Hg. Ex-Press drainage device implantation was rated according to the following criteria: IOP, time course of visual functions, the need for additional drug therapy and reoperation, the presence of intraoperative and postoperative complications. Examination of the patients was carried out from 1 to 8 days after the surgery and within 1, 3, 6, 12, 24 and 36 months. Results: According to our research results relative hypotensive effect equaled 74.4% (64/86) within a year after the surgery; 67.4% (58/86) — within 2 years; 65.1% (56/86) — after 3 years of follow-up period. The maximum decrease in IOP by 61.6% was observed immediately after the surgery. There was no effect of surgical treatment within3 years in 34.9% (30/86). Complications were observed in 23.2% (20/86) of cases: choroidal detachment — 12.8% (11/86), hyphema — 3.5% (3/86), eruption and dislocation — 3.5% (3 / 86), delayed expulsive hemorrhage — 2.3% (2/86), cyst of filtering bleb — 1.2% (1/86). Conclusion . Fistulizing operations with implantation of Ex-Press drainage device for refractory glaucoma provide normalization of IOP in 65.1% of cases (including 15.1% on the background of additional drug therapy) at follow-up period up to 3 years.

Objective To evaluate time-dependent changes in filtering bleb parameters using 3-dimensional anterior segment optical coherence tomography (3-D AS-OCT) in high-risk eyes after a limbal-based trabeculectomy procedure. Design Prospective, observational study. Participants Twenty-three patients who underwent uncombined limbal-based trabeculectomy surgery and who also had a history of prior intraocular surgery. Methods Of 23 eyes, 15 eyes were followed for 1 year without additional glaucoma surgeries, and their bleb parameters were measured 0.5, 3, 6, and 12 months after the trabeculectomy using 3-dimensional anterior segment optical coherence tomography. The correlations of these parameters to other clinical data were investigated. Results Statistical analysis showed significant changes in the bleb wall thickness (0.7 ± 0.4 mm vs 0.4 ± 0.2 mm; p = 0.007) and fluid cavity height (0.3 ± 0.2 mm vs 0.7 ± 0.4 mm; p = 0.005) between 0.5 and 3 months only. The width of the filtration openings at 0.5 months after trabeculectomy (2.1 ± 1.0 mm) was significantly associated with the intraocular pressure at 12 months (15.1 ± 5.7 mm Hg; R 2 = 0.37, t = −2.65, and p = 0.021). Conclusions The width of the filtration opening in the early stage may be a prognostic factor for long-term intraocular pressure control.

PURPOSE To evaluate the effectiveness and safety of aponeurotic blepharoptosis surgery and the morphology of filtering bleb in patients with filtrating bleb. METHODS This retrospective case series included 7 consecutive patients (9 eyes) with filtering bleb after trabeculectomy. They underwent transcutaneous levator aponeurotic advancement from May 2018 to April 2019. The authors evaluated margin reflex distance-1 and intraocular pressure and analyzed filtering bleb morphology, such as filtering bleb volume, filtering bleb height, and filtering bleb wall thickness, using anterior segment optical coherence tomography before and after aponeurotic advancement. The authors also evaluated intra and postoperative complications. RESULTS The mean age was 75.6 ± 7.8 years; the mean duration from glaucoma surgery to blepharoptosis surgery was 36.9 ± 26.8 months; the mean follow-up after blepharoptosis surgery was 6.1 ± 2.9 months. The mean margin reflex distance-1 value changed significantly from 0.7 ± 0.8 mm before surgery to 3.3 ± 0.4 mm after surgery (p < 0.0001). The mean intraocular pressure showed no significant change from 12.9 ± 2.6 mm Hg before surgery to 12.7 ± 3.3 after surgery. In the filtering bleb analysis using anterior segment optical coherence tomography no significant differences were found, such as in bleb volume, height and wall thickness, before and after blepharoptosis surgery. There were no intraoperative complications in any of the cases. A postoperative corneal disorder was seen in 1 eye, but there was no infection of or damage to filtering bleb in any of the cases during the postoperative follow-up period. CONCLUSIONS In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be highly safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.

PURPOSE To evaluate, using optical coherence tomography-angiography (OCT-A), the vascular features of good bleb function after XEN gel implantation (XGI) for uncontrolled glaucoma. METHODS Forty-three patients (43 eyes), who underwent XGI, were enrolled. According to the intraocular pressure (IOP) reduction, patients were classified into Group 1 (21 eyes; success) and Group 2 (22 eyes; failure). Optical coherence tomography-angiography (OCT-A) was performed to image the vascularization of the conjunctival bleb-wall. The main outcomes were as follows: vessel displacement areas (VDAs), major vessel displacement area (MVDA; mm2 ), non-flow whole area (NFWA; mm2 ) and bleb-wall vessel density (BVD; %). Co-registered B-scans were also considered to evaluate the bleb-wall cyst-like structure density and area (BCSD, cysts/mm2 ; BCSA, mm2 ), and the bleb-wall thickness (BT, µm). RESULTS Mean postoperative follow-up was 7.5 ± 0.14 months; Group 1 and 2 IOP were 14.0 ± 2.5 and 25.3 ± 2.1 mmHg, respectively (p