Clinical morphological charactristics of iris-ciliary zone in secondary posttraumatic aniridic glaucoma

• Main Authors: N. P. Sobolev, I. E. Ioshin, A. V. Shatskikh, S. V. Novikov
• Format: Article
• Language: Russian
• Published: Publishing house "Ophthalmology" 2016-01-01
• Series: Офтальмохирургия
• Subjects: posttraumatic aniridia; secondary glaucoma; ultrasound biomicroscopy; light microscopy; iris-lens diaphragm implantation; deep sclerectomy; hydrogel drainage implantation
• Online Access: https://www.ophthalmosurgery.ru/jour/article/view/200

Purpose. To evaluate clinical morphological characteristics or iris-ciliary zone in patients with secondary posttraumatic aniridic glaucoma.Material and methods. The study included 43 patients (43 eyes) aged 18-62 years with secondary posttraumatic aniridic glaucoma: after open globe injury – 32 eyes and contusion trauma – 11 eyes; primary surgical debridement was performed at the place of residence. Associated pathology: traumatic cataract – 15 patients, aphakia – 28 patients. Time after trauma was 5-9 years. All patients underwent reconstructive surgeries, including iris-lens diaphragm implantation and deep sclerectomy with hydrogel drainage implantation. The follow-up period was 18 months. The standard ophthalmologic examination and the additional ultrasound bio-microscopy were performed in preand post-operative period. Fragments of sclera were excised intra-operatively during the opticoreconstructive surgery with deep sclerectomy in 3 patients and were studied in histological examination.Results. The performed complex morphological studies revealed the continuation of fibroplastic processes at all levels of aqueous humor outflow despite the long period after trauma (5-9 years). According to the ultrasound biomicroscopy data in vivo, there was a sclerotic deformation of ciliary body and its processes, collapse of trabecular meshwork with locuses of its occlusion with iris root. However, according to the histopathologacal data, cicatrization process was not completed, the evidence of this was a fibroplastic cell reaction with neo-vascular invasion. Probably, this contributes to the block of neo-formed intra-scleral outflow pathways. All this can explain unstable results after surgery for secondary glaucoma in eyes with aniridia.Conclusion. The found features of iris-ciliary zone should be taken into consideration during the reconstructive and glaucoma surgery in patients with secondary aniridic glaucoma. The revealed factor of uncompleted fibroplastic process with a moderate active cell and vessel proliferation needs a further study to increase the efficacy of prevention and treatment in such group of patents.