ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2014-3-80-88ophthalmology-194Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCASE REPORTАктивация фильтрационной подушки в раннем периоде после фистулизирующей операцииFiltering bleb activation in the early post-operative period after fistulizing surgeryПетровС. Ю.PetrovS. Yu.post@glaucomajournal.ruАнтоновА. А.AntonovA. A.ВострухинС. В.VostrukhinS. V.ПанюшкинаЛ. А.PanyushkinaL. A.СафоноваД. М.SafonovaD. M.ФГБУ «НИИ глазных болезней» РАМНРоссияScientific Research Institute of Eye Diseases of the Russian Academy of Medical SciencesRussian Federation2014121020141138088Copyright © Петров С.Ю., Антонов А.А., Вострухин С.В., Панюшкина Л.А., Сафонова Д.М., 20142014Петров С.Ю., Антонов А.А., Вострухин С.В., Панюшкина Л.А., Сафонова Д.М.Petrov S.Y., Antonov A.A., Vostrukhin S.V., Panyushkina L.A., Safonova D.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/194

В статье описан клинический случай пациента с кистозно измененной фильтрационной подушкой в раннем периоде после синусотрабекулэктомии. Больной обратился к офтальмологу с жалобами на ощущение дискомфорта в оперированном 4 недели назад глазу. Рекомендованный лечащим врачом медикаментозный режим соблюдался нерегулярно. При биомикроскопии над лимбом визуализировалась кистозная, тонкостенная, высокая, отграниченная гиперемированная фильтрационная подушка. Офтальмотонус составил 27 мм рт. ст., местные гипотензивные препараты пациент на момент обращения не использовал. Проведена инстилляционная противовоспалительная терапия (фиксированная комбинация тобрамицин / дексаметазон) и гипотензивная терапия (фиксированная комбинация бримонидин / тимолол). Через сутки на сниженном внутриглазном давлении до 20 мм рт. ст. проведен нидлинг подушки с деструкцией ее стенки и введением под конъюнктиву растворов дексаметазона, фторурацила и ранибизумаба. На следующий день фильтрационная подушка стала более плоской, разлитой, с менее выраженной гиперемией, в центральной зоне визуализировалось большое количество конъюнктивальных микрокист. Внутриглазное давление составило 10,2 мм рт. ст. Офтальмоскопически и по данным ОСТ отслойки сосудистой оболочки выявлено не было. Пациенту продолжили проведение противовоспалительной терапии. Через 2 недели на фоне некоторого усиления гиперемии в профилактических целях повторно проведен нидлинг с теми же препаратами. К концу срока наблюдения (4 недели) фильтрационная подушка оставалась плоской и разлитой, внутриглазное давление составляло 13,2 мм рт. ст. Пациенту рекомендованы инстилляции дексаметазона 1‑2 раза в сутки в течение месяца.Данный клинический случай продемонстрировал методику восстановления функционирования фильтрационной подушки с деструкцией ее стенки в комплексе с применением противовоспалительных, цитостатических и анти-VEGF препаратов для продления гипотензивного эффекта фистулизирующей антиглаукомной операции в условиях избыточного рубцевания.

The article presents a case report of a patient with a cystic bleb in the early postoperative period after trabeculectomy. Patient complained of discomfort in a recently (4 weeks) operated eye. Medical regimen administered previously had been taken irregularly. Biomicroscopy revealed a high, encapsulated cystic bleb with thin walls and hyperemia. Intraocular pressure at the moment of examination was 27 mmHg. Local hypotensive therapy had been neglected by the patient. A local anti-inflammatory (tobramycin / dexamethasone fixed combination) and hypotensive (brimonidine / timolol fixed combination) therapy was administered. 24 hours later, when intraocular pressure decreased to 20 mmHg, a needle revision procedure was conducted for partial bleb wall destruction and subconjunctival injection of dexamethasone, fluorouracil and ranibizumab. During the next day examination the bleb was diffuse, with less hyperemia and an abundance of conjunctival microcysts in the central bleb’s zone. Intraocular pressure was 10.2 mmHg. No choroidal detachment was noted during ophthalmoscopy and OCT examination. The patient continued anti-inflammatory therapy. Another needling procedure with the same drug combination was repeated two weeks after due to an increased hyperemia. At the end of the four-week follow-up period the filtering bleb remained diffuse and the intraocular pressure was 13.2 mmHg. Dexamethasone drops were prescribed to be instilled 1‑2 times a day for a month. This case report demonstrates the method of restoring a functioning filtering bleb by the needle revision with antiinflammatory, cytostatic and anti-VEGF therapy for prolonging the hypotensive effect of a trabeculectomy in the presence of wound healing.

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The authors declare that there are no conflicts of interest present.