The method of combined surgical treatment of primary glaucoma

 

(57) Abstract:

The invention relates to medicine, namely to ophthalmology, and is intended for the surgical treatment of patients with primary glaucoma. From the surface layers of the sclera by one third or half of its thickness to form a single rectangular patch with two feet on the top flap. Scleral flap folded on the cornea. In the deeper layers of the sclera in the projection of the bases of legs produced through the incision to suprachoroidal space on the entire width of the scleral flap. At the limbus excised deep layers of the filtration zone together with the sine and the trabecula in the form of a triangle. Through the obtained triangular access perform the basal iridectomy. Both scleral legs seasoned with a spatula in suprachoroidal space through a linear incision. The Central part of the top flap attached to the convex part of the sclera one U-shaped seam so that the flap is formed a channel for the free flow of aqueous humor from the anterior under the flap in the back. Fix surface of the flap to the surrounding sclera. The method allows to reduce the invasiveness of the surgery and get persistent hypotensive effect. 4 Il.

The picture is of primary glaucoma.

Known surgical methods of treatment of primary glaucoma in order to intensify the outflow of intraocular fluid mainly on the front of the drainage system of the eye, for example trabeculoectomy, /J. E. Cairns, American J. of Ophthalmology, 1968, v.66, No. 4, p.673-679/.

Along with that there is the operation that triggers the outflow of intraocular fluid on the rear, uweoscleeralny paths that are less traumatic, do not cause pronounced drop in intraocular pressure, and prevents early postoperative complications and to achieve a more stable hypotensive effect /S. N. Fedorov. Vestnik of ophthalmology, 1982, N 4, PP 6-10/.

Recently there is a trend towards the development of combined operations, combining the positive aspects of both the first and second interventions.

The prototype of the present invention is a method of combined operations of the filtering iridociliary /A. P. Nesterov. Primary glaucoma, 2nd edition. M. : Medicine, 1982/, which is the formation of two surface strips sclera base to limb and holding them in supraciliary space through the T-shaped incision in the anterior drainage system angle front camera is Thus, T-shaped incision implements the idea of stepping outflow of aqueous humor in the anterior drainage system of the eye, and the conduct of the scleral flap in supraciliary space with their subsequent excretion in the posterior part of the eyeball helps to activate the outflow of intraocular fluid on the rear, uweoscleeralny way.

The disadvantages of this method are the necessity of cutting out two separate flaps, significant trauma surgery related to the received flaps in supraciliary space, scarring of the T-shaped incision associated with tight scleral tissue flaps and deep layers of the sclera, and that, in turn, leads to a reduction of the outflow of aqueous fluid from the anterior chamber angle in the posterior segment of the eye.

The aim of the invention is to reduce the morbidity of the operation, obtaining persistent hypotensive effect by increasing the outflow of aqueous fluid as the front drainage and rear, uweoscleeralny way.

This goal is achieved by creating fistulizing element in front of the drainage system and drainage suprachoroidal about the surgical treatment of primary glaucoma.

The method is as follows. In the lower outer sector of the eyeball 6 mm from the limbus and parallel to it, an incision of conjunctiva, 8-10 mm, after which it usepreview together with subconjunctival tissue to the limb. On the lower and outer rectus muscles of the eyeball suture-holders. After initial hemostasis of the surface layers of the sclera by one third or half of its thickness to form a single rectangular flap 1 length 13-15 mm, 7-8 mm wide, with two legs 2 on the top flap, size 2x7 mm /Fig. 1/.

Scleral flap folded on the cornea, in the deeper layers of the sclera, in the projection of the bases of legs /about 7 mm from the limbus/ produce through the slit 3 to suprachoroidal space for all /Fig.3/ the width of the scleral flap under the control of a spatula /Fig.2/. At the limbus excised deep layers of the filtration zone together with the sine and the trabecula in the form of a triangle 4 after a preliminary determination of the projection of schlemm's canal. The size of the dissected area in the drainage zone 2,5x2,5 mm In all cases, perform the basal iridectomy 5, obtained through a triangular access. Then both scleral leg 2 filled with a spatula in suprachoroidal space chesney fluid from fistulizing opening angle of the anterior chamber in the rear division suprachoroidal space. The Central part of the top flap attached to the convex part of the sclera one U-shaped seam /Fig.4/ so that the flap is formed a channel for the free flow of aqueous humor from the anterior under the flap 1 in the rear, suprachoroidal space.

Two additional seam impose about 3-4 mm from the limbus to the fixing surface of the flap 1 to the surrounding sclera /Fig.4/. The conjunctival wound is sutured with a continuous suture.

Example. Patient K., 60 years old, with diagnosis: right eye - open-severe, uncompensated glaucoma. The left eye is open, terminal, non-compensated glaucoma. Right eye previously operated for glaucoma. On the left eye twice made antiglaucoma surgery. Visual acuity at admission: right eye -0,04, the left eye - hand movement of a person.

The field of vision on the right eye a total of 8 meridians - 220 degrees, the left eye is not defined. Intraocular pressure: the right eye is 45 mm RT. senior left - 35 mm RT.article These electroholography: right eye Pabout- 35,6 mm RT.art., C - 0.02 mm3/min/mm RT.article F - 0.46 mm3/min. Left eye: Pabout- 25,2 mm RT.art., C - 0.08 mm

In January 1994 the operation of double drainage on the right eye, 3 months left eye. The operations were performed in the lower outer sectors of the eyeball. The incision is made parallel conjunctival limb length of 10 mm, after preliminary useprofile her and suturing-taped on the bottom and the outer rectus muscles produced hemostasis of blood vessels of the sclera. Formed and cut a single rectangular flap of sclera one third of the thickness, length 14 mm, width 7 mm, with two legs on the top flap, size 2x7 mm Scleral flap folded on the cornea at the limbus excised deep layers of the filtration zone together with the sine and the trabecula in the form of a triangle, 2,5x2,5 mm Through the triangular access produced basal iridectomy.

Then both scleral legs tucked into suprachoroidal space through a linear incision. The Central part of the top flap sewn to the convex part of the sclera one U-shaped seam. Imposed two additional seam 4 mm from the limbus for fixing the superficial and deep layers of the sclera. The conjunctival wound is sutured with a continuous suture.

Operation and Polevaya of the right eye has expanded to 290oleft - 25o. Intraocular pressure was stabilized - the right eye is 20 mm RT.art., left - 22 mm RT.article Electroholography right eye: Pabout- 17,1; C IS 0.27; F - 1,87. Left eye: PaboutTO 18.6; C - 0,29; F - TO 2.57.

After 3 years was noted for the preservation of visual acuity in both eyes. The field of vision of the right eye has expanded to 320othat left eye is preserved. Intraocular pressure stably compensated on both eyes; on the right is 21 mm RT. Art. on the left - 19mm RT. Art.

The positive effect of the operation is to cut a single superficial scleral flap and placing greater part formed in the bed of the deep layers of the sclera, which significantly reduces the invasiveness of the surgery. The formation of trabeculectomy triangular in anterior chamber angle, supplemented basal iridectomy, the introduction of a single scleral flap in suprachoroidal space posterior of the eyeball, creating a channel for constant and direct current of aqueous humor from the anterior chamber at the rear division under a single scleral flap provides long-lasting hypotensive effect of the operation.

The method of combined surgical treatment pervinca, create outflow of aqueous humor in the anterior and posterior uweoscleeralny paths, wherein form a single rectangular scleral flap from the limbus to the posterior segment of the eye with two feet at its top, at the base of the projection of the legs produce a linear incision deep layers of the sclera to suprachoroidal space at the limbus perform trabeculectomy in the form of a triangle, obtained through the access to produce basal iridectomy, legs single scleral flap injected into suprachoroidal space in the form of spacers through a linear incision deep layers of the sclera to form the channel and create under the flap of sclera free circulation of the aqueous humor from the anterior eye in the rear, then scleral flap is fixed in the bed with three interrupted sutures.

 

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FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.

3 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva. Direct muscle is exposed and separated. Forceps is applied to the separated muscle 4-7 cm far from the place of its attachment to sclera. The muscle is notched to 1/2 of its width 1-2 mm far from the forceps on the proximal side. The muscle is bluntly exfoliated. Muscle flap is turned to after cutting it from sclera. The flap end is sutured to sclera 1-5 mm distal from the previous attachment place. Eyeball is displaced in conjunctival sack to opposite side with respect to the feeble muscle. Interrupted sutures are placed on conjunctiva incision.

EFFECT: enhanced effectiveness in correcting large squint angles.

4 dwg

FIELD: medicine.

SUBSTANCE: method involves cutting off external wall of Schlemm's canal on the whole width extent of internal scleral flap bed after making non-penetrating deep sclerectomy operation. At least three drains are entirely introduced into Schlemm's canal lumen and arranged all over the whole circumference of the Schlemm's canal. Hydrated hydrogel is used as draining polymer material. The hydrogel contains 0.5-5.0% aminocaproic acid solution, etamzylate solution and diprospan solution.

EFFECT: increased and retained hypotensive action; increased distance between internal and external wall of Schlemm's canal; reduced risk of traumatic complications in implanting drains; avoided inflammatory response of eye structures.

1 dwg

FIELD: medicine; medical engineering.

SUBSTANCE: method involves introducing device for fixing retina rupture edges into vitreous cavity after having done subtotal vitrectomy. The device has a pair of microsurgical needles connected to each other with surgical thread. Required number of needle pairs is introduced in succession to have required number of straight segments for fixing rupture edge. Needle ends are brought out in pairs together with thread to external sclera surface and cut, and the thread ends are fixed near the sclera surface.

EFFECT: reduced risk of traumatic complications; reliability of retina rupture edges fixation.

3 cl

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

4 cl

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

4 cl

FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

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