This study evaluated the effectiveness of transciliary filtration (TCF) and transconjunctival transciliary filtration (TCTCF) procedures for 20 patients with refractory primary open-angle glaucoma. The success rate after 3 months was 65%, with additional medication needed in 15% of cases and surgical revision required in 35% of cases. While technically simple to perform, the failure rate remains high due to blockages from fibrosis or trauma to the inner opening. Modifying the procedure with antimetabolites may improve the success rate.

1. Department of Ophthalmology
Russian People’s Friendship University1
Moscow, Russian Federation
Ophthalmic unit of Skhodnya city hospital 2,
Moskovskaya oblast.
Kumar V.1,2, Frolov M.A.1 , Dzumova A.A.2 ,Isufaj E. 1, Bojhok
E.V. 1
Results of transciliary filtration (TCF)
and transconjunctival transciliary
filtration (TCTCF) in surgical
management of refractory primary
open-angle glaucoma (RPOAG).
Innovative educational program of the University
Financial disclosure - none

2. Surgical treatment of refractive glaucoma
Drainage of anterior chamber with the
use of different implants and
drainage devices or without them
 Less effective.
 Complication rates during surgery and
in postoperative periods are
significantly high.
 As a result in most of the cases the
eyes are subjected to either
evisceration or enucleation.

3. Posterior chamber drainage through ciliary body –
transciliary filtration
Professor Daljit Singh Professor Takhchidi K.P.
(Amritsar, india) (Russia)
Manual TCF – 1979. Diode laser TCF– 1992г.
Erbium laser TCF – 1993-2000
Plasma TCF – 2001

4. Fugo plasma blade - new
fundamental energy
(Nanotechnology in the truest
sense )
The tissues are treated at the
molecular and atomic levels,
without causing collateral
damage.
When the tip is activated, it gets
coated with plasma, which is
resonant with the tissues that are
touched.
The tissue absorbs energy by
resonance, the tissue molecules
become unstable, therefore they Video clip
(by Prof. Richard Fugo, USA)
shatter, and they get removed in Voice
the form of a plume. (Prof. Daljit Singh, India)

5. Surgical technique of TCF and TCTCF

6. Purpose
To study effectiveness of TCF and TCTCF
procedures in surgical management of
RPOAG.
Setting
Department of ophthalmology,
Russian people’s friendship university,
Moscow
Ophthalmic unit of Skhodnya city hospital,
Moscovskaya oblast

7. Methods and material
Total 20 cases (20 eyes): male – 10 (50%); female – 10 (50%)
TCF : 6 cases (30%) and TCTCF : 14 cases (70%)
Study period: September 2009 - December 2009
Exclusion criteria: minimum follow – Less than 3 months
• Cases were admitted for evisceration for painful terminal
glaucoma
• Intraocular pressure (IOP) varied from 25 – 45 mmHg (avg. IOP
was 32.75 +– 4.79 mmHg).
• All patients were instilling not less than 2 eye drops

8. Methods and material
Main outcome measures:
IOP change,
complication rate,
additional glaucoma medication,
need for surgical revision.
Criteria for success:
relief from pain,
normal outlook of the eye ball,
decrease in preoperative IOP by 30% or more
with or without glaucoma medication.

9. Results
Observations during surgery:
TCF and TCTCF procedures
were technically easy to
perform.
PC drainage was achieved in
all cases.
Surgical time ranged between
7 to 10 minutes.
Deepening of anterior
chamber in every case.
No case of hemorrhagic
choroidal effusion.
Bleeding from the tunnel – in
3 cases (15%).

10. Results
Observations in post-operative period
(follow-up period – 3 months) 1st day
7th day
 Success rate – 65% (13 cases)
Additional glaucoma medication - 3 cases (15).
 Need for surgical revision – 35% (7 cases)
Repeat TCF or TCTCF - 4 cases (20%).
Implantation of stainless steel wire drainage
device - 2 cases (10%).
Evisceration of eye ball – 5% (1 case)
Choroidal effusion - 5 cases (25%).
Hyphema – 6 cases (dissolved spontaneously). OCT after 6 months

11. Failure reasons
 Blockage of the outer opening
fibrosis
antimetabolites?
 Blockage of the inner opening
anterior chamber irrigation
More trauma ?
 Due to high reactivity and
elasticity of ciliary body

12. Conclusions
TCF and TCTCF though is a technically
simple and easy to perform procedure, but in
its present day form failure rate in surgical
management of RPOAG is significantly high.
Modification of this procedure by using
antimetabolites perioperatively may enhance
its success rate.