Kumar VKumar V..1,21,2,, Frolov M.A.Frolov M.A.11 , , Dzumova A.A.Dzumova A.A.22 ,Isufaj E.,Isufaj E. 1 1, Bojhok E.V., Bojhok E.V. 1 1

Results of transciliary filtration (TCF) and Results of transciliary filtration (TCF) and transconjunctival transciliary filtration transconjunctival transciliary filtration

(TCTCF) in surgical management of (TCTCF) in surgical management of refractory primary open-angle glaucoma refractory primary open-angle glaucoma

(RPOAG).(RPOAG).

Innovative educational program of the UniversityInnovative educational program of the University

Financial disclosure - noneFinancial disclosure - none

Department of OphthalmologyDepartment of Ophthalmology

Russian People’s Friendship UniversityRussian People’s Friendship University11

Moscow, Russian FederationMoscow, Russian Federation

Ophthalmic unit of Skhodnya city hospitalOphthalmic unit of Skhodnya city hospital 22,, Moskovskaya oblastMoskovskaya oblast. .

Surgical treatment of refractive glaucomaSurgical treatment of refractive glaucoma

Drainage of anterior chamber with the use of Drainage of anterior chamber with the use of different implants and drainage devices or different implants and drainage devices or

without them without them

Less effective. Complication rates during surgery and in

postoperative periods are significantly high. As a result in most of the cases the eyes are

subjected to either evisceration or enucleation.

Posterior chamber drainage through ciliary body – Posterior chamber drainage through ciliary body –

transciliary filtration transciliary filtration

Professor Daljit Singh (Amritsar, india)

Manual TCF – 1979.

Plasma TCF – 2001

 Professor Takhchidi K.P.(Russia)

Diode laser TCF– 1992г.

Erbium laser TCF – 1993-2000

Fugo plasma blade - new Fugo plasma blade - new fundamental energyfundamental energy

Video clip (by Prof. Richard Fugo, USA)

Voice (Prof. Daljit Singh, India)

The tissues are treated at the molecular and atomic levels, without causing collateral damage.

When the tip is activated, it gets coated with plasma, which is resonant with the tissues that are touched.

The  tissue absorbs energy by resonance, the tissue molecules become unstable, therefore they shatter, and they get removed in the form of a plume.

(Nanotechnology (Nanotechnology in the truest in the truest sense )sense )

Surgical technique of TCF and TCTCF

PurposePurposeTo study effectiveness of TCF and TCTCF To study effectiveness of TCF and TCTCF procedures in surgical management of procedures in surgical management of RPOAG.RPOAG.

Department of ophthalmology, Department of ophthalmology, Russian people’s friendship university, Russian people’s friendship university, MoscowMoscow

Ophthalmic unit of Skhodnya city hospital, Ophthalmic unit of Skhodnya city hospital, Moscovskaya oblast Moscovskaya oblast

SettingSetting

Total 20 casesTotal 20 cases ( (20 eyes): 20 eyes): male – 10 (50ale – 10 (50%%); female – 10 (50); female – 10 (50%%) )

TCF TCF :: 6 cases (30%) and 6 cases (30%) and TCTCF TCTCF :: 1 14 cases (70%)4 cases (70%) Study Study period: period: September 2009 - December 2009September 2009 - December 2009

Exclusion criteria: Exclusion criteria: minimum follow – Less than 3 monthsminimum follow – Less than 3 months

• Cases were admitted for evisceration for painful terminal glaucoma

• Intraocular pressure (IOP) varied from 25 – 45 mmHg (avg. IOP was 32.75 +\– 4.79 mmHg).

• All patients were instilling not less than 2 eye drops

Methods and materialMethods and material

Methods and materialMethods and material

Main outcome measures: Main outcome measures: IOP change,

complication rate,

additional glaucoma medication,

need for surgical revision.

Criteria for success:Criteria for success: relief from pain,

normal outlook of the eye ball,

decrease in preoperative IOP by 30% or more

with or without glaucoma medication.

Observations during surgery: Observations during surgery:

TCF and TCTCF procedures were technically easy to perform. PC drainage was achieved in all cases. Surgical time ranged between 7 to 10 minutes. Deepening of anterior Deepening of anterior chamber in every case.chamber in every case.No case of hemorrhagic No case of hemorrhagic choroidal effusion.choroidal effusion.Bleeding from the tunnel – in Bleeding from the tunnel – in 3 cases (15%).3 cases (15%).

ResultsResults

Observations in post-operative period Observations in post-operative period

(follow-up period – 3 months)(follow-up period – 3 months)

Success rate – 65% (13 cases)

Additional glaucoma medication - 3 cases (15).

Need for surgical revision – 35% (7 cases)

Repeat TCF or TCTCF - 4 cases (20%).

Implantation of stainless steel wire drainage device - 2 cases (10%).

Evisceration of eye ball – 5% (1 case)

Choroidal effusion - 5 cases (25%).

Hyphema – 6 cases (dissolved spontaneously).

1st day

7th day

OCT after 6 months

ResultsResults

Blockage of the outer opening Blockage of the outer opening fibrosis fibrosis

antimetabolites?antimetabolites?

Blockage of the inner opening Blockage of the inner opening anterior chamber anterior chamber

irrigation irrigation More trauma ?More trauma ?

Due to high reactivity and Due to high reactivity and elasticity of ciliary body elasticity of ciliary body

Failure reasonsFailure reasons

ConclusionsConclusions

TCF and TCTCF though is a technically simple and easy to perform procedure, but in its present day form failure rate in surgical management of RPOAG is significantly high. Modification of this procedure by using antimetabolites perioperatively may enhance its success rate.