Özet

Glaucoma, which is one of the most common causes of permanent blind- ness worldwide and has a prevalence of 1-4%, is a neurodegenerative disease characterized by damage to retinal ganglion cells and axons, progressive optic neuropathy, and associated visual field loss. Primary open angle glaucoma is the most common type of glaucoma, which accounts for almost half of all glaucoma cases. Intraocular pressure is the most important risk factor for the development of glaucomatous optic neuropathy. Also, lowering the intraocular pressure value is still the only treatment approach proven to be effective in preserving visual function. Generally, the first step in treatment is medical, but it may not be sufficient. By bridging the gap between conservative treatment (drugs and laser treatments) and invasive traditional glaucoma surgeries, Microinvasive Glaucoma Surgeries mark an important milestone in the field of glaucoma management. New surgical interventions have been considered to reduce the complications encountered in trabeculectomy, which is considered the gold standard surgical method of primary open angle glaucoma. Glaucoma gel mi- croimplant (The XEN^® Gel Stent Allergan INC, Dublin, Ireland), one of the Microinvasive Glaucoma Surgeries methods, creates an outflow path similar to trabeculectomy with an internal procedure. In this way, with the internal route, conjunctival incision is avoided, and it also allows the surgical process to be completed in a shorter time. This book is one of the pioneering studies investigating conjunctival fibro- sis at the molecular level, which affects the success of Microinvasive Glau- coma Surgeries, one of the most popular glaucoma surgeries of recent years, and the most commonly performed gel microimplant surgery. The primary purpose of the book is to investigate MCP-1, SPARC and TSB-2 proteins, which is thought to cause subconjunctival fibrosis formation, surgical failure and the need for bleb needling, in primary open angle glaucoma patients re- ceiving glaucoma gel microimplants. In addition, the other aim of the book is to investigate the relationship between markers indicating the progression of primary open angle glaucoma and these molecules. While phacoemulsification surgery was conducted on 20 patients out of 36 patients diagnosed with primary open-angle glaucoma (Group 1); 16 patients underwent glaucoma gel microimplant and phacoemulsification combined   surgery (Group 2). While bleb needling should be applied to five patients in Group 2a; it was not applied to 11 patients (Group 2b). Samples taken from the limbal paracentesis region were analysed by Enzyme-linked immunoas- say method for a total of three molecules. The patients were between 46 to 80 years old, 9 of whom (25%) were female and 27 were male (75%). The mean age of the patients in Group 1 was 68.50 ± 8.88 years, whereas those in Group 2 were 62.12 ± 7.26 years in Group 2. There were no intraoperative complications in the patients included in this study. Postoperative complica- tions occurred 31.25% in Group 2 and were resolved with medication. On the other hand, at the end of six months, the partial success rate was 93.3% (>20% reduction in IOP with and without antiglaucomatous medication), and the complete success rate was 60% (>20% reduction in IOP without medica- tion). Also, the need for bleb needling occurred in 37.5% of the patients to who underwent combined surgery. The IOP values of the patients in Group 2a on postoperative day-1 and in week-1 were significantly higher than those in Group 2b (p < 0.05). In this case, it can be said that IOP values in postop- erative week-1 are guiding in predicting the need for bleb needling. Also, the average bleb needling time was 3.60±1.95 months. In conclusion, all three molecules (MCP-1, SPARC and TSB-2) were found to be highly associated with the number of antiglaucomatous molecules used preoperatively, and these three molecules were found to be relevant in chronic inflammation. Therefore, it has been taken into consideration that es- pecially SPARC and TSB-2 matricellular proteins may be effective on chronic inflammation, glaucomatous progression and fibrosis, but these effects may be caused by many factors. It is predicted that the surgical procedure followed creates minimal trauma to the tissue, so it does not trigger high levels of in- flammation. Additionally, considering the Computerised Visual Field Tests Mean Deviation value, which is a guiding finding in terms of the progres- sion of primary open angle glaucoma, it was observed that the values seen in Group 2a patients were more advanced. Therefore, the result obtained makes an extremely important contribution to the literature. In the book, it was de- termined that among the patients to whom we applied glaucoma gel microim- plant, those in advanced stages and those who used more antiglaucomatous molecules were more likely to have fibrosis and need bleb needling.