Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics

Vinod Kumar
* ORCID logo ,
Andrey Igorevich Bezzabotnov
,
Zarina Shaykuliyevna Rustamova
,
Galina Nikolaevna Dushina
,
Kamal Abdulmuhsen Abu Zaalan
,
Ahmad Saleh Soliman Shradqa
,
Mikhail Aleksandrovich Frolov
Version 1 : Received: 4 August 2023 / Approved: 4 August 2023 / Online: 4 August 2023 (13:18:18 CEST)

A peer-reviewed article of this Preprint also exists.

Kumar, V.; Bezzabotnov, A.I.; Rustamova, Z.S.; Dushina, G.N.; Abu Zaalan, K.A.; Shradqa, A.S.S.; Frolov, M.A. Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics. Vision 2023, 7, 59. Kumar, V.; Bezzabotnov, A.I.; Rustamova, Z.S.; Dushina, G.N.; Abu Zaalan, K.A.; Shradqa, A.S.S.; Frolov, M.A. Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics. Vision 2023, 7, 59.

Abstract

A surgical technique aimed at rerouting aqueous humor (AH) outflow from the anterior chamber to the suprachoroidal space (SCS) without performing surgical cyclodialysis was developed to decrease intraocular pressure (IOP) in glaucoma patients. The surgical outcomes of the technique were retrospectively analyzed in fifty-eight patients. At 6, 12, and 24 months, the mean IOP decreased from 27.8±8.3 to 14.95.0 mmHg, median 15.0 (25th percentile (p25 )13.0; 75th percentile (p75) 18.0), and 15.23.3 mmHg; hypotensive medication use reduced from median (p25; p75) 3 (2; 3) to 0 (0; 2), 0 (0; 2), and 0 (0; 1.5), and complete success was achieved in 62.8%, 51.2%, and 32.5% cases, with partial success in 28.4%, 44.2%, and 62.5% cases, respectively. Eight cases (13.8%) presented unsatisfactory outcomes. Intra- and postoperative complications were few and manageable. No bleb formation was observed in any of the cases. In 50% of cases, conjunctival lymphatic vessels (CLVs) developed following surgery in superior quadrants. The technique is safe and effective in providing a long-term decrease in IOP and hypotensive medication use. It was hypothesized in this study that the IOP decrease occurred as a result of enhanced AH outflow from the SCS to CLVs through intrascleral microchannels connecting the SCS to CLVs.

Keywords

glaucoma; open-angle glaucoma; collagen implant; glaucoma surgery; bleb less glaucoma surgery; bleb independent glaucoma surgery; suprachoroidal space; uveolymphatic aqueous humor outflow; conjunctival lymphatic vessels; conjunctival lymphatics

Subject

Medicine and Pharmacology, Ophthalmology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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