First results of channel dilation in non-penetrating surgery for primary open-angle glaucoma

Cover Page

Cite item

Full Text

Abstract

The surgery of Schlemm's canal is related to microinvasive surgery for primary open-angle glaucoma, which is why this area in ophthalmology is rapidly advancing and is a priority. The goal is to develop a technique for canal dilation performed during non-penetrating deep sclerectomy, as well as to assess its impact on the condition of Schlemm's canal and the hydrodynamic parameters of the eye.

Materials and methods: This paper presents an analysis of the results of non-penetrating surgery with Schlemm's canal dilation in 30 patients (30 eyes) with advanced primary open-angle glaucoma (main group) compared to standard technology for minimally invasive non-penetrating surgery (30 patients, 30 eyes). All patients underwent ophthalmoscopy, biomicroscopy, keratorefractometry, computer perimetry, tonometry, tonography, gonioscopy, pachymetry, optical coherence tomography of the optic nerve head and anterior segment with measurement of the longitudinal and transverse axis diameters, as well as the area of sagittal scanning of Schlemm's canal.

Results and discussion: The hypotensive effect after surgery was more pronounced in the main group of patients at 45.3 %, compared to 39.3 % in the control group (p < 0.05). The hypotensive effect in the main group was due to a significantly greater outflow of intraocular fluid. The difference between the mean values of the outflow facility coefficient of intraocular fluid in the main group, (0.3 ± 0.05) mm³/mm Hg × min, and the control group, (0.24 ± 0.04) mm³/mm Hg × min, was statistically significant (p < 0.001). Six months after surgery, the average area of Schlemm's canal was 41.7 % larger than that of the control group patients. The difference between the mean values of the area of Schlemm's canal in the main group, (1996.7 ± 232.4) µm², and the control group (1163.4 ± 226.9) µm², was statistically significant (p < 0.001).

Conclusion: Canal dilation during non-penetrating glaucoma surgery allows for the safe elimination of Schlemm's canal collapse, significantly expanding its lumen, normalizing intraocular hydrodynamics, and contributing to the stabilization of visual functions.

About the authors

Benta G. Dzhashi

S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd

Email: benta1@yandex.ru
ORCID iD: 0000-0001-5763-888X

Candidate of Medical Sciences, Ophthalmologist, Head of the Glaucoma Treatment Department

Russian Federation, Volgograd

Sergey V. Balalin

S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd; Volgograd State Medical University

Author for correspondence.
Email: s.v.balalin@gmail.com
ORCID iD: 0000-0002-5250-3692

MD, Professor of the Department of Ophthalmology, Head of the Scientific Department

Russian Federation, Volgograd; Volgograd

References

  1. Shan S., Wu J., Cao J., Feng Y., Zhou J., Luo Z. et al. Global Health Epidemiology Research Group (GHERG). Global incidence and risk factors for glaucoma: A systematic review and meta-analysis of prospective studies. Journal of Global Health. 2024;8:14:04252. doi: 10.7189/jogh.14.04252.
  2. Nesterov A.P., Bunin A.Ya., Katsnelson L.A. Intraocular pressure. Physiology and pathology. Moscow, 1974. 381 p. (In Russ.).
  3. Nesterov A.P. Glaucoma, Moscow, 1995. 256 p. (In Russ.).
  4. Engel J., Furthmayr Н. Electron microscopy and other physical methods for the characterization of extracellular matrix components: Laminin, fibronectin, collagen IV, collagen VI, and proteoglycans. Methods in Enzymology. 1987;145:3–78. doi: 10.1016/0076-6879(87)45003-9.
  5. Marshall G.E., Konstas A.G., Lee W.R. Immunogold localization of type IV collagen and laminin in the aging human outflow system. Experimental eye research. 1990;51(6):691–699.
  6. Kagemann L., Wang B., Wollstein G., Ishikawa H., Nevins J. E., Nadler Z. et al. IOP elevation reduces schlemm’s canal cross-sectional area. Investigative ophthalmology & visual science. 2014;55(3):1805–1809. doi: 10.1167/iovs.13-13264.
  7. Hong J., Xu J., Wei A., Wen W., Chen J., Yu Х. et al. Spectral-domain optical coherence tomographic assessment of Schlemm's canal in Chinese subjects with primary open-angle glaucoma. Ophthalmology. 2013;120:709–715. doi: 10.1016/j.ophtha.2012.10.008.
  8. Kagemann L., Wollstein G., Ishikawa H., Sigal I.A., Folio L.S., Xu J. et al. 3D visualization of aqueous humor outflow structures in-situ in humans. Experimental eye research. 2011;93:308–315. doi: 10.1016/j.exer.2011.03.019.
  9. Kagemann L., Wollstein G., Ishikawa H., Bilonick R.A., Brennen P.M., Folio L.S. et al. Identification and assessment of Schlemm's canal by spectral-domain optical coherence tomography. Investigative ophthalmology & visual science. 2010;51:4054–4059. doi: 10.1167/oivs. 09-4559.
  10. Haili Н., Lijia Т., Xinghuai S., Yuhong С. En face optical coherence tomography detection of Schlemm’s canal in primary open angle glaucoma. J. Frontiers in Physiology. 2023;14. doi: 10.3389/fphys.2023.1214427.
  11. Schlemm F. Arteriarum capitis superficialum icon nova. Berlin, 1830.
  12. Ashton N. Anatomical study of Schlemm's canal and aqueous veins by means of neoprene casts. The British journal of ophthalmology. 1951;35:291–303.
  13. Bahler C.K., Hann C.R., Fjield T., Haffner D., Heitzmann Н., Fautsch М.Р. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments. American journal of ophthalmology. 2012;153:1206–13. doi: 10.1016/j.ajo.2011.12.017.
  14. Lewczuk K., Jabłońska J., Konopińska J., Mariak Z., Rękas M. Schlemm's canal: the outflow ‘vessel’. Acta ophthalmologica. 2022;100:e881-e890. doi: 10.1111/aos.15027.
  15. Stegmann R. Viscocanalostomy: a new surgical technique for open angle glaucoma. An Inst Barraquer Spain. 1995;25:229–232.
  16. Nikolashin S.I., Machekhin V.A. Non-penetrating deep sclerectomy with Schlemm canal drainage in the treatment of primary open-angle glaucoma. Oftal'mokhirurgiya = Fyodorov Journal of Ophthalmic Surgery. 2002;1:17–20. (In Russ.).
  17. Shkvorchenko D.O., Kashtan O.V., Kislitsyna N.M. Method of surgical treatment of glaucoma. RF Patent for invention No. 2177288. (In Russ.).
  18. Gusev Yu.A., Trublin V.N. Non-penetrating viscoangular reconstruction – a new technology in the treatment of open-angle glaucoma. Aktual'nye problemy oftal'mologii. Sbornik po materialam 5-i nauchno-prakticheskoi konferentsii = Current problems of ophthalmology. Collection based on the materials of the 5th scientific and practical conference. Moscow, 2002:13–14. (In Russ.).
  19. Spiegel D., Kobuch K. Trabecular meshwork bypass tube shunt: initial case series. The British journal of ophthalmology. 2002;86:1228–1231.
  20. Bochkarev M.V. Channelodilation of the venous sinus of the sclera. Current problems of ophthalmology. Sbornik nauchnykh statei 8-i nauchno-prakticheskoi konferentsii FMBA Rossii = Collection of scientific articles of the 8th scientific and practical conference of the FMBA of Russia. Moscow, 2005:46. (In Russ.).
  21. Bochkarev M.V., Rudkovskaya E.M. Intracanal polydrenation of the venous sinus of the sclera. Tezisy dokladov VIII s"ezda oftal'mologov Rossii = Abstracts of the VIII Congress of Ophthalmologists of Russia. Moscow, 2005:154. (In Russ.).
  22. Alekseev V.V. Trabeculodialysis: (clinical and experimental substantiation of a new method of surgical treatment of primary open-angle glaucoma)ю Abstract of the dissertation for the degree of Candidate of Medical Sciences. Yaroslavl, 1992. 16 p. (In Russ.).
  23. Vranka J.A., Kelley M.J., Acott T.S., Keller K.E. Extracellular matrix in the trabecular meshwork: intraocular pressure regulation and dysregulation in glaucoma. Experimental eye research. 2015;133:112–125. doi: 10.1016/j.exer.2014.07.014.
  24. Fan Y., Wei J., Guo L., Zhao S., Xu C., Sun H., Guo T. Osthole reduces mouse IOP associated with ameliorating extracellular matrix expression of trabecular meshwork cell. Investigative ophthalmology & visual science. 2020;61:38. doi: 10.1167/iovs.61.10.38.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2025 Dzhashi B.G., Balalin S.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).