[Transciliary vitreous drainage as a treatment method for hypertensive pain syndrome in terminal glaucoma].

OBJECTIVE: To develop a surgical technique based on transciliary vitreous drainage and aimed at pain elimination in refractory glaucoma. MATERIAL AND METHODS: A total of 33 eyes with terminal painful glaucoma were assessed and surgically treated. RESULTS: A drain opening was made under the superficial scleral flap in the site of pars plana projection and was further used for local vitrectomy in the form of a wide well directed to the posterior pole of the eye. In 51.5% of cases normal ocular pressure was achieved without antihypertensive drops. In the rest of cases there was a tendency for ocular hypertension and therapeutic regimen was required. Pain relief after the surgery was achieved in all eyes. CONCLUSION: Vitreous drainage is an effective technique for pain elimination in terminal-stage refractory glaucoma. The presumable mechanism of action involves creating an opportunity for easy evacuation of osmotically active substances (urea in the first place) along with the humour from the vitreous cavity. The operation enables direct draining of the vitreous cavity regardless of organic changes in the anterior chamber that impede the outflow.

[Vitreous cavity drainage in absolute painful glaucoma (clinical case)].

A case of transciliary vitreous drainage with simultaneous local vitrectomy as surgical treatment for hypertensive pain syndrome (HPS) in absolute glaucoma is described and analyzed. The patient presented with severe eye pain, high intraocular pressure, corneal edema, and hyphema. During surgery a drain opening was made under the superficial scleral flap in the site of pars plana projection. This opening was further used for local vitrectomy with removal of a truncated cone-shaped fragment of the vitreous. The apex of the cone was located at the drain opening and its base (10 mm in diameter) was directed at the posterior pole of the eye. The authors consider the retrohyaloid space, which is always present in eyes with absolute glaucoma, as an enabling factor for such drainage. A surgical revision of the drain opening was performed due to its obstruction in the postoperative period. After the revision a durable pain relief was achieved. Vitreous drainage, in authors' opinion, is of good potential in refractory glaucoma treatment.

[Treatment of bleedings from cystic formations of the pancreas].

Treatment of 10 patients with bleedings from the pancreatic cysts was analyzed. Angiography with endovascular occlusion of the source of bleeding was used in 4 patients. Hemostasis was achieved in 2 patients. Emergency operations were made on 7 patients with continuing and repeated bleedings, and unsuccessful attempts of roentgen-endovascular treatment. Two patients after correction of anemia were subjected to planned operations according to the indications accepted for chronic cystic pancreatitis. The operation allows reliable liquidation of the source of bleeding and the symptoms of chonic pancreatitis.