[The clinico-morphologic foundation of the modern pathogenetically oriented surgery of hydrophthalmos simplex]

On materials of 45 biopsies dissected at the time of antiglaucomatous operations and 10 eyes of newborns, a detailed morphologic analysis of the state of the drainage apparatus of the in norm and at relatively early stages of hydrophthalmos simplex is presented, and considering results of clinical investigations (105 eyes, of them 45 eyes mentioned) a foundation of modern surgery of congenital glaucoma is given. It is shown that the basis of congenital pathology of retinocorneal angle is disturbance of anatomotopographic relationships of its structures as well as expressed trabeculodysgenesis and dysgenesis of scleral sinus. The paper describes three main variants of combinations of pathologic changes in the drainage apparatus, characterized by a common gonioscopic picture and reflecting the degree of severity of congenital pathology (3 degrees of goniodysgenesis). It is noted that the presence of a coarse congenital pathology of trabecular plexus in hydrophthalmus, incompatible with the possibility of its functioning, and at the same time a satisfactory enough state of the "scleral sinus-emissary" link allow to consider the basic element of surgical reconstruction of anterior outflow passage to be trabeculotomy from outside. Indications in the choice of adequate surgical intervention and its volume are shown (the degree of goniodysgenesis and the state of functional preservation of scleral sinus and emissaries). The approved, within 15 years, system of operations in case of hydrophthalmos simplex and their results are presented.