Features of the condition of the perilimbal tissues of the eye during the surgical treatment of patients with open-angle glaucoma

Abstract

primary open-angle glaucoma is a multifactorial chronic neurodegenerative disease characterized by acquired loss of retinal ganglion cells and subsequent optic nerve atrophy, and is often associated with increased intraocular pressure (IOP). As the leading cause of blindness and vision loss, glaucoma affects more than 70 million people worldwide (Tang et al., 2021), and unfortunately, there is no downward trend. Most currently available glaucoma treatments tend to target the formation of the aqueous humor or the uveal-scleral outflow pathway. They do not affect the primary outflow pathway, which is usually responsible for 70–90% of aqueous humor drainage into the circulatory system. However, dysfunction and blockage of this major pathway can lead to increased outflow resistance, increased IOP, and ultimately the development of glaucoma. Purpose: to investigate the condition of the perilimbal tissues of the eye during the surgical treatment of patients with open-angle glaucoma. Materials and methods: 22 patients with primary open-angle glaucoma who underwent combined treatment for glaucoma and age-related cataract were included in the examination and made up the main group of the examination. The comparison group, which consisted of 7 patients, included patients who had age-related cataracts and did not have glaucoma. The main group of patients was divided into two subgroups. In the first subgroup of the main group, the Tenon's sheath of the area where anti-glaucomatous intervention was performed was studied. Trabecula examination was performed in patients of the second subgroup of the main group. Results: on the histological preparations of the patients of the main group, unlike the comparison group, signs of a chronic inflammatory process were revealed: neovascularization with proliferation of endotheliocytes. It was established that the nuclei of cells of fibrous tissue are changed, namely, they are increased in size and more intensely colored. Significant swelling of the surrounding tissue was observed, which pathologically changed the very structure of the tissue. Pathological deposition of diffusely located pigment was noted extracellularly in tissue structures. Conclusions: The results obtained during the study of changes in the perilimbal tissues of the eye in patients with primary open-angle glaucoma will open new ways of personalized management of this category of patients, which will make it possible to formulate additional criteria for the diagnosis and treatment of glaucoma, aimed at overcoming the inflammatory process and prolonging the postoperative result.