Clinical aspects of the application of endoscopic laser cyclodestruction

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BACKGROUND: Glaucoma remains one of the leading causes of irreversible vision loss worldwide, due to the steadily increasing incidence with age. In recent years, minimally invasive glaucoma surgery combined with cataract extraction has gained significant popularity as an alternative to traditional filtering surgeries. Among the methods of hypotensive action included in the minimally invasive glaucoma surgery concept, endoscopic laser cyclodestruction plays a special role, allowing for effective reduction of aqueous humor production.

AIM: The aim of this study is to determine the optimal conditions for achieving maximum efficiency and safety of endoscopic laser cyclodestruction.

MATERIALS AND METHODS: The present study analyzed the results of 110 combined procedures (phacoemulsification and endoscopic laser cyclodestruction) performed in our clinic. The study included 110 patients (56 men and 54 women) aged from 56 to 89 years (mean age 73.7 years) diagnosed with stage I–IV glaucoma and initial complicated cataract. All patients underwent anterior endoscopic laser cyclodestruction using the E2 videoendoscopic laser ophthalmic device (Endo Optiks Inc., USA) after phacoemulsification and intraocular lens implantation. Dynamic follow-up included visual acuity testing, perimetry, tonometry, instillation regimen assessment, anterior segment OCT, and registration of complications over 60 months.

RESULTS: The data analysis showed no hemorrhagic complications and significant inflammatory reactions in the vast majority of patients. The average dynamics of intraocular pressure reduction over 60 months was 24.6%, indicating the high efficacy of endoscopic laser cyclodestruction in intraocular pressure lowering and in stabilizing the condition in glaucoma patients.

CONCLUSIONS: Endoscopic laser cyclodestruction demonstrates high efficacy and safety, with virtually no contraindications, except in cases of technical difficulties. The optimal efficiency of the procedure is achieved by destructing the ciliary body processes over 180–200°, significantly reducing intraocular pressure and decreasing dependence on hypotensive therapy.

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作者简介

Alexei Kulikov

Kirov Military Medical Academy

Email: alexey.kulikov@mail.ru
ORCID iD: 0000-0002-5274-6993
SPIN 代码: 6440-7706

MD, Dr. Sci. (Medicine), Professor, Colonel of the Medical Service

俄罗斯联邦, 6G Akademika Lebedeva st., Saint Petersburg, 194044

Vyacheslav Skvortsov

Kirov Military Medical Academy

Email: docuran@gmail.com
ORCID iD: 0000-0002-1345-9537
SPIN 代码: 6417-1899

MD, Cand. Sci. (Medicine)

俄罗斯联邦, 6G Akademika Lebedeva st., Saint Petersburg, 194044

Dmitrii Tulin

Kirov Military Medical Academy

编辑信件的主要联系方式.
Email: d.v.tulin@gmail.com
ORCID iD: 0000-0003-3485-8227
SPIN 代码: 8336-7272

MD

俄罗斯联邦, 6G Akademika Lebedeva st., Saint Petersburg, 194044

参考

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2. Fig. 1. Fibrinoid network in the pupil lumen on the first day after combined operation — phacoemulsification + endoscopic laser cyclodestruction

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3. Fig. 2. Typical example of native (not processed) images of inflammatory elements in the anterior chamber fluid at optical coherence tomography of the anterior segment: a — after standard phacoemulsification (PEC); b — after PEC + endoscopic laser cyclodestruction (ELCD) without vaporization bioeffect; c — after PEC + ELCD with vaporization bioeffect

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4. Fig. 3. Stages of image analysis obtained by anterior segment optical coherence tomography: a — image cropping (Adobe Illustrator CC 2018); b — adjustment of upper and lower threshold values for the image (60–255); c — counting of studied objects (ImageJ, National Institutes of Health, USA)

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5. Fig. 4. Dynamics of intraocular pressure in the whole study group of patients

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