Comparison of the Clinical Efficacy of Draining Autovalve Limbosclerectomy and Trabeculectomy in the Treatment of Primary Open-Angle Glaucoma with Long-Term Follow-Up

Abstract

Purpose: to evaluate the immediate and long-term hypotensive efficacy, the number of complications, and the clinical benefits of a draining autovalve limbosclerectomy (DALS) performed using a kit of disposable instruments in patients with POAG of various stages in comparison with trabeculectomy (TE).Patients and Methods. The study is based on the analysis of the clinical and functional condition of 127 eyes of 127 patients with primary open-angle glaucoma (stage I POAG was detected in 2 eyes, stage II in 30 eyes, stage III in 88 eyes and stage IV in 7 eyes). Patients were divided into groups: the main group—76 people who underwent DALS using a set of disposable instruments, and the control group—51 people who underwent TE. The average age of patients is 68.9 ± 10.3 years. Before and within 24 months after surgery, all patients underwent standard diagnostic examinations. The initial level of IOP against the background of the maximum antihypertensive mode varied from 24 to 50 mm. Hg. According to gonioscopy, the angle of the anterior chamber was open in all cases (III–IV degree). Patient exclusion criteria: history of laser or surgical treatment of glaucoma, cataract treatment.Results. After 24 months of follow-up after DALS, the level of IOP in patients with stage I–II of POAG was 14.19 ± 1.83 mm Hg and with III–IV stage of POAG 14.95 ± 2.15 mm Hg, compensation was achieved in 88.2 % of patients without the use of antihypertensive drops. After TE, compensation was received in 72.6 % of patients, the IOP level was 16.9 ± 2.21 and 17.78 ± 2.31 mm Hg. respectively (p < 0.01). After DALS surgery, a decrease in the number of complications was revealed in comparison with TE: a decrease in сiliochoroidal detachment by 9.1 %, hyphema by 2.5 %, ophthalmic hypertension in the early p/o period by 3.2 %, cystic changes in the filtering bleb by 7.1 %.Conclusion. The standardized DALS operation using a disposable tool kit is a new highly effective and safe method for the surgical treatment of glaucoma. DALS may be the operation of choice in the treatment of POAG of all stages.