COMBINED TREATMENT OF NEOVASCULAR GLAUCOMA IN DIABETES MELLITUS

Relevance. Neovascular glaucoma is characterized by a severe course, usually resistant to druginduced hypotensive therapy, comparatively quickly passes into the terminal stage. Purpose: To develop and clinically evaluate a new treatment for neovascular glaucoma based on non-penetrating scleral action in combination with antiVEGF therapy. Material and methods. Total number: 13 patients with rubeosis and 1 patient with rubeosis stage and open-angle glaucoma on paired eyes; 13 patients with GL and two in combination with a closed-angle GL and 4 patients with bilateral o / a glaucoma; 8 patients with closed-angle glaucoma. All patients at the beginning of the treatment underwent intravitreal injection of the Eyelea VEGF inhibitor (Aflibercept, Bayer) in a standard dosage. After further investigation and insufficient compensation for diurnal fluctuations in IOP, a non-penetrating hypotensive laser sclerotomy was performed in full volume by a standard procedure. Results. In the postoperative period during the entire follow-up period, visual acuity in patients with neovascular glaucoma slightly improved. In patients of all groups (100 % of cases), there was a desolation or partial resorption of the newly formed vessels. Alignment of circadian fluctuations was noted in all groups as early as 3-4 weeks of the study, including preglaucoma. Сonclusion. Laser, scleral non-penetrating transconjunctival applications in combination with anti-VEGF preparations allow to achieve the necessary stable dosed decrease in IOP depending on the stage of neovascular glaucoma in a short time without postoperative complications. It was revealed that in different stages of neovascular glaucoma there are different types of increase in diurnal ophthalmotonus oscillations, and with a combined effect, their correction at early stages is possible.