ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2014-1-45-51ophthalmology-34Research ArticleКЛИНИЧЕСКИЕ И ЭКСПЕРИМЕНТАЛЬНЫЕ ИССЛЕДОВАНИЯCLINICAL & EXPERIMENTAL RESEARCHРасчёт параметров контактной транссклеральной диод-лазерной циклофотокоагуляции на основе оценки исходного состояния цилиарного тела у больных с терминальной глаукомой методом ультразвуковой биомикроскопииCalculation of contact transscleral diode laser cyclophotocoagulation parameters on the basis of ciliary body original state assessment using ultrasound biomicroscopy in terminal glaucoma patientsЕгороваЭ. В.EgorovaJe. V.ДробницаА. А.DrobnicaA. A.drobnica1986@mail.ruБессарабовА. Н.BessarabovA. N.ФГБУ «МНТ К «Микрохирургия глаза» им. акад. С. Н. Федорова Росмедтехнологии»РоссияFGBI «IRTC» Eye Microsurgery «. Acad. SN Fedorov RosmedtechnologyRussian Federation2014090720141114551Copyright © Егорова Э.В., Дробница А.А., Бессарабов А.Н., 20142014Егорова Э.В., Дробница А.А., Бессарабов А.Н.Egorova J.V., Drobnica A.A., Bessarabov A.N.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/34

Цель: Изучение у больных с терминальной болящей глаукомой исходной степени атрофии цилиарного тела и прогрессирования атрофии цилиарного тела (ЦТ) после контактной транссклеральной диод-лазерной циклофотокоагуляции (КТДЦК) с учётом используемой суммарной лазерной энергии.Материал и методы: обследовано 56 пациентов (92 глаза) с терминальной болящей глаукомой, которым проведена КТ- ДЦК с различной суммарной лазерной энергией в диапазоне от 43,2 мДж до 86,4 мДж. Выбор параметров суммарной лазерной энергии при КТДЦК определяли, исходя из наличия и степени атрофии ЦТ больного глаза по отношению к парному (здоровому) глазу. Кроме того, обследовано 5 глаз с терминальной глаукомой и клинически выраженной субатрофией глазного яблока после ранее проведённой КТДЦК с суммарной лазерной энергией, превышающей используемую в данной работе.Результаты и заключение: У всех больных с терминальной глаукомой при ультразвуковой биомикроскопии выявлена различная степень атрофии цилиарного тела, что проявлялось уменьшением его толщины по сравнению с парным здоровым глазом на 28,37 %. Выраженность послеоперационной реакции после транссклеральной диод-лазерной циклофотокоагуляции зависит от суммарной лазерной энергии. Выбор её параметров с учетом исходной величины атрофии цилиарного тела позволяет купировать болевой синдром, свести к минимуму осложнения послеоперационного периода и предупредить дальнейшее прогрессирование атрофии цилиарного тела, а также снизить показатели офтальмотонуса до уровня субкомпенсированных. Математический анализ изменений толщины цилиарного тела оперируемого глаза с учётом используемой лазерной энергии явился основой построения номограммы, позволяющей проводить индивидуальный расчёт максимально допустимой и минимально необходимой суммарной лазерной энергии.

Aim. To analyze the initial atrophy of ciliary body in patients with painful terminal glaucoma using ultrasound biomicroscopy (UBM) and the progression of ciliary body atrophy following transscleral diode laser cyclophotocoagulation (TSCPC) considering total laser energy used.Materials and methods. 56 patients (92 eyes) with terminal painful glaucoma were examined. In these patients, TSCPC with total laser energy ranged from 43.2 to 86.4 mJ was performed. Total laser energy parameters for TSCPC were determined according to the presence and degree of ciliary body atrophy of the affected eye as compared withhealthy one. Additionally, 5 terminal glaucoma eyes with clinically apparent eye globe sub-atrophy following previous TSCPC with total laser energy above the level used in this study were examined.Results. In all terminal glaucoma patients, various degrees of ciliary body atrophy was revealed using UBM. This atrophy was diagnosed by ciliary body thinning as compared with healthy eye by 28.37 %. Post-op reaction degree following TSCPC depends on total laser energy. Total laser energy parameters selection depending on initial ciliarybody atrophy reduces pain syndrome, minimizes post-op complications, prevents further ciliary body atrophy progression and decrease IOP to sub-compensated level.Conclusion. Mathematical analysis of ciliary body thickness changes depending on laser energy used was assumed as a basis of nomogram construction that provides individual calculation of maximum allowable and minimally required total laser energy.

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[Assessment of the impact-energy effect of diode laser on the ciliary body in patients with a terminal pain glaucoma]. Ocenka vlijanija lazernoj jenergii diodnogo-lazera na ciliarnoe telo u bol’nyh s terminal’noj boljashhej glaukomoj. Prakticheskaja medicina. Oftal’mologija [The practice of medicine. Ophthalmology] 2013. Kazan; 70:18‑23. (in Russ.).Egorova E. V., Drobnica A. A., Uzunjan D. G. [Assessment of the impact-energy effect of diode laser on the ciliary body in patients with a terminal pain glaucoma]. Ocenka vlijanija lazernoj jenergii diodnogo-lazera na ciliarnoe telo u bol’nyh s terminal’noj boljashhej glaukomoj. Prakticheskaja medicina. Oftal’mologija [The practice of medicine. Ophthalmology] 2013. Kazan; 70:18‑23. (in Russ.).

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