[Morphological evaluation of the results of laser activation of scleral hydropermeability in the treatment of glaucoma].

Autor:	Yusef YN; Krasnov Research Institute of Eye Diseases, Moscow, Russia.; I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia., Novikov IA; Krasnov Research Institute of Eye Diseases, Moscow, Russia., Gamidov AA; Krasnov Research Institute of Eye Diseases, Moscow, Russia., Gavrilina PD; Krasnov Research Institute of Eye Diseases, Moscow, Russia., Baum OI; Institute of Photonic Technologies of the Crystallography and Photonics Research Center, Moscow, Russia., Surnina ZV; Krasnov Research Institute of Eye Diseases, Moscow, Russia.
Jazyk:	ruština
Zdroj:	Vestnik oftalmologii [Vestn Oftalmol] 2023; Vol. 139 (3), pp. 15-22.
DOI:	10.17116/oftalma202313903115
Abstrakt:	Purpose: The study attempted to experimentally substantiate the possibility of using the laser activation of scleral hydropermeability (LASH) technique in glaucoma treatment by morphological evaluation of treatment outcomes. Material and Methods: The pulsed-periodic radiation from an Er-glass fiber laser (λ=1.56 μm) was used. The model experiment consisted of evaluating ultrafiltration of fluid through the tissues of human sclera autopsy specimen according to the original technique using neodymium chloride-based labeling agent and scanning electron microscopy. The clinical part of the study consisted of optical coherence tomography (OCT) and laser confocal microscopy of the sclera and conjunctiva (CMSC) performed in vivo immediately after laser treatment in the laser application sites in 5 patients (5 eyes) aged 57 to 68 years with uncompensated advanced (IIIb-c) stage of glaucoma who had previously underwent LASH surgery. Results: Results of morphological evaluation after LASH revealed structural changes indicating increased transscleral ultrafiltration: increased intrastromal hyporeflective areas in the sclera, thinning of collagen fibers, formation of porous structures. Using an original technique involving neodymium chloride-based labeling agent and scanning electron microscopy, we were able to prove the enhancement of transscleral ultrafiltration. The results of the experiment were confirmed by in vivo OCT images of the sclera and CMSC performed in 5 patients with advanced glaucoma after LASH surgery, in which tissue decompaction in the laser-exposed areas was clearly visualized. Conclusion: The revealed structural changes indicate the possibility of reducing intraocular pressure after LASH by the means of forming scleral porous structures and increasing transscleral ultrafiltration. Experimentally selected optimal mode of laser exposure (0.66 W with total exposure time of 6 seconds) during LASH helps avoid gross destructive changes in the eye tissues, making the proposed intervention a sparing approach to the treatment of glaucoma.
Databáze:	MEDLINE
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