Trabeculectomy and EX-PRESS Implantation in Open-Angle Glaucoma: An Updated Meta-Analysis of Randomized Controlled Trials

PROGNOSIS OF POSTOPERATIVE PROGRESSION OF GLAUCOMA OPTIC NEUROPATHY AT PRIMARY OPEN-ANGLE GLAUCOMA

Search for new informative markers and methods of prognosis prediction glaucomatous optic neuropathy (GON) in primary open-angle glaucoma (POAG) is an urgent task. We have established efficiency surgical treatment of POAG, but the progression of GON is observed in 10–15 % patients. It is known that the main mechanism of GON is apoptotic death retinal ganglion cells, a marker of which is recognized as tumour necrosis factor-α (TNFα), Fas-ligand (FasL) and a soluble form of the Fas-receptor (sFas/APO-1). The aim of the study: to find out the possibility of using apoptosis factors (TNFα, FasL and sFas/APO-1) to predict postoperative progression of GON at POAG. Methods. 69 patients (69 eyes) with POAG stage I–III were examined, who underwent trabeculectomy with implantation of an Ex-Press shunt. In intraocular fluid (IOF) markers of apoptosis was determined by the method enzyme-linked immunosorbent assay. Repeated ophthalmological examination was performed in 1 year. The control group consisted of 25 patients who were operated on about phacoemulsification of cataracts. For statistical and regression analysis used software package GLZ (Statistica 10, StatSoft, Inc. USA) and module of analysis of operational characteristics of regression models – ROC-diagrams (MedCalc 18.9.1, MedCalc Software, Belgium). Results. Multivariate regression analysis showed that the progression of GON determine the content in IOF of TNFα and sFas/Apo-1 before surgery and intraocular pressure after three months. Based on these indicators, it is calculated satisfactory model of GON progression prediction with 95.4 % accuracy. One-factor logistic regression analysis proved the influence of the content of TNFα, FasL and sFas/Apo-1 for the presence or absence of progression of GON during the year after operations: direct dependence took place for TNFα and FasL and inverse – for sFas/Apo-1. The critical limits of the content in the IOF markers are calculated apoptosis, in which the progression of GON is unmistakably predicted during year after surgery. Conclusions. The obtained results prove the significant influence of the studied markers apoptosis on the progression of GON after surgery. Direct pathogenetic influence belongs to TNFα and FasL.