PURPOSE. Improving the results of the operation and achieving its reliability in secondary glaucoma, including refractory glaucoma, can be done using a non-biodestructible allograft drainage with spongy structure fabricated by Alloplant^® technology.METHODS. Experimental and morphological studies conducted in the Russian Eye and Plastic Surgery Center showed that the allogeneic spongy biomaterial used for anti-glaucoma sponge drainage surgery is gradually replaced by loose tissue with a porous structure, similar to trabecular, forming a new drainage system. During the operation, the proximal part of the drainage is inserted through the excised drainage zone in the anterior chamber angle (ACA). The distal part is tucked into the suprachoroidal space through a linear incision in the scleral bed.RESULTS. The newly created topography of the ACA after sponge drainage operation with the use of allogeneic biomaterial features not only the expansion of the ACA profile, but also the replacement of the excised part of the drainage zone with biomaterial after sinus trabeculectomy (STE) and elimination of retention of the intraocular fluid (IOF) outflow. Ultrasound biomicroscopy (UBM) performed at various times after antiglaucoma surgery showed that the microtubule system preserved. Optical coherence tomography (OCT) of the ACA demonstrates the location of the drainage in the long-term follow-up.CONCLUSION. Antiglaucoma operation with the use of allogeneic biomaterial with spongy structure promotes the formation of trabecula-like tissue in the ACA, eliminates retention of IOF outflow, and reduces the risk of scleroscleral and sclero-conjunctival adhesions.

Modifitsirovannyy allogennyy biomaterial - matritsa dlya regeneratsii endotelial'nykh kletok Модифицированный аллогенный биоматериал - матрица для регенерации эндотелиальных клеток

PURPOSE. To refine the technique of filtering bleb (FB) plasty using allografts in an experimental model on laboratory animals, evaluate the histomorphological outcomes, and assess the efficacy and safety of plastic reconstruction of cystic FBs in the clinical setting.METHODS. Steroid-induced glaucoma was modeled in 30 rabbits (30 eyes), followed by an anti-glaucoma procedure with allogeneic sponge drainage. Ninety days post-operatively, a conjunctival defect was created in the FB area and covered with an allogeneic biomaterial derived from fascial sheaths for conjunctival reconstruction.In cases of cystic FBs, revision was performed with dissection of sclero-conjunctival adhesions. The allograft was placed over the scleral flap in the filtration area, shaped, and secured to the surrounding sclera. The Tenon’s capsule and conjunctiva were then positioned over the biomaterial and anchored to the limbus.RESULTS. A moderately diffuse FB was observed in the early postoperative period following conjunctivoplasty. The allogeneic biomaterial was visualized under the conjunctiva in the filtration area, adjacent to the eye globe. Over time, a connective tissue regenerate, structurally similar to the underlying bed, formed at the site of the allograft. Histomorphological studies confirmed that the stages of allograft replacement with newly formed tissue were a natural result of the transplantation process.In FB revisions, sclero-conjunctival adhesions were dissected, and the allograft for conjunctival reconstruction was placed over the scleral flap, shaped, and secured with 8/0 interrupted sutures. Ultrasound biomicroscopy was performed to examine the topography of ocular surface structures in the long-term follow-up period after conjunctival reconstruction.CONCLUSION. The developed technique for conjunctivoplasty in cystic FBs using allografts is a safe and reliable method for reinforcing ocular surface tissues involved in FB formation. This approach provides therapeutic, functional, and cosmetic benefits.